Paramedic practicing in ED

[RUGBY66X]

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.

 

[NomadicMedic]

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.

 

[purdue1014]

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

 

[NomadicMedic]

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.

 

[Level1pedstech]

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.

 

[Level1pedstech]

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.

 

[FireMedic3409]

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.

 

[Level1pedstech]

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.

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.

 

[Shishkabob]

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?

 

[Level1pedstech]

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.

 

[FireMedic3409]

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.