Question about the ER

[skyreaper]

Alright, I'm planning on taking an EMT-B course this summer...Basically I just need someone to tell me what being an EMT-B is like. I know you work with the ambulance...either via hospitals or private businesses but what else? Like what is the day to day agenda...what do you actually DO. When I go to look for anything everything seems so circumspect. Also, can someone with EMT-B license be an ER tech? Any input would put a closure to my ignorance.

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[12R34Y]

You most definately don't need to be an EMT to be an ER tech in many many hospitals.

Many have on the job training and will hire you with little skill at all. Great learning experience either way you go.

EMT-B may make you get the job a little easier if they are chosing between 2 applicants.........one is an EMT and one isn't for example.

i'm sure there are some hospitals that require you to be an EMT to be a tech, but the three i've worked in in the past do not.

later

 

[lytesnsyrens]

Ok, I'll chime in. I'm an EMT-B and have worked as an ER tech for the past 2 years. No you do not have to be an EMT to work there, but I think it helps. You do alot of the same stuff you learn in EMT school, like EKGs, CPR, basic vital signs, wound dressing, suture removal, splints, lots of cleanup, patient transport (to x-ray, the floor), and also more such as phlebotomy, catheters, assisting with spinal taps, suturing, pelvic exams, etc. I also triage patients when the nurses are tied up and I sometimes take reports from the paramedics. It really is an enjoyable experience and when I have free time I can still ride with the ambulances. I recommend working in the ER, if only part-time, just to gain the confidence and experience in how the dept. is run which can be especially helpful if you plan on an EM residency. Granted the hours are killers, at least mine are since I switch back and forth between days, nights, and midshifts all throughout the week (12 hour shifts), but like my friends tell me, I'll be ready for residency. lol
I hope that helped some, and good luck in whatever you do.

 

[southerndoc]

A good summary of job duties: http://www.nwgaems.org/info/career.html

 

[skyreaper]

Thank you to all who have replied.

 

[12R34Y]

There are only a few things that lytesnsyrens mentioned that you would actually learn while in EMT-B school..........splinting, CPR, wound dressing. that's it.

The rest........EKG's, catheters, phlebotomty, patient transport, assisting with procedures etc....is all on the job training.

bottom line. you absolutely don't need to be an EMT to do a tech job. However, i still recommend the EMT route because it is just plain cool and you do learn alot.

if you can get a job as an ER tech now then take it.........don't think you have to wait to get your EMT first.

later

 

[Febrifuge]

Even better, although not particularly likely, would be if you could get hired as a Tech first, and then finagle the EMT-B training from your employer.

But as many have said, EMT-B is not necessary for ER Tech-hood. It just helps. A lot. It puts the phlebotomy, the EKG, the assisting with procedures, the triage, etc., into a context which is more medical model (how stuff works, and why) than nursing model (what's the right thing to do, and how)*.

I work in the same job, at the same level, alongside people trained as NA's, MA's, and even a Paramedic or two. I'll try not to be snotty about it, and just say it like this: some of us feel like we have a better grasp of the more... medical aspects of the care we provide, and some of us are, uh, perfectly good ED Techs. (I should note, it's by no means a 100% correlation between skill or intelligence and level of training. It's more to do with where we plan to be in 5 years.)

There's this one guy, he seems to take pride in his abilities to keep the laundry hampers from overflowing. Truthfully, it's nice to have him around, because I'm as good at the more housekeeping-like aspect of things as the residents.


* total generalization, yes. Please don't flame me.

 

[Dr. Wexler]

12R34Y: You most definately don't need to be an EMT to be an ER tech in many many hospitals.

