Can EMTs work as tech's in your hospital?

BuckyBadgerRN, ASN, RN · Jul 23, 2011

In my area, to work in patient care areas other than the ED, the CNA, PCT or some recognized certificate would be required. It is doubtful an EMT, which is also a certificate, could challenge any of these in the majority of states since the knowledge and skills are vastly different. In our ED we prefer CNAs with a phlebotomy and ECG certificate which then allows them to work under the title of ER Tech. This way they can also float to where they are needed if they want to work and some particular shift is overstaffed. By hiring only EMTs or Paramedics in the ED, we still had to train them and also get them certified in phlebotomy which I believe now requires over 140 hours and an additional state certification. The CNAs we use are actually PCTs who already have met these extra certification requirements.

In my state, EMT's are lisenced, NOT just a certificate!

GreyGull · Jul 23, 2011

Because of the limitations placed on EMT-I and Paramedic personnel in terms of where their scope of practice may be utilized, while phlebotomy is usually in a Paramedic's scope of practice, in the clinical (non-field) setting, that scope often may not be utilized under their cert/license. This means that means that phlebotomy may not be practiced by a Paramedic (or an EMT-I) in that clinical setting unless it's part of an educational program.
End result: That person that may legally perform Phlebotomy in the field has to sit through 140 hours of training they already have. An RN who has Phlebotomy already in their scope can do it, and yet they may receive fewer hours of classroom time to do the same thing. Providers that whose scope of practice