ER Tech vs Rig Work

Vetitas86

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Ok, as you may know, I'm going to be starting EMT-B training this fall. What I'd like to know is this.

Those of you who've had experience in both or either, what's the pros and cons of ER vs ambulance?

I'm considering doing ambulance full time and ER PRN, so I can get clinical experience for med/PA school.
 

Chan

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Two different things but really ER-Tech is a difficult position to obtain as many who are working as ER-Techs are medics.
 

DesertMedic66

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Based on my experience in the clinical setting during my EMT class it seems that the ER techs that are EMTs do: make and clean the beds, record but not read 12-lead EKGs, move patients to different areas in the hospital, and play babysitter for the psych patients.
 

DrankTheKoolaid

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Depends on the ED and its staff. But depending on who your partenered with and area call volume I would say it would take a Field EMT 5 years to get the same experience 1 year as a ED tech would bring. And thats only for a Full time 911 emt, not a bls IFT rig. ED techs have the ability to pick the brains of experienced ED MD's and learn their assessment techniques. And when a Tech doesnt pick up on suttle things he can chat with the MD later to ask what he saw that the tech did not.
 

Handsome Robb

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Our TC requires techs to be medics. A few are intermediates but they were on staff before the policy changed. With that said most tech positions require 6 months to a year of field experience before they even look at you.

Techs at our TC record 12 leads, start IVs, some start EJs which is fun since most nurses can't do it ;) pt movement, stocking rooms, cleaning rooms, taking reports from EMS and can actually attend patients if the rooms are full. That's why they are medics, so the EMS medic can pass pt care off to them and move them to a temporary bed so they can get back into service.

I've never worked as a tech but I have done quite a bit of time in the ER during medic school operating basically as a tech with the exception of being able to intubate and push medications. I like it but I would never do it full time, only PRN. It's totally personal preference.
 

Vetitas86

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So its sounding to me that you sort of have the trade off of doing more complex things at the ER and getting more actual clinical experience vs getting more autonomy and advanced prodedure on rig.

Does that about get it, generally speaking?

Sounds like the PRN idea for me would work well, since it'd give me the extra exposure.
 

Handsome Robb

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So its sounding to me that you sort of have the trade off of doing more complex things at the ER and getting more actual clinical experience vs getting more autonomy and advanced prodedure on rig.

Does that about get it, generally speaking?

Sounds like the PRN idea for me would work well, since it'd give me the extra exposure.
Complex in what way? I'd say the field is more complex than tech work in an ER. Only paramedic techs in the ER can do EJs and they have to take a class through the hospital to enable them to place them. While techs do IVs and 12s in the ER they can't interpret them, place advanced airways and can't push meds. Also they don't have the power to make clinical decisions in the ER either.
 

DrankTheKoolaid

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What NV says is true to a point. While you have little to no autonomy while working in a ED. The skills and knowledge you pick up will help you and your patients in the field later. In the ED you will learn more about wound management then you could ever wish for, Splinting and casting techniques and the whys of positioning. You will read (and look up medication names and uses hopefully) so often you will have a understanding of home meds most paramedics dont even have, unless they had the initiative to learn them on their own. While you wont be reading the 12 lead to the ED doc you will see each one and form your own assessment of it and can ask the MD's what they see. Starting IV's in the ED is a null as it is nothing like doing it in the back of the rig while driving through potholes. Once you master that, IV's on a veinless cabbage in a well lit room with the bed at whatever level you want it to be will be cake......
 

Handsome Robb

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What NV says is true to a point. While you have little to no autonomy while working in a ED. The skills and knowledge you pick up will help you and your patients in the field later. In the ED you will learn more about wound management then you could ever wish for, Splinting and casting techniques and the whys of positioning. You will read (and look up medication names and uses hopefully) so often you will have a understanding of home meds most paramedics dont even have, unless they had the initiative to learn them on their own. While you wont be reading the 12 lead to the ED doc you will see each one and form your own assessment of it and can ask the MD's what they see. Starting IV's in the ED is a null as it is nothing like doing it in the back of the rig while driving through potholes. Once you master that, IV's on a veinless cabbage in a well lit room with the bed at whatever level you want it to be will be cake......
I definitely do agree with this. You will learn a ton in the ER as well as get to assist with and watch some pretty cool procedures. My partner is a per diem tech and is a wealth of knowledge.

