Working in the ER

[phideux]

I work in the ER of a Level II Trauma Center. We work under a sort of modified scope of practice, sort of a Drs assistant. We do alot more than tech work here, but tech work is included. Anyone else work as a Paramedic in the ER??? What kind of scope of practice do you have????

 

[MonkeyArrow]

Scope is basic tech stuff + IVs and monitor tech/EMS receiver. Most of the time, the first medic is manning the ED monitor tech/EMS comms center, and the second one (when we have one) is out in triage doing labs and lines. No expanded scope here.

 

[TransportJockey]

The ER i worked in we were titled as ER paramedics and in theory had our full scope of practice as authorized by the state of NM plus some extra suturing, wound care, and splitting stuff added in.

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[ExpatMedic0]

The ER i worked in we were titled as ER paramedics and in theory had our full scope of practice as authorized by the state of NM plus some extra suturing, wound care, and splitting stuff added in.

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How did the other hospital staff receive you? Especially the nurses

 

[TransportJockey]

How did the other hospital staff receive you? Especially the nurses

Some of the nurses did not like us, since we managed the fast track area. We carried our own patient load, passed meds, charted, etc.but the rest of the ER staff knew we took a decent workload off of them and helped us out and liked having us

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[CANMAN]

The ER i worked in we were titled as ER paramedics and in theory had our full scope of practice as authorized by the state of NM plus some extra suturing, wound care, and splitting stuff added in.

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The new program I am working for has our medics work in the trauma bays when we aren't on the aircraft. We do a few shifts in there every 6 week schedule to help supplement the nurses that work there. The unit is a stand alone inner city trauma unit, staffed with only 3 nurses and 1 paramedic. No MD's are actually in the unit and only come when paged for traumas. Like TransportJockey was saying we have full scope, as well as expanded scope for airway management in the bays. On Fri, Sat, and Sunday the paramedics have first right of refusal over the residents in running the airway for any trauma coming in not already intubated. Running the airway you are doing everything from calling out meds, to placing the patient on the vent post intubation, etc. When no doing airway the medics can function fully in the primary or "responder" nurse role, which is like a second assist for meds, procedures, etc. Flight medics are well received in the bays and once you're familiar with the unit you will carry a patient assignment as well when they are busy.

I have only works two weeks as of now with the program but seems like an awesome setup for skills and autonomy when not on the aircraft. No quarterly O.R. rotations due to getting your airways in the bays so I am looking forward to not having to go to the O.R. quarterly anymore.

 

[medichopeful]

Some of the nurses did not like us, since we managed the fast track area. We carried our own patient load, passed meds, charted, etc.but the rest of the ER staff knew we took a decent workload off of them and helped us out and liked having us

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Why exactly did they not like you? Was it they felt you were taking away work? Encroaching on their space? Or simply because you were managing fast track and they thought they should be doing that?

 

[TransportJockey]

Why exactly did they not like you? Was it they felt you were taking away work? Encroaching on their space? Or simply because you were managing fast track and they thought they should be doing that?

A little of all of the above. Their nursing union saw us as taking away nurse jobs, some of them didn't like the ones they perceived as ambulance drivers having an active role as more than just a tech, and quite a few thought nurses could handle fast track and that we shouldn't carry a patient load since we were not licensed staff.

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[medichopeful]

A little of all of the above. Their nursing union saw us as taking away nurse jobs, some of them didn't like the ones they perceived as ambulance drivers having an active role as more than just a tech, and quite a few thought nurses could handle fast track and that we shouldn't carry a patient load since we were not licensed staff.

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I have to say, the continual pissing match between nursing and EMS gets old. Sorry you had to deal with that!

 

[Akulahawk]

A little of all of the above. Their nursing union saw us as taking away nurse jobs, some of them didn't like the ones they perceived as ambulance drivers having an active role as more than just a tech, and quite a few thought nurses could handle fast track and that we shouldn't carry a patient load since we were not nursing licensed staff.

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Just "fixed" the statement to reflect how those certain nurses view Paramedics working in the ED (or anywhere else in a hospital as Paramedics). As said above, the whole thing really just gets old. Of course we in EMS have similar feelings/reactions toward nurses (non-transport/flight) if they say they could handle "our world" because it is easier.

Of course those of us that have worked both sides know that it's not "easier" on either side of those ED doors. Nurses that are fresh out of nursing school or who have never been trained to work safely as a prehospital provider can just be downright dangerous in the field. Paramedics likewise have no idea how to manage multiple patients and how to prioritize between all of the needs/tasks necessary for patient safety. Ignorance of this from both "camps" fuel the arguments and proper education is the best way to fight it... from both sides.

