# Paramedic practicing in ED



## scmedic85 (Oct 29, 2010)

I am looking for information about Paramedics working in emergency departments and what skills they are allowed to perform. 

I am a Paramedic and work in an ED in order to earn some extra money as my service isn't playing nice with the schedule. I have approached the ED leadership about allowing techs that are certified as paramedics to perform advanced skills such as starting IVs, fluid administration, tele transport from the ED to floor when admitted, etc (I'm currently bored out of my mind).

I am looking for information on other hospitals allowing their techs to perform any or all of these skills in the ED. If you respond and let me know that your ED allows tech IV starts please let me know if this is allowed by all techs or just a limited group (ie EMT-I/P).


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## Pittsburgh77 (Oct 29, 2010)

Where I'm from [Pittsburgh lol] we have ALS Techs in our EDs as well as basic PT. Care Techs.

Each perform within standard scope of practice. I know some Basic-Techs that take the phelebotomy (spelling?) course, and are then allowed to do IVs as well as the 12-lead class.


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## lightsandsirens5 (Oct 29, 2010)

As far as I know, WA does not allow that kind of stuff anywhere in the state. I have heard that might change sometime in the next few (read 25) years to allow EMS personnel to operate under their protocols in hospital. (With minor modifications obviously. Ie. medics can admin all medic drugs, but only after ordered to. And so on.)


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## scmedic85 (Oct 29, 2010)

lightsandsirens5 said:


> As far as I know, WA does not allow that kind of stuff anywhere in the state. I have heard that might change sometime in the next few (read 25) years to allow EMS personnel to operate under their protocols in hospital. (With minor modifications obviously. Ie. medics can admin all medic drugs, but only after ordered to. And so on.)



I am in SC and DHEC (our EMS regulating body) does not allow it either. What we are looking at is creating an advanced emergency department tech position of which holding a current P card (and maybe I) would be a qualification.

My nurse manager is looking for information about what other hospitals are doing and I thought this would be a great place to gather some information. We actually have several hospitals in the general area that allow their techs to start IVs but they allow it for all techs regardless of prior certification. 

I am interested in seeing just how far we can take this. I know many nursing organizations are opposed as they don't want to give up any control/skills to outside groups but most EDs are so overworked and under budgeted right now that this helps the nursing staff and almost everyone in my ED is in favor.


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## lightsandsirens5 (Oct 29, 2010)

That is pretty cool. Keep us updated if you would.


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## LonghornMedic (Oct 29, 2010)

Our ER's use EMT-B, EMT-I and Paramedic as ER Techs. On occasion a Paramedic ER Tech might do a 12 lead. But all IV's and meds are done my RN's. ER Techs are nothing more than glorified CNA's. They go around collecting vitals, cleaning up homeless patients, fetching pillows and blankets and moving stable patients to the floor.


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## scmedic85 (Oct 29, 2010)

LonghornMedic said:


> On occasion a Paramedic ER Tech might do a 12 lead.


Interesting, in our ED techs (medic or not) do practically all ECGs. The med surg floors are a whole different situation though, nurses dont even do them there... They have an ECG tech come do them.


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## Mike Honcho (Oct 29, 2010)

I think it depends on what hospital you're at. When I did my EMT-B rotations in E.R., the paramedics were running I.V.'s and drawing blood. I was told by the same paramedics that another nearby hospital would'nt allow them to do either.


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## TransportJockey (Oct 29, 2010)

As a tech in an ED in ABQ, I could run twelve leads, start lines, and do blood draws. 
At university hospital in ABQ they hire medics with a limited drug scope, ivs and io insertion, suturing, and of course splinting and basic wound care like I did in my ed


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## Shishkabob (Oct 29, 2010)

Really depends on the hospital.


Some hospitals hire only Paramedics as techs, and allow them to do alot.  Some hire EMTs, Medics, CNAs, and MAs, and they all have scaled back skills.

Some hire all levels, but seperate Paramedics from the rest, and give medics more leeway.



Some allow all to start IVs and flush them.  Some only allow techs to start IVs, but not even flush the line with 5cc of saline.  


Some allow techs to give many drugs, some do not.


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## Emtpbill (Oct 29, 2010)

I was working at a local ER in Philly, I am not sure of the legality but it was probably mre of a trust issue with the nurses. Many a times they would be busy and hand me IV Ativan to push on a patient and even would have me give morphine. Now obviously they are in my scope of practice but once you cross into the ER you are no longer the top doggy.