I just want to make sure I didn't come across as knocking working in the ER, it just isn't some I couldn't do full time.
 

SliceOfLife

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IMHO the biggest thing you will lose out on being in the ED is critical decision making. It's all kinda academic untill your alone in the back of a truck.
 

Tigger

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IMHO the biggest thing you will lose out on being in the ED is critical decision making. It's all kinda academic untill your alone in the back of a truck.
For better or for worse, one of the few places that someone with only a 120 hour course will be responsible for clinical decision making is the back of an ambulance. As an ER tech, that power will not likely be given to you.
 

SliceOfLife

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For better or for worse, one of the few places that someone with only a 120 hour course will be responsible for clinical decision making is the back of an ambulance. As an ER tech, that power will not likely be given to you.
Yup. But that's not to say you won't get some great experience and skills in the ED. It's just a different animal.
 

DrankTheKoolaid

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Not only will you gain great skills in a ED, you will learn when to truely be concerned about a patients condition. Instead of getting an adreniline rush during every call, which trust me is not a good thing. After a while in an ED you will be able to spot a truely sick patient from half a block away. If you can remain calm as the paramedic on scene, everyone else around you will be able to hopefully remain calm also.

Granted not all ED's are the same. I spent 10 years teching in a 6 bed 1 MD 1 RN, 1 Tech ER so I was fortunate to be able to do more then most once I had established trust with the staff and created some great relationships. After a while the nurses will no longer be able to answer your questions and likely will just tell you like they did to me to just go straight to the MD with questions. As they couldn't answer the majority of them.

Granted if you work as a EMT and have a good partner who treats you as more then a driver and isn't himself/herself already burnt out and likes to mentor, you have a chance to learn quite a bit also.
 
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Linuss

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Not only will you gain great skills in a ED, you will learn when to truely be concerned about a patients condition. Instead of getting an adreniline rush during every call, which trust me is not a good thing. After a while in an ED you will be able to spot a truely sick patient from half a block away. If you can remain calm as the paramedic on scene, everyone else around you will be able to hopefully remain calm also.
Corky... your pros of working in the ED aren't just pros for the ED. You're saying a field provider can't see a sick patient from accross the room? You're saying a field provider can't learn / become / be calm under the pressure?


In fact, I'd argue, that a lone Paramedic (or EMT?) needs to be calmer, and better at recognizing sick patients, in the field than in the ED, as they don't have a higher provider to back them up or take control and make the decisions.


You will read (and look up medication names and uses hopefully) so often you will have a understanding of home meds most paramedics dont even have, unless they had the initiative to learn them on their own.
Uhh.. what? So, a pro of working in the ED as opposed to the truck is that you will look up medications "so often" that you'll get an understanding of them... that field medics won't... without looking them up themselves? Huh?

"Hey guys, guess what, you'll do something so much more than other people unless they do it alot too!" is essentially what you just said...



Sure, in general, you will see a 'wider variety' of patients in any given shift at a busy ED compared to a busy EMS system because that's where the patients are taken, HOWEVER, working in the field is invaluable, much more beneficial, as you are actually in the decision making and critical thinking aspect of patient care as opposed to "I'm going to splint your leg then take you to the bathroom'. Most EDs don't used Paramedics to their fullest potential as it is, so as an EMT, you'll do almost nil in that aspect aside from the nursing tasks the nurses don't want to do themselves.


Do one FT and the other per diem. Benefit from both.
 

DrankTheKoolaid

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Linus I think you missed my point. Ive been doing this for 20 years, 10+ in the field and 10 in an ED. What I am trying to do is dispel any notion that ED experience is wasted time. It is far, far from it.

And as to the medication, unless a EMT or Medic is motivated enough to spend their free time reading home medications then yeah I stick to what I said. In an ER you are constantly bombarded with different and new medication names as you are getting patient information. Which I found invaluable in learning medications and how they react with other medications.