Where are you from? I live in Philadelphia and every job I have seen requires experience, and almost every job requires formal training of some kind. Maybe it's just because Philadelphia hospitals can be more selective about who they hire. (BTW, I have looked at small community type hospitals in/near Philly too...same story)

 

[12R34Y]

i have worked in 3 different states (kansas, missouri and iowa) and NONE required any formal training for ER tech. absolutely none. i'm quite positive i was the only paramedic/EMT to work as an ER tech in those hospitals.

one was major level 1 trauma center.

one was suburubia level 2 trauma center.

small community ED was the other.

this echoes the other folks on this board that you don't have to be an EMT to be an ED tech.

this is the norm in most cases. i think yours (philly) is not the norm by any means. usually these are scutwork jobs and ED's can't be picky about who they hire. they just need the help.

later

 

[pseudoknot]

It sounds like this varies quite a bit by region. Here in LA, I've heard that ER tech jobs are very hard to come by and generally look for EMT-1s (that's EMT-B outside of California) with at least six months experience. Private ambulance jobs, on the other hand, are said to be a dime a dozen.

Jordan

 

[EMT036]

I am an AEMT-I (formerly EMT-D) that worked in an ER. The experience in the field definately helped -- I actually knew how to treat basic things, and had an idea of what was an emergency and what was not. Because I was the only EMT trained on my shift, when they ran short of nurses, I got promoted to RN... working triage, working the sub-acute section as the only care provider, and even watching 3 vented pts in a mini-icu to make sure no one died. This was middle management decision based on necessity. However, upper management has gone the other way -- my hospital does not want to hire EMT's to work as techs anymore. It turns out that they are independant, and can think! I actually got reprimanded for taking a patient from traige, putting them in a room, and applying a NRB O2 mask because the O2 sat was 67%. According the my supervisor, I should have waited for an RN to wander into the room and give me the order for O2. (gasp!)

 

[niko327]

I am an AEMT-I (formerly EMT-D) that worked in an ER. The experience in the field definately helped -- I actually knew how to treat basic things, and had an idea of what was an emergency and what was not. Because I was the only EMT trained on my shift, when they ran short of nurses, I got promoted to RN... working triage, working the sub-acute section as the only care provider, and even watching 3 vented pts in a mini-icu to make sure no one died. This was middle management decision based on necessity. However, upper management has gone the other way -- my hospital does not want to hire EMT's to work as techs anymore. It turns out that they are independant, and can think! I actually got reprimanded for taking a patient from traige, putting them in a room, and applying a NRB O2 mask because the O2 sat was 67%. According the my supervisor, I should have waited for an RN to wander into the room and give me the order for O2. (gasp!)

Are you serious? What kind of ridiculous garbage is that all about??!!?? You should have asked your supervisor if it was his/her mother you saw with a 67% sat, if they would have appreciated you leave her in triage to get by on room air? Heaven forbid the EMT infringe on anything related to nursing, lives be damned! If you really must follow absurd rules (as your supervisor demands) remind him/her that nurses (RN/LPN) are not authorized to prescribe anything to anybody including O2.
P.S. I have no problem with nurses, I think they provide an invaluable service in healthcare, that can not be replaced. I just hate the imaginary hierarchy, petty crap that doesn't put the patient first.

 

[OSUdoc08]

That's the difference between paramedics and RNs. Medics and RNs have the same clinical skills, but medics can do things without asking because they have standing orders in the field. As a tech, you are reduced to the RNs "helper" and cannot do anything without being told to do something by someone else. I think the ER should be full of paramedics that have standing orders so things get done 500 times faster without all of the waiting around.

For those of you have been discussing EMT-B techs, all that additional "on-the-job" training that you refer to is actually part of the medic training. Most of the trauma centers in Dallas require paramedic only techs, but the non-trauma level centers allow EMT-B's. Many, unfortunately, are switching to LVN's instead, who don't have the practical emergency expertise.

 

[southerndoc]

That's the difference between paramedics and RNs. Medics and RNs have the same clinical skills, but medics can do things without asking because they have standing orders in the field. As a tech, you are reduced to the RNs "helper" and cannot do anything without being told to do something by someone else. I think the ER should be full of paramedics that have standing orders so things get done 500 times faster without all of the waiting around.

Not all services have standing orders... (even the one regarded as the best EMS system in the nation -- Seattle Medic One -- doesn't have standing orders).

Secondly, the JCAHO actually forbids standing orders in the hospital.