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## MrBrown (Oct 29, 2010)

99% of ED staff here are either MDs or RNs we do not have "Techs"


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## 46Young (Oct 29, 2010)

scmedic85 said:


> I am looking for information about Paramedics working in emergency departments and what skills they are allowed to perform.
> 
> I am a Paramedic and work in an ED in order to earn some extra money as my service isn't playing nice with the schedule. I have approached the ED leadership about allowing techs that are certified as paramedics to perform advanced skills such as starting IVs, fluid administration, tele transport from the ED to floor when admitted, etc (I'm currently bored out of my mind).
> 
> I am looking for information on other hospitals allowing their techs to perform any or all of these skills in the ED. If you respond and let me know that your ED allows tech IV starts please let me know if this is allowed by all techs or just a limited group (ie EMT-I/P).



The Inova Health System has their techs start IV's, do blood draws (not arterial) and cultures, and also run 12's, but that's about it regarding paramedic capable skills.


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## 46Young (Oct 29, 2010)

scmedic85 said:


> We actually have several hospitals in the general area that allow their techs to start IVs but they allow it for all techs regardless of prior certification.



Hospitals hire phlebotomists to do their blood draws. Having a certified paramedic start lines when ordered shouldn't be an issue. It's my understanding that each particular hospital will train a new RN to do lines and such the way they want it. Training a medic to do the same would be a similar process, with similar results.

BTW, where do you work? I used to work for Charleston County EMS I was hired by them three years ago, but I only stayed for five months.


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## FrostbiteMedic (Oct 29, 2010)

As far as I know, any ER tech here can start IVs...That being said, there are only two levels of EMT in this state, EMT-IV (read that 85 standard intermediate with a few things thrown in) and EMT-P (We also have CCEMT-P, but I am lumping that with regular EMT-P). So, starting IVs is a basic part of EMS here, and can be done on BLS rigs.....


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## scmedic85 (Oct 29, 2010)

46Young said:


> Hospitals hire phlebotomists to do their blood draws. Having a certified paramedic start lines when ordered shouldn't be an issue. It's my understanding that each particular hospital will train a new RN to do lines and such the way they want it. Training a medic to do the same would be a similar process, with similar results.
> 
> BTW, where do you work? I used to work for Charleston County EMS I was hired by them three years ago, but I only stayed for five months.



Phlebotimists don't come to the ED, we are pretty much self sufficient for all skills with the exception of "rapid response" for CVA pts and respiratory to setup vents (but we don't let them intubate). 

The interesting thing at the hospital I work at is that ED (not floor) techs can straight stick for blood but can't start IV as that would be administering medication with the flush.

I've been here for somewhere around 3-3.5 years so it sounds like we may have been hired at the same time.


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## jjesusfreak01 (Oct 29, 2010)

Techs can't do anything here, but techs are all CNAs too, so that's expected.


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## scmedic85 (Oct 29, 2010)

scmedic85 said:


> Phlebotimists don't come to the ED


 young46 I apologize I think I misread your post earlier (on my phone). I thought you were saying they wouldn't need medics because phlebotomy could come if more help would be needed.

A little more background I should have provided up front as well:
We have already determined that we cannot just let Paramedics practice in the ED while working as ED Techs as the job description currently stands. I will likely be putting a proposal together to create a second modified tech position that we could call "Advanced ED Tech", "Critical Care Tech" (or some other way over complicated name that is not just Paramedic). I am trying to determine what skill sets these type of positions cover when Paramedic certification/licensure is a qualification for the position. At a minimum I hope to add IV starts, fluid administration, and the use of the cardiac monitor/defibrillator. ACLS drugs wouldn't be a bad addition but I won't be holding my breath for that. Hopefully by adding these skills I will be able to cure my boredome while helping the nurses out.


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## RUGBY66X (Oct 30, 2010)

when I was in the ED the other day working on clinicals for medic a nurse tech was there complaining all she can do is ECG and vitals and then chart them because she wasn't a nursing assistant which are allowed to do those things and was even more pissed because I could do everything that the nurses could. The nurses just showed me the orders and i did just about everything for our section of ten beds while they just kept charting everything i brought back to them.