I am not knocking field experience as this is what we do. But for a new EMT I think tech'ing for a while makes MUCH more sense then working a BLS IFT rig where you need to make no critical decisions. At least in a ED you watch others make those decisions and have the ability to discuss with them why they chose to go one route versus another, with how the patient presented and lab studies etc etc.

Linus you also have to remember that not all EMT/Medics are the same. Trust me I know of many that I would not want working on my family members and I am positive you have the same, so you know exactly what I am talking about. Sure any monkey with a license is fine with urban 10 minute ETA to super centers, but come play in my neck of the woods and the not so bright stand out like sore thumbs, quickly when they are stuck on a snow covered summit with 2+ hours to the nearest Level 2/STEMI/Stroke center with a truly critical patient.
 

Linuss

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And as to the medication, unless a EMT or Medic is motivated enough to spend their free time reading home medications then yeah I stick to what I said.In an ER you are constantly bombarded with different and new medication names as you are getting patient information.
How is that NOT happening in the field if you're doing your job? Do patient medications just not exist until a patient crosses the threshold of the ER? Do ED providers learn medications just by reverse osmotic pressure, or do they themselves ALSO have to be motivated enough to learn about the medications?

I'm not dispelling the benefits of working in one place over another, but "learn medications" in the ED over in the field is not one. Seeing the meds used in more variety, more often, in off box uses? Sure. But not just learning patient meds, where in both avenues, you have to care enough to learn what they are and what they do.


Yay Epocrates.
 
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Ackmaui

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I've been an ER Tech for 10 1/2 years and an EMT-B for 12 and I am currently in paramedic school. I also have been an on call EMT with the local fire department as well. I think that the experiences that I have had in the ED have made me a better EMT. I think that it has made me more comfortable with people and I have learned so much form the staff here. I do EKGs and the docs ask me for my interpretation to help me learn to read them and this was before I was in medic school. I agree that there isn't the critical decision making that happens in the back of the rig. I have also had the charge nurse tell me she trusts me to tell her when a patient isn't doing well if for some reason there isn't a nurse with the patient.
I think you should try both of them and see which you like best. Both are great for experience and both have their pros and cons.
 

DrankTheKoolaid

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The OP posted he is just starting his training as an EMT. In what world is a new EMT going to be doing much more then driving and maybe assisting the medic with IV setup on a 911 rig. They do not have time to look up medications or even know what the patient even says they are on for that matter if history is obtained in the back of the rig.

Understandably every medic is different with his/her approach, but I know plenty of medics who spend absolutely as little as time as possible on scene, that means they walk in the door get a complaint and that patient is in the back of the truck and they are en route to the ED. Any further history is established while en route including medications, which were just bagged up blind and bagged for transport. What could a new EMT possibly learn from that? Especially if it is in a busy system with very little down time to be able to talk to the medic about calls.

But I concede, either way they have to be self-motivated as I knew other tech's at the time that did not belong in a ED and probably should have been kept in the litter box known as skilled nursing
 

Tigger

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The OP posted he is just starting his training as an EMT. In what world is a new EMT going to be doing much more then driving and maybe assisting the medic with IV setup on a 911 rig. They do not have time to look up medications or even know what the patient even says they are on for that matter if history is obtained in the back of the rig.

Understandably every medic is different with his/her approach, but I know plenty of medics who spend absolutely as little as time as possible on scene, that means they walk in the door get a complaint and that patient is in the back of the truck and they are en route to the ED. Any further history is established while en route including medications, which were just bagged up blind and bagged for transport. What could a new EMT possibly learn from that? Especially if it is in a busy system with very little down time to be able to talk to the medic about calls.

But I concede, either way they have to be self-motivated as I knew other tech's at the time that did not belong in a ED and probably should have been kept in the litter box known as skilled nursing
There are many, many places where basics are not the medics driver. I've worked in places that have P/B and the basic attends as many calls as possible. I work on a straight BLS truck that does get dispatched alone to calls. Is our system providing the best possible care by not having medics going to every call? No, absolutely not but that's how it works in the system I work in.

Also in regards to ER techs being "bombarded" by meds, how is this any different than a basic working IFT? Neither the ER tech nor the IFT EMT must know an extensive list of medications since they are not actually administering any of them. As a result, both positions will require self study to learn them. Merely being continuously exposed to them is not learning them.
 
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