EMT working in ER: Does anyone know process and rules?

[coolparamedic]

The ambulance service I work for is trying to have me work in the ER. We are a critical access hospital (less than 15 pts a day on average). I have heard conflicting stories that I have to get what Washington calls a Health Care Provider. Other people have told me that I don't have to. It has also been brought up that as soon as an EMT-B up to an EMT-P sets foot in a hospital, they are stripped of there ability to do pt care. It's a little confusing to me and I would like to have some unbiased opinions and answers.

1. Do you have to have a special certification or training to work in an ER at your scope?

2. Is it true that you are stripped of your cert once you are inside of a hospital?

Thank all of you in Advance

Nick

[Just Plain Ruff]

Nick, we need more information on this.

1. is it Washington DC or Washington state.

I would definately contact your state dept of nursing and see what their rules and regulations are.

I would think that if the hospital has bylaws or policies and procedures set up and they have been blessed by the state in their most recent survey then I think you will be ok.

I've worked in two hospitals in Missouri as a medic(for Fire's edification) and in Missouri you are allowed to work as a medic in the ER with all it's respective abilities(skills) but you practice under the RN's license in the ER. The only thing I was unable to do was to spike a bag of blood and that has changed since I started, we now can spike blood.

But if you are an EMT I would think that you should have no problems with being able to perform skills.

Good luck and god speed.

[Ridryder 911]

As Ruff described, you need to check local and state laws. As well, be sure they have a specific job description written at your level on what is allowed at your certification and license level. This will also help clarify things up to others as well.

R/r 911

[Just Plain Ruff]

right on Rid, if there's no detailed job description then he will fall under the same guise as a patient transporter or a gopher.

You can still do cpr on the patient but you will not get to do it after the code team gets there.

as soon as you become a integral part of the team there more than likely you will be able to get more into patient care. Don't expect to be allowed to do anything until you prove yourself. I speak from experience on that. Even though I was a paramedic and had been for about 3 months I was still watched over like a hawk for about 1 month so they could be sure I could do what I said I could as well as do what my cert's allowed.

Good luck, I found in my past experience that working in the ER is a great place to get experience and do things you would not be able to do in the field.

You get free ceu's and access to docs, nurses, resp therapists and the like.

You see more patients and more types of patients than you will see in the ambulance unless your daily call volume is much higher than the number of ER patients the ER sees. Remember this, in a given shift you may run 6 calls but you may see 6 patients in the first 2 hours of your 12 hour shift in the er and you will be able to take care of or have a part in the care of all 6.

[coolparamedic]

I am talking about Washington state. As I am sure you know, state offices are hard to get ahold of, my boss and I have both been playing phone tag with them. The state has a cert called a Health Care Assistant. In that, the state decides what you can do according to your training, which should be what I can do as an EMT-ILS/AW.

In response to the hospital policy, There is only one other person doing this job and it has come under scrutiny as well in regards to certification required to work there and the scope of practice. The hospital isn't even sure of the rules, since they have never had experience with this sort of thing. The hospital doesn't have policies and procedures for this and the nurses don't have any idea of what our scope is. My understanding is that I would be working under the liscence of a RN (even though a doctor has to say you are working under them). I am only one step below a medic (be it a long step). The reason I am asking about all this is so I can figure out if I will actually be able to work there or I should go get another job.

Besides the money, It will be nice to have pt contacts, considering our service runs an average of 2 calls a day. The first car runs about 85% of the 911 calls. I am on the second rig so you see how that sucks. I am worried about being the gopher which I am sure I will get to do quite a bit. I guess I'm just not sure of what to expect and am a little uneasy about the whole thing, not knowing and fully understanding the whole process. I appreciate the response.

Nick

[FormerEMSLT297]

I worked in an ER years ago in N.Y.,,, the bottom line was you could do basically what your hospital allowed you to do.

Remember that is some hospitals certain RN's are not allowed to do I.V.'s, others are.

As far as our "scope of practice" (as EMT-P's in ER's) we did I.V.'s, Foley caths, IM, SQ, SL meds, we triaged, wrapped sprains and strains and gave discharge directions in how to use crutches, etc. (however each skill we wered allowed to do had to be signed off on, and we had to have a letter in our employee file.

All the medics were also part of the in house code team, so we would go on all the codes and do the ACLS thing with the house resident.

In some places I know that medic did central lines, after being certified by the Doc's.

[Just Plain Ruff]

it sounds like your hospital doesn't have a clue about what you can or cannot do then I would stay away from that place until they can get you a good valid job description and what you can and cannot do.

You are putting yourself in extreme liability that if you do something that your hospital does not make allowances for you to do then both you and the hospital are in extreme danger.

I would never work somewhere that did not have what I could do delineated out. You do something that the hospital doesn't have you allowed to then you are SCREWED!!!!!!!!!!!!!!!!!

Be real careful on this one. With that information you put out on your last post, I'd turn that job down in a heartbeat.

No job is worth your licensure and livliehood. That hospital if you were to do something that they didn't have a clue on whether you could or couldn't do, will drop you like a hot potato when the legal eagles start to circle.

In my opinion - too much liability on your end my friend.

Work there at your own peril.

[chbare]

If the hospital has an actual position for you, an official "job description" should exist. This document should describe what is required and expected of you. If the hospital does not have a job description for your job title and cannot put in writing your scope of practice, then listen to Ruffems and look for employment elsewhere.

Take care,

chbare.

[coolparamedic]

I was thinking the same thing about not working there but my boss, who is the ambulance director came to the rescue. He hunted down an ER tech job description (not the Health Care Assistant the hospital wanted me to have) There is no state cert for it but it is a hospital cert. He is getting a job description from Southwest Washington Medical Center for ER techs and some of their training cirriculum. What I'm being told now is that I have to sit through a class and go through all the skills they want me to do. I have to work under a doctors ok. An MD gave his ok, so now I guess I just have to wait until the Chief Nursing Officer, the MD, and my boss decide what I can and can't do and put an actual job description togehter, I have to re-interview and then go through my orientation. I hope thats the way it goes, but with the way thing happen up here it could be a while.

[Just Plain Ruff]

That's a good thing..

One other thing, make sure you know that job description backwards and forwards. Know what you can and cannot do. Do not go over that because if you do something that is not allowed by the job description then you are liable and the hospital is not.

I've worked in the ER before as a medic and we had a very strict stringent guideline of what we could and could not do, those guidelines were we worked in the capacity of a nurse but could not hang blood. We could do everything else but hang blood.

Good luck and keep your eyes out on extra classes and free education - hospitals are full of em. Even if they don't apply to your certification go to them because they can only help you in your future as a medic or from here on out.

Good luck - if you need anything feel free to PM me. I've been there before my friend.