# EMT-IVs working in hospital settings



## Zodiac (Mar 16, 2011)

Not sure if this is the proper location for such a question but I'm just trying to find out the answer to a grey area that wasn't really touched on in class. I know that on an ambulance, EMT-IVs are held to protocols and such concerning what medications they can and can not administer but what if they're working in a hospital setting? During one of my ER clinicals, an RN drew up a syringe of XYZ medication and instructed me to administer it to a patient via IV bolus. I complied but was it technically permissible? Are EMT-IVs allowed to administer different medications if they're given orders to do so by someone higher up on the totem pole?


----------



## NomadicMedic (Mar 16, 2011)

Zodiac said:


> Not sure if this is the proper location for such a question but I'm just trying to find out the answer to a grey area that wasn't really touched on in class. I know that on an ambulance, EMT-IVs are held to protocols and such concerning what medications they can and can not administer but what if they're working in a hospital setting? During one of my ER clinicals, an RN drew up a syringe of XYZ medication and instructed me to administer it to a patient via IV bolus. I complied but was it technically permissible? Are EMT-IVs allowed to administer different medications if they're given orders to do so by someone higher up on the totem pole?



Sounds like a great question for your supervisor or the Medical Director.

My gut tells me no. After all, what meds would you carry (or have access to) that you would feel comfortable giving?


----------



## TransportJockey (Mar 16, 2011)

Hospitals are much more dependant on job title to limit or allow functions on the job. In the ED if you work there, your EMT title means absolutely nothing. It's your job title that will let you do things.


----------



## Shishkabob (Mar 16, 2011)

In most, if not all states, the "scope of practice" for pre-hospital medicine is just that:  Pre-hospital.  You technically aren't working as an EMT in the hospital, but as a tech.


----------



## Zodiac (Mar 16, 2011)

So technically an EMT is permitted to administer whatever medication they've been delegated to give as long as the position they're filling allows them to do so and has direct oversight?


----------



## TransportJockey (Mar 16, 2011)

Zodiac said:


> So technically an EMT is permitted to administer whatever medication they've been delegated to give as long as the position they're filling allows them to do so and has direct oversight?



Yes, but very few hospitals would ever trust jsut an EMT to do that. UNMH in ABQ lets their paramedics operate as paramedics, but their job title is ER Paramedic.


----------



## Shishkabob (Mar 16, 2011)

jtpaintball70 said:


> Yes, but very few hospitals would ever trust jsut an EMT to do that. UNMH in ABQ lets their paramedics operate as paramedics, but their job title is ER Paramedic.



Heck, because of BONs, very few hospitals even let Paramedics do that.


Funny how I can give any number of drugs and as much fluid as I want in an ambulance, but step foot in to an ER as a tech and a Paramedic can't even flush IVs they start.


----------



## Zodiac (Mar 16, 2011)

Linuss said:


> Funny how I can give any number of drugs and as much fluid as I want in an ambulance, but step foot in to an ER as a tech and a Paramedic can't even flush IVs they start.



I also find that interesting and have noticed this sort of thing isn't limited to just hospitals. I have a friend who is an LPN and she works in a dental office starting IVs on sedation patients but I doubt they'd allow an EMT-IV or paramedic to work in the same position even though they are qualified to obtain IV access and hang NS. In this situation, I think it has a lot to do with simple ignorance. I haven't met a whole lot of people who even know what an EMT is, let alone what they're capable of doing. Most people are familiar with the word "Paramedic" but even then, what percentage of those people are aware of what their duties actually consist of?


----------



## the_negro_puppy (Mar 16, 2011)

Linuss said:


> Heck, because of BONs, very few hospitals even let Paramedics do that.
> 
> 
> Funny how I can give any number of drugs and as much fluid as I want in an ambulance, but step foot in to an ER as a tech and a Paramedic can't even flush IVs they start.



Really?

Over here we are responsible for pt care right up until we offload them to a bad and handover to the nurse. Often due to our pathetic public health system, the hospitals are full. If we have acute patients that arent sick enough to go to the resus section, we sometimes wait for hours in the corridor with the pt on our stretcher. During this time we are responsible for them, so often do things like run nebulised salbutamol, or give IV fluids etc if needed.


----------



## Shishkabob (Mar 16, 2011)

the_negro_puppy said:


> Really?
> 
> Over here we are responsible for pt care right up until we offload them to a bad and handover to the nurse. Often due to our pathetic public health system, the hospitals are full. If we have acute patients that arent sick enough to go to the resus section, we sometimes wait for hours in the corridor with the pt on our stretcher. During this time we are responsible for them, so often do things like run nebulised salbutamol, or give IV fluids etc if needed.



Sorry, didn't clarify:

When working on the ambulance, my patient is my patient.  If I'm in a hospital to transfer a patient and I think they need to be intubated, they will get intubated.


I was speaking as a Paramedic working as a tech in the ER, and not on the ambulance, is extremely restricted in what they can do in most EDs around here.  IE a Paramedic working as a nurses gofer, and not as their own provider.


----------



## medicRob (Mar 16, 2011)

Zodiac said:


> Not sure if this is the proper location for such a question but I'm just trying to find out the answer to a grey area that wasn't really touched on in class. I know that on an ambulance, EMT-IVs are held to protocols and such concerning what medications they can and can not administer but what if they're working in a hospital setting? During one of my ER clinicals, an RN drew up a syringe of XYZ medication and instructed me to administer it to a patient via IV bolus. I complied but was it technically permissible? Are EMT-IVs allowed to administer different medications if they're given orders to do so by someone higher up on the totem pole?



There are laws in TN governing your scope of practice while in-hospital. While you are in the hospital, your oversight is the attending physician, unless a medical director has been otherwise designated. As an EMT-IV, you can push that medication so long as,

A. You were not the one who drew it up, dosed it, etc.
B. The physician in charge has verified that you have the knowledge and the training necessary for administering said medication (This all falls under Continuing education and standards compliance)
C. The physician has signed off to allow EMT-IVs in your facility to administer meds.


------------------------
HOWEVER, 

If a nurse looks at you and says, go to the med room, draw up 2 of morphine, and administer it to John Doe in curtain 3, you cannot do this.

If you have any more questions regarding in-hospital scope of practice for EMT-IVs, I would suggest that you get in contact with the TN Board of EMS, specifically our state licensing director, Ms Donna Tidwell who oversees the board meetings and works to create the committees who establish these scopes for the state of TN. If there was one person in TN who could tell you every regulation involving EMTs in the state of TN, Miss Tidwell would be your person.


----------



## MEDIC802 (Mar 18, 2011)

and then the Question is, is the ER/ED pre hospital or not has the pt been admitted to the ER or to the floor(hospital) that's always an ongoing disagreement, if you look at the admission process pt's have to be admitted to the floor from the ER/ED.


----------



## Hockey (Mar 18, 2011)

Linuss said:


> Sorry, didn't clarify:
> 
> When working on the ambulance, my patient is my patient.  If I'm in a hospital to transfer a patient and I think they need to be intubated, they will get intubated.
> 
> ...



During my clinicals, I made the decision ER work isn't for me.  Waiting to get orders for every little thing.  Have to let the EKG tech do the 12 lead.  Can't do an IV till doc says so.  I understand there are standing orders in the ER, but its quite restrictive.  

I like the freedom and not having some RN tell me what to do.


----------