 

[zzyzx]

The new program I am working for has our medics work in the trauma bays when we aren't on the aircraft. We do a few shifts in there every 6 week schedule to help supplement the nurses that work there. The unit is a stand alone inner city trauma unit, staffed with only 3 nurses and 1 paramedic. No MD's are actually in the unit and only come when paged for traumas. Like TransportJockey was saying we have full scope, as well as expanded scope for airway management in the bays. On Fri, Sat, and Sunday the paramedics have first right of refusal over the residents in running the airway for any trauma coming in not already intubated. Running the airway you are doing everything from calling out meds, to placing the patient on the vent post intubation, etc. When no doing airway the medics can function fully in the primary or "responder" nurse role, which is like a second assist for meds, procedures, etc. Flight medics are well received in the bays and once you're familiar with the unit you will carry a patient assignment as well when they are busy.

I have only works two weeks as of now with the program but seems like an awesome setup for skills and autonomy when not on the aircraft. No quarterly O.R. rotations due to getting your airways in the bays so I am looking forward to not having to go to the O.R. quarterly anymore.

You're lucky to work for such a progressively minded hospital! That's very cool.

 

[StCEMT]

The new program I am working for has our medics work in the trauma bays when we aren't on the aircraft. We do a few shifts in there every 6 week schedule to help supplement the nurses that work there. The unit is a stand alone inner city trauma unit, staffed with only 3 nurses and 1 paramedic. No MD's are actually in the unit and only come when paged for traumas. Like TransportJockey was saying we have full scope, as well as expanded scope for airway management in the bays. On Fri, Sat, and Sunday the paramedics have first right of refusal over the residents in running the airway for any trauma coming in not already intubated. Running the airway you are doing everything from calling out meds, to placing the patient on the vent post intubation, etc. When no doing airway the medics can function fully in the primary or "responder" nurse role, which is like a second assist for meds, procedures, etc. Flight medics are well received in the bays and once you're familiar with the unit you will carry a patient assignment as well when they are busy.

I have only works two weeks as of now with the program but seems like an awesome setup for skills and autonomy when not on the aircraft. No quarterly O.R. rotations due to getting your airways in the bays so I am looking forward to not having to go to the O.R. quarterly anymore.

I don't really have an interest in working in a hospital as a medic, but if I ever were to, this is the kind of place I would want to work. It sounds like a legitimately awesome place to work as a medic. Great scope, yet no being woken up for a call or carrying someone up/down steps? Heck yea I'd like that.

 

[CANMAN]

Just realized I shouldn't write posts after nightshifts lol. Clearly didn't edit my previous post . I am just now getting settled into this new company, and will report back after my orientation is complete in 7 more weeks

 

[phideux]

How did the other hospital staff receive you? Especially the nurses

The nurses here like having me there, I do lots of stuff for them. The docs like us in the ER, some are better at letting us do stuff than others, but it's not bad. Plus the pay is alot more than any EMS around here.

 

[VFlutter]

It would be awesome if I could find an ER/ICU job that would allow me to practice to my flight scope of practice. I hear some rural hospitals allow this.

 

[EpiEMS]

It would be awesome if I could find an ER/ICU job that would allow me to practice to my flight scope of practice. I hear some rural hospitals allow this.

What's your flight RN scope like?

 

[VFlutter]

What's your flight RN scope like?

Along the lines of a paramedic scope. More so procedures than anything else such as intubation, IOs, etc. I have always worked at large hospitals with plenty of Doctors, PAs, and Anesthesia so the RNs were not trained in such. I think it would be tough to go back and not be allowed all the things I am now trained and allowed to do.

 

[EpiEMS]

Along the lines of a paramedic scope. More so procedures than anything else such as intubation, IOs, etc. I have always worked at large hospitals with plenty of Doctors, PAs, and Anesthesia so the RNs were not trained in such. I think it would be tough to go back and not be allowed all the things I am now trained and allowed to do.

Makes sense - anything beyond typical medic scope? Blood products? Chest tubes? Escharotomy?

 

[VFlutter]

Makes sense - anything beyond typical medic scope? Blood products? Chest tubes? Escharotomy?

We do not carry blood products but can get it from referring facilities, yes chest tubes and escharotomy. Used to have pericardiocentesis in the protocols.

 

[Tigger]

It would be awesome if I could find an ER/ICU job that would allow me to practice to my flight scope of practice. I hear some rural hospitals allow this.

One of our EDs allows the flight crews full scope in the EDs and also has a Medic Techs with their ground scope and some additions. They have not decided what they are but there are talks of expanding it to what flight has with additional education.