# Splinting



## tawnymarie (Jul 22, 2012)

Hey Everyone,

I am in the process of completing my EMT-B here in California.  I was a CNA back home and my license lapsed.  I worked mostly critical care and ER.  Here in California the EMT is much more desired than the CNA which is why I chose it.  It's also where my parents started before furthering their careers (Paramedic/RN).  My long-term goal is medical school.  

Annnnyway, many ER's really want someone with splinting experience or who has the skill-set.  They specifically ask for this skill in all job postings.  My ACLS, Phlebotomy etc is all taken care of.  Does anyone know if classes are offered in Northern California that focus on more advanced skills?  I plan on doing ITLS eventually.  Anyone else focusing on ER or have experience working in one?  What helped you?

Any information would be useful!  Thanks!


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## Anjel (Jul 22, 2012)

I am confused.

Splinting is a basic skill. You will learn it in basic class.

How do you have ACLS? What is it exactly you are trying to do? Work in the ER? Most places around here require you to be a medic.

If you want advanced classes why not just take a paramedic course?


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## rwik123 (Jul 22, 2012)

Yeah ITLS and ACLS are useless to you as a basic. Maybe not useless in knowing all the things going on, but treatment wise you can do nada. I've heard of basics sitting though the course but never getting the actual qualification. 

Splinting is a basic skill. They are probably just pulling out a stating a few skills that they emphasize and will employ you to do regularly.


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## mycrofft (Jul 22, 2012)

OOps see below


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## mycrofft (Jul 22, 2012)

I think she and the employers are referring to plaster splinting, such as you do to discharge a patient home with a referral to follow up at an ortho clinic for X-ray and casting, or even an orthotic company.

I am ignorant of such classes, that unit may be part of a larger class/major at a community or tech college. Maybe get experience with it as a volunteer at a County clinic or such, and get a letter of recommendation?

There used to be quite a bit on Youtube about doing plaster casting. I used to like doing it when I work at a "doc in a box" (aka nowadays as an "urgent care clinic").

(I guess nowadays also it wold mostly be fiberglass, but plaster is still used.)

EDIT: googled "youtube plaster splints" and gobs came up.


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## tawnymarie (Jul 22, 2012)

ITLS and ACLS are not useless here in the bay area. Most ER's require an EMT-B to have both ACLS and PALS in order to even apply for an ER Tech position. If you complete the courses even as a CNA you get the card. I had ACLS as a CNA back home.  It comes in very handy when your working in any critical care situation. And your right I don't find any advanced education useless which is why I was seeing if any other EMT's work in ER's. Seems splinting will be a skill I acquire more on the job or through some other volunteer/clinic experience. ER Techs have a little bit of a different job description  Paramedicine isn't necessary to work in the ER...Not saying I won't pursue it eventually but not many working mom friendly paramedic programs in my area :-/ so Im finishing pre-med classes since that is long-term goal. Thanks for the insight so far everyone!




rwik123 said:


> Yeah ITLS and ACLS are useless to you as a basic. Maybe not useless in knowing all the things going on, but treatment wise you can do nada. I've heard of basics sitting though the course but never getting the actual qualification.
> 
> Splinting is a basic skill. They are probably just pulling out a stating a few skills that they emphasize and will employ you to do regularly.


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## Anjel (Jul 23, 2012)

You still can't do anything that they teach you in ACLS or PALS as a basic or CNA. 

I have never heard of a CNA having to take those classes. Very strange.


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## MMiz (Jul 23, 2012)

Anjel1030 said:


> You still can't do anything that they teach you in ACLS or PALS as a basic or CNA.
> 
> I have never heard of a CNA having to take those classes. Very strange.



Not to get too far off topic, but Beaumont requires all of their EMT-Basic ER techs to take a phlebotomy course for blood draws and an ACLS
course so they could work codes. The axle of practice was expanded in the hospital. 

To the OP, I haven't heard of a course in splinting/casts. Is this something you could potentially arrange with a local hospital or urgent care?


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## tawnymarie (Jul 23, 2012)

Hello, you're correct...The ER Techs do require ACLS and Phlebotomy and we do work codes.  Even as a CNA I had ACLS and worked codes.  I'm not sure how it works otherwise since I've never worked an ambulance.  I'm hoping I can try to arrange something with a hospital.  I work for a contractor of Sutter right now and under a group of psychiatrists so I'm hoping that will help get me in even if it's on a volunteer basis first   American Health Education offers an extra trauma course aimed at EMT's and CNA's.  I'm probably going to take it since it does go over splinting more in detail.  





MMiz said:


> Not to get too far off topic, but Beaumont requires all of their EMT-Basic ER techs to take a phlebotomy course for blood draws and an ACLS
> course so they could work codes. The axle of practice was expanded in the hospital.
> 
> To the OP, I haven't heard of a course in splinting/casts. Is this something you could potentially arrange with a local hospital or urgent care?


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## tawnymarie (Jul 23, 2012)

Hi Anjel,

As an EMT-B who works in the ER you are required to attend codes and work the patients.  This includes anything from injections to CPR and Defibrillation.  ACLS comes in handy for understanding different rhythms especially if you have to work with ventilators and cardiac monitors in an ER or ICU.  In California an EMT certification is preferred over a CNA certification in the ER's.  ACLS and PALS is required.



Anjel1030 said:


> You still can't do anything that they teach you in ACLS or PALS as a basic or CNA.
> 
> I have never heard of a CNA having to take those classes. Very strange.


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## rwik123 (Jul 23, 2012)

tawnymarie said:


> Hi Anjel,
> 
> As an EMT-B who works in the ER you are required to attend codes and work the patients.  This includes anything from injections to CPR and Defibrillation.  ACLS comes in handy for understanding different rhythms especially if you have to work with ventilators and cardiac monitors in an ER or ICU.  In California an EMT certification is preferred over a CNA certification in the ER's.  ACLS and PALS is required.



Injections? So you are pushing drugs too?


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## tawnymarie (Jul 23, 2012)

Hi rwik123,

Yes EMT's in an ER Setting do give injections.  IM injections are a given on a regular basis.  Thankfully during a code situation nurses are pretty much doing the drug pushing.  I've never had to push a drug but, they want you trained in ACLS for the sake of learning code routine etc.  Anytime I participated in a code as an tech back home (in the south) I was usually doing chest compressions, bagging, or doing the EKG on the patient.  EMT-P's here in California start IV's and even administer IV medications in the ER's.  That's pretty understandable since they can do it in the field.  I think what a tech can do in the hospitals is very dependent on the hospital.  I remember when I was just a ward clerk in ICU I was still asked to go to mock code classes etc because you never know what can happen in those units and they want everyone trained.  I can understand why they would want those in the ER to have more training ie...Phlebotomy, ACLS, ITLS, PALS, etc.  I keep hoping to find someone here on the board who is an EMT that works in an ER as well for more insight especially here in the state of California.



rwik123 said:


> Injections? So you are pushing drugs too?


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## Anjel (Jul 23, 2012)

MMiz said:


> Not to get too far off topic, but Beaumont requires all of their EMT-Basic ER techs to take a phlebotomy course for blood draws and an ACLS
> course so they could work codes. The axle of practice was expanded in the hospital.
> 
> To the OP, I haven't heard of a course in splinting/casts. Is this something you could potentially arrange with a local hospital or urgent care?



But they can't push meds and defibrillate. 

McLaren is the same way.


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## Handsome Robb (Jul 23, 2012)

Not to throw stones and I'll have to ask my old partner along with some other coworkers who work PRN in the Trauma Center as Trauma Tech IIs (Paramedic ER tech) and if I'm not mistaken they can't push drugs or defibrillate. Under direct supervision of an MD possibly but I won't say for certain until I ask one of them.


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## tawnymarie (Jul 23, 2012)

NVRob said:


> Not to throw stones and I'll have to ask my old partner along with some other coworkers who work PRN in the Trauma Center as Trauma Tech IIs (Paramedic ER tech) and if I'm not mistaken they can't push drugs or defibrillate. Under direct supervision of an MD possibly but I won't say for certain until I ask one of them.



Im not throwing stones either but those objecting don't live or work in California. Do look at a job description of an ER Tech in the major trauma centers centered around LA and SF...Those are required skills. Whether or not you will use them is another story and up to the facility. Defibulator use is part of the EMT curriculum here in California. I know NREMT has their own standards but ultimately the scope up practice is up to the state and local EMS Agencies. Why would such things be a part of someone's training if they are not required or expected to use it if the circumstance arises?


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## Anjel (Jul 23, 2012)

An AED and defibrillator in the hospital world are completely different things.


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## tawnymarie (Jul 23, 2012)

Anjel1030 said:


> An AED and defibrillator in the hospital world are completely different things.



Yes definitely. Difibrillator use is taught at the EMT-Adv. level and in ACLS. EMTs working in an ER are expected to know how to use it. But they hardly ever do...Leave it to the nurses. 

Anyway I appreciate everyone's insight. If anyone happens to be an ER EMT in California and can let me know about the splinting techniques etc that'd be great 

I am thrilled to see the variety of experience and diversity in this forum!


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## mycrofft (Jul 23, 2012)

California has (had?) a loophole that_* techniques*_ (such as defib or IV starting) can be allowed by an employer if they can certify (train) then track and keep current people working as_* technicians*_, as long as it is done at the order of and under the close attendance of the ordering MD or other licensed person. Example: LVNs starting IVs. The hospital ER I worked in allowed LVNs to start an IV but they had to immediately get a licensed person (RN, MD) to start any fluids or drugs. (Silly, no? I saw at least one clotted IV start due to delay). I don't know if this applies to EMTs and CNAs or if it has been closed,  but employers love this as it saves money. (In theory if something goes wrong it is the supervising license's fault since they are supposed to supervise, and I lost one pretty good job over that).


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## Tigger (Jul 23, 2012)

tawnymarie said:


> Hi rwik123,
> 
> Yes EMT's in an ER Setting do give injections.  IM injections are a given on a regular basis.  Thankfully during a code situation nurses are pretty much doing the drug pushing.  I've never had to push a drug but, they want you trained in ACLS for the sake of learning code routine etc.  Anytime I participated in a code as an tech back home (in the south) I was usually doing chest compressions, bagging, or doing the EKG on the patient.  EMT-P's here in California start IV's and even administer IV medications in the ER's.  That's pretty understandable since they can do it in the field.  I think what a tech can do in the hospitals is very dependent on the hospital.  I remember when I was just a ward clerk in ICU I was still asked to go to mock code classes etc because you never know what can happen in those units and they want everyone trained.  I can understand why they would want those in the ER to have more training ie...Phlebotomy, ACLS, ITLS, PALS, etc.  I keep hoping to find someone here on the board who is an EMT that works in an ER as well for more insight especially here in the state of California.



I've done a lot of looking at ER tech positions and I can't say I've heard of such an expanded "scope" for EMT ER techs in any place I've ever been, and it sounds like most of our community has not even. I would not hold my breath over finding someone with a similar experience to yours. It really does not make any sense to have an EMT administering meds or manually defibrillating  when there are many more providers routinely licensed to do so in an ED to begin with. Honestly I'm not sure I like the idea, just because an EMT takes ACLS does not mean they have proper background knowledge to implement it.


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## mycrofft (Jul 23, 2012)

oops see below


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## mycrofft (Jul 23, 2012)

It makes negative sense. It does not save time or money for the hospital since the license is supposed to oversee and supervise the technique being done; they cheat, however, and then fob off errors on the supervising licenses. 
Rule #1 is Do No Harm, and even if a MD made the call, if something appears wrong or changing unexpectedly a tech cannot be expected to be able to recognize and act on that, just follow the order. Tech who do this are being shortchanged (if you want to start IV's etc., trust yourself, get your license and make a lot more money while you are at it), patients are endangered, and licenses who accept this sort of "supervisorial" duties (without supervisor pay) are ignorant or foolish.


Splinting though, just to get back on track, is pretty innocuous. Our entire county had (has?) ONE tech with a pager and a rolling trunk full of materials going between clinics and jails.