 

[DocWagner]

Standing orders are different from city to city...absolutely ( I hold EMS standing orders for Dayton in my hand...revised for 2004). Each and every year they change, either becoming more or less complicated. Personally outside of basic ACLS, I am a personal believer in SCOOP and SCRAM.

EMT's make the BEST techs from my perspective.

One last pet peeve...it ain't the ER (emergency room), its the ED (emergency department). Old saying die hard.

 

[southerndoc]

One last pet peeve...it ain't the ER (emergency room), its the ED (emergency department). Old saying die hard.

Oh c'mon, you know every hospital only has ONE ROOM dedicated for emergencies! It's an emergency room!!!

Actually calling the ED an ER doesn't bother me as much as someone saying I'm going into ER medicine. Pet peeve...

 

[12R34Y]

The director of our ER at my school hates the term ED.............he says..................ED equals ERECTICLE DYSFUNCTION to way to many people nowadays.

 

[OSUdoc08]

Standing orders not only include morphine & valium, but all basic meds such as D50, ASA, and NTG, as well as suctioning, intubation, cric, c-spine, KED, etc. To tell me that you don't have any standing orders makes no sense whatsoever.

Off-line medical control = standing orders

If it is in the protocols and doesn't say call medical control, then it is a standing order.

 

[southerndoc]

Standing orders not only include morphine & valium, but all basic meds such as D50, ASA, and NTG, as well as suctioning, intubation, cric, c-spine, KED, etc. To tell me that you don't have any standing orders makes no sense whatsoever.

To whom are you replying?

As mentioned previously, standing orders/protocols vary significantly from city to city.

Where I used to work, we had standing orders for everything on the truck (including conscious sedation for intubation -- no RSI though as the state strictly forbids paramedics from giving paralytics for RSI). I know of some services that require paramedics to call for orders to cannulate an IV!

 

[blotto geltaco]

I am a personal believer in SCOOP and SCRAM.
QUOTE]


Round these here parts we SWOOP n SCOOP

 

[EMT036]

I agree, but in my hospital RN's are allowed to initiate O2, diagnostic testing (blood/med imaging) and some meds (NTG, ASA, etc) based on protocols, since it can take up to 4 hours for MD evaluation.....

Heirarchy sucks, but most of the nurses I work with are cool -- once they know you are competant, they will let you do whatever. I have done IV's (and removed them), changed fluids, set drip rates, given meds, done assesments, etc, as a tech -- all of which is somewhat illegal in NYS, but our ED is so understaffed it is ridiculous. The supervisors have the problem with it, but I am putting the patient first, and if they can't see that, oh well -- I'll be their boss in a few years

 

[EMT036]

I agree medics should be in the ED -- however in NYS there is this thing called the "Nursing Law" -- only RN's can preform assesments, start IV's, give meds, etc. Basically it's job protection.

 

[niko327]

Nursing law, out-friggin-standing!! It's a nice thing to have a 100+ year old lobby isn't it.

 

[OSUdoc08]

Thats why I like it when you see RN's who are cross-trained as EMT's and sometimes even as paramedics. You will sometimes see this in the ER, but mostly on the helicopter. These are the people you can always depend on. I know it isn't practical, but wouldn't it be great to have an ER full of these people?

 

[southerndoc]

Thats why I like it when you see RN's who are cross-trained as EMT's and sometimes even as paramedics. You will sometimes see this in the ER, but mostly on the helicopter. These are the people you can always depend on. I know it isn't practical, but wouldn't it be great to have an ER full of these people?

I agree. It would be nice to have a bunch of RN/paramedics in the ED.

Regarding the nursing law, the nursing profession is lobbying left and right to get more autonomy.

 

[EMT036]

Yeah we have a couple of RN's/EMT-P's -- its great when you, as a tech, don't have to tell the RN whether to put in a foley or give NTG/ASA/Plavix/LMW Heparin/etc to the AMI first... they actually have a concept of emergency vs. not... (unfortunately sometimes lacking in the ED)