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## Akulahawk (Oct 30, 2010)

RUGBY66X said:


> when I was in the ED the other day working on clinicals for medic a nurse tech was there complaining all she can do is ECG and vitals and then chart them because she wasn't a nursing assistant which are allowed to do those things and was even more pissed because I could do everything that the nurses could. The nurses just showed me the orders and i did just about everything for our section of ten beds while they just kept charting everything i brought back to them.


Just wait until you get your cert and start working... something tells me that you won't have the same privileges if you were to work as a Tech there.


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## RUGBY66X (Nov 1, 2010)

Akulahawk said:


> Just wait until you get your cert and start working... something tells me that you won't have the same privileges if you were to work as a Tech there.



probably not but im happy because it leaves more for me to do so i get more practice before im out doing it on the road.


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## NomadicMedic (Nov 4, 2010)

In Tacoma, the Multicare EDs (TG, Allenmore) have paramedics. With less acute patients, they handle most aspects of patient care, with the exception of PO meds. IVs, blood draws, med admin, charting... It's a hard job to land and plays pretty decent.


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## purdue1014 (Nov 4, 2010)

At the level 1 trauma center where I did my clinicals for EMT-B...They had one level of "tech" that could do phlebotomy, EKG, and basically all the rest of the BLS stuff, etc.  They also had CC-EMTPs who would "appear" for any trauma code, cardiac alert, anything big really, and worked with the MD's to help get things done....(I almost got to see a chest tube inserted, but then they decided to wisk said pt away to the OR and do it there...)

Purdue


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## NomadicMedic (Nov 4, 2010)

lightsandsirens5 said:


> As far as I know, WA does not allow that kind of stuff anywhere in the state. I have heard that might change sometime in the next few (read 25) years to allow EMS personnel to operate under their protocols in hospital. (With minor modifications obviously. Ie. medics can admin all medic drugs, but only after ordered to. And so on.)



Incorrect. See my above post.


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## Level1pedstech (Nov 5, 2010)

lightsandsirens5 said:


> As far as I know, WA does not allow that kind of stuff anywhere in the state. I have heard that might change sometime in the next few (read 25) years to allow EMS personnel to operate under their protocols in hospital. (With minor modifications obviously. Ie. medics can admin all medic drugs, but only after ordered to. And so on.)



 At SW Washington medical center in Vancouver the techs do all the lab draws but don't start lines. Everyone who needs a blood work up and a line gets stuck twice, once by a tech for labs then by an RN for an IV. The department has an in house EKG technician that does all the EKG;s.


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## Level1pedstech (Nov 5, 2010)

Akulahawk said:


> Just wait until you get your cert and start working... something tells me that you won't have the same privileges if you were to work as a Tech there.



 Most teaching facilities extend privileges to students that are not usually available to their regular staff. This applies to all levels of students from EMT-B's to Med students.


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## FireMedic3409 (Nov 7, 2010)

I am not sure if it is the same throughout all of the hospitals in NJ, but I can speak from my experiences.  In NJ, the ALS systems must be hospital based, but in my particular area of the state MONOC (a corporate EMS company with controlling input from like 13 hospitals) is its own company which operates completely separate from the hospital and in day to day operations has nothing to do with the hospital staff.

I worked as an ED Tech at Ocean Medical Center (Brick, NJ) (part of the Meridian Healthcare System) prior to getting my medic, and did part of my hospital based clinical paramedic training in the same ED under two different scopes of practice.  At any of the hospitals under Meridian, to be qualified as an ED Tech you must have a BLS cert.  You must either be an EMT-B, OR a CNA WITH 911 experience on a volunteer first aid squad as a non-EMT.  ED Techs perform O2 administration, venous straight-stick phlebotomy, 12-lead EKG's (but know nothing about interpretation), fiberglass splinting/casting of non-displaced fractures and those already set by the MD, routine pt cleaning and pampering like a CNA, vitals, transport/physical transfer bed-to-bed of non-critical/non-tele patients to the floor alone, transport/physical bed-to-bed transfer of critical/telemetry patients to the floor with a supervising RN (in other words with all due respect, they walk and talk while you do the work), making/cleaning ED stretchers, stocking of supplies, and basic electronic charting of vitals and care provided to patients.  You were not allowed to start IV's or give any medications unless you really consider O2 to be a medication.

As a paramedic intern in the ED, I could perform all of the duties of the paramedic under guidance of a supervising RN or MD, with the appropriate orders.  

Under normal circumstances, the Paramedics are not stationed at the hospital but once in a while after transferring care of a patient, the nursing staff will request that the Paramedics attempt an IV on a hard stick patient because we are better at it.  While the paramedics here aren't really supposed to provide any care within the confines of the hospital, because at Monoc they have no direct affiliation with the individual hospital (they aren't covered by the hospital for liability should something happen because they are not hospital employees, and have no privileges), they often do as a courtesy.  Hope that helps some.


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## Level1pedstech (Nov 7, 2010)

FireMedic3409 said:


> I am not sure if it is the same throughout all of the hospitals in NJ, but I can speak from my experiences.  In NJ, the ALS systems must be hospital based, but in my particular area of the state MONOC (a corporate EMS company with controlling input from like 13 hospitals) is its own company which operates completely separate from the hospital and in day to day operations has nothing to do with the hospital staff.
> 
> I worked as an ED Tech at Ocean Medical Center (Brick, NJ) (part of the Meridian Healthcare System) prior to getting my medic, and did part of my hospital based clinical paramedic training in the same ED under two different scopes of practice.  At any of the hospitals under Meridian, to be qualified as an ED Tech you must have a BLS cert.  You must either be an EMT-B, OR a CNA WITH 911 experience on a volunteer first aid squad as a non-EMT.  ED Techs perform O2 administration, venous straight-stick phlebotomy, 12-lead EKG's (but know nothing about interpretation), fiberglass splinting/casting of non-displaced fractures and those already set by the MD, routine pt cleaning and pampering like a CNA, vitals, transport/physical transfer bed-to-bed of non-critical/non-tele patients to the floor alone, transport/physical bed-to-bed transfer of critical/telemetry patients to the floor with a supervising RN (in other words with all due respect, they walk and talk while you do the work), making/cleaning ED stretchers, stocking of supplies, and basic electronic charting of vitals and care provided to patients.  You were not allowed to start IV's or give any medications unless you really consider O2 to be a medication.
> 
> ...



 I was with you till you got to the hard stick IV part. I always thought it was the other way around. In fact I was on shift in the peds ed yesterday and this very subject came up after one of the crews brought us a 17 year old with a blown 20g in her hand. It happens but to compare ER RN's to most medics is a stretch at best.

 I would much rather have an experienced ER RN starting a line on a hard stick patient than a field medic. In the six years I have worked in the ER I have seen some pretty poor work on the field medics part, but to be fair I have seen alot of good work to. I have seen very few times when we had to call IV resources down to the department to help get a line on a patient and we get our fair share of hard sticks in both the adult and the peds ED. I have never seen one of our nurses ask a medic to start a line in the ED and I dont think I ever would. Its not only a legal issue but you have to keep in mind the inside outside rivalry that has always been around like it or not.


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## Shishkabob (Nov 7, 2010)

I saw an RN, not once but twice, start an iv backwards in a patient.


How about we don't make generalizations about which cert is better?


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## Level1pedstech (Nov 7, 2010)

Linuss said:


> I saw an RN, not once but twice, start an iv backwards in a patient.
> 
> 
> How about we don't make generalizations about which cert is better?



 You mean IV's dont work both ways,go figure. I bet that was a hard one to live down.


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## FireMedic3409 (Nov 7, 2010)

I agree that you will have people who are excellent and people who have poor IV skills in any applicable profession, and also varying from location to location.  My point was purely that the general consensus in this region is that the Paramedics in most cases are better at IV's than the nurses.  The nurses will agree with me, because they cannot understand how we can function on the move in the back of a bouncing ambulance, when they have difficulty enough with a patient sitting still in an ED stretcher.  The majority of RN's in this area, if there aren't huge screaming pipes that I could place a #14G in, will proceed to fish with their #20G or smaller needle 5-10 x's until they get lucky, realize the site is blown, or they haven't hit anything and have caused the area to swell with localized tenderness.  I can also say I've seen a Paramedic or two (not naming any names) blow lines and let near a pint of blood spill from the cannula before getting it secured.  Don't get me wrong, I'm not bashing all of the RN's out there by any means, in fact some of the health care practitioners whom I admire most are RN's or RN/Paramedics.


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