EMTs/Paramedics working in an ER

[DrParasite]

Spinning out of the Texas ENA letter thread, I had a question for those paramedics who were employed in ERs, or knew about the topic.....

1) are you hired as a paramedic (job title and everything), or was paramedic a prerequisite for the job?

2) if you were hired as an ER tech, what classroom training did your hospital provide to you?

3) if you were hired as a paramedic, were you able to function as a paramedic in the ER, or was your scope of practice modified because you were working in an ER?

my reason for asking is as follows:
when I was living in NJ, a good friend of mine got a job at the local hospital/trauma center as an ER tech. EMT was helpful, but not required for the job. once she was hired, she was given 160 hrs of training, monday to friday, 9 to 5, for 4 weeks, on how to be a tech. topics covered included taking a 12 lead, BGL testing, PPE, and basically everything she needed to know to do the job. I don't know all the details, but typically the turnover was high, and many of the applicants were nursing students looking to get hospital experience.

They made about $13 an hour, which is why many who were EMTs transferred to EMS for the pay raise and better working environment.

Everything you could do was "in house only," your "scope of practice" was whatever the hospital administration and emergency room physician administration said you could do. there was no formal credentialing process, no certification you received, and if you left for another hospital, you would have to retake their in house training. but you were allowed to do more than a typical EMT, and a typical lay person. But it was still all at the hospital discretion.

Does it work differently in other places, and if so, how?

 

[escapedcaliFF]

Look into Arizona. They have a lot of EMTs and medics in the ER.

 

[MonkeyArrow]

1. I don't really understand what you're asking. You are hired as a paramedic, with paramedic a requirement to get hired.
2. No training is provided by the hospital. Every employee has to go through general orientation with safety info, infection prevention, etc. (1-3 days), and then a few shifts with an experienced nurse who will orient you to the department.
3. Paramedics here work as the ED monitor tech/EMS receiver. Pretty self-explanatory, look at all the patient's ECG tracings, make sure no one dies. Field incoming calls from EMS units, triage and let appropriate staff know. By virtue of their role, they don't really have a scope of practice that is relevant. If for whatever reason paramedics are working with patients, they basically have an ED tech role, except for they can start IVs.

 

[OnceAnEMT]

1. They are hired as Paramedics
2. I got on as an ER Tech, and EMT-B was a requirement, and not interchangeable with CNA. Interestingly enough, throughout the rest of the hospital on the floors CNA was required to tech, and EMT was not interchangeable. I agree, 2 completely different training processes, but just found it interesting because I haven't seen that being in issue in other hospital systems. I had 3-5 days (can't remember) of general hospital orientation, 2 of which are group lectures of all new hires (which just happened to be at my hospital, woop!), 1-2 for hospital specific orientation, then 1-2 for unit specific orientation (ED for me, which just meant working with the clinical education coordinator where she showed me where big things were, explained how the ED works, showed me how to use the wiz-bang glucometers and iSTATs, and random "specific" things like that). For CNAs the next week is "Tech Bootcamp", which is a full week of teaching you how to bathe patients and wipe bottoms with proper form and the like. Fortunately because I was an EMT they only had me there for the first 2 days which involved leadership skills, communication skills, foleys, and NG tube removal. I have no idea what they practiced for the next 3 days, I'm just glad I wasn't there. All staff are on Orientation for their first month, where they are partnered with another team member of their level (tech-tech, nurse-nurse, etc). Its supposed to be pretty strict and supervised, but we were busy enough and I was learning well enough that we started splitting up by the 2nd week. During this time we are also completing specific competencies which include code tasks, foleys, splinting, BGL, iSTAT, chest tube setup, suture setup, things like that. For the next 2 months after 1 month Orientation I was still on "Probation", a hospital-wide term for the first 3 months of employment. During that time I had to complete 3 CE classes. Aseptic technique (foley cath) (2 days), EKG interp (3), and phlebotomy (2).
3. I am not sure if the Paramedics' scopes are restricted below NREMT, but I do know they are enhanced in certain places, including foley placement and specific medications (but not as enhanced as an RN). I know they cannot sign for an EKG interpretation. My scope as an EMT is NREMT and up, to include straight sticks, foleys, BGL/iSTAT, EKG printing but not interpreting, and maybe some other little things I'm not thinking of. My only wish with my job is that I had more opportunity to perform full assessments. At this point I'm stuck with hurrying a patient back, starting the assessment, then giving the RN or ERP what I've got so far. That said, they've grown to respect my assessment (at least the first half...) enough to listen, so I suppose that is a start.