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## tawnymarie (Jul 23, 2012)

mycrofft said:


> It makes negative sense. It does not save time or money for the hospital since the license is supposed to oversee and supervise the technique being done; they cheat, however, and then fob off errors on the supervising licenses.
> Rule #1 is Do No Harm, and even if a MD made the call, if something appears wrong or changing unexpectedly a tech cannot be expected to be able to recognize and act on that, just follow the order. Tech who do this are being shortchanged (if you want to start IV's etc., trust yourself, get your license and make a lot more money while you are at it), patients are endangered, and licenses who accept this sort of "supervisorial" duties (without supervisor pay) are ignorant or foolish.
> 
> 
> Splinting though, just to get back on track, is pretty innocuous. Our entire county had (has?) ONE tech with a pager and a rolling trunk full of materials going between clinics and jails.



I definitely by no means agree with the policy.  I agree that drug pushing and defibrillation should be done by a nurse.  But, with the MD and nurse right there I can't say I'd say "no" if they asked me to do a task that I am trained to do and have done before as long as it's within my scope of practice.  For example I have no issue with doing chest compressions.  Many times they prefer the techs to do the compressions so they can focus on the root of the problem and getting the drugs/code going.  I feel the hospitals require their EMT/ER Techs to have ACLS so it gets them more familiar with a code situation.  My ACLS class included mock codes etc and I'm glad I took the course...During my first code I understood what was going on.  EMT-P's are expected to do a lot of different procedures even beyond that if they work in an ER but, I have no intention of getting the EMT-P. By then my hope is to be applying to medical school.

This has all been interesting information....


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## mycrofft (Jul 23, 2012)

ACLS training is not a bad thing, but I hope they pay for it. As I recall it required knowledge I did not have when I was an EMT (back with BArney and Fred at Bedrock EMS), but did get in nursing college.

"Scope of practice" is the slippery thing here. Theoretically, your scope is defined by what your CNA and/or other technical training included, and what is defined by law. The "if certified by the institution" etc etc loophole allows the hospital to get around that. It is tempting to go beyond scope if one had been trained (or for some people, present company excepted (, if they saw it on tv once), and if it is expected, but watch out. Many verbal reassurances evaporate the moment a lawsuit or termination rears its ugly head, then it's every person for themselves.


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## tawnymarie (Jul 23, 2012)

mycrofft said:


> ACLS training is not a bad thing, but I hope they pay for it. As I recall it required knowledge I did not have when I was an EMT (back with BArney and Fred at Bedrock EMS), but did get in nursing college.
> 
> "Scope of practice" is the slippery thing here. Theoretically, your scope is defined by what your CNA and/or other technical training included, and what is defined by law. The "if certified by the institution" etc etc loophole allows the hospital to get around that. It is tempting to go beyond scope if one had been trained (or for some people, present company excepted (, if they saw it on tv once), and if it is expected, but watch out. Many verbal reassurances evaporate the moment a lawsuit or termination rears its ugly head, then it's every person for themselves.



HeHe I recall a moment when I was asked by an RN to remove the drains from a patient.  I got a good laugh...I knew better   Some nurses thoroughly enjoy taking the scut work of their techs tooooo far.  However, sutures are interesting


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## Akulahawk (Jul 25, 2012)

Unless CA regs have changed, Paramedics working as techs in a hospital can only do what the hospital certifies they can do. Paramedics can function as full-scope Paramedics only in "small and rural" hospitals, not all hospitals. Typically those facilities have their own hospital-based ambulances and the Paramedics augment the ED staff, but do not replace them because at a moment's notice, they could be gone doing a call...

"*100145.  Scope of Practice of Paramedic.*
...
(c)  A paramedic student or a licensed paramedic, as part of an organized 
EMS system, while caring for patients in a hospital as part of his/her 
training or continuing education under the direct supervision of a physician,
registered nurse, or physician assistant, or while at the scene of a medical 
emergency or during transport, or during interfacility transfer, *or while 
working in a* *small and rural hospital* pursuant to Section 1797.195 of 
the Health and Safety Code..."


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## Doczilla (Jul 25, 2012)

I beleive by "splinting" she's referring to ortho glass. That's s common tech skill on my side. It's a good bridge between aluminum splints and plaster. You still need a pretty extensive knowledge of splinting, especially hand configurations. 

As far as I know all of that knowledge Is obtained on the job.


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## mycrofft (Jul 25, 2012)

Thanks Akula and Doc, +1 each. 
Splinting is also art (as in artisan, not artist) as well as technique. If your mentor is not correcting you very much, you are not learning enough. Ask questions, read outside materials, but always ask questions, don't challenge.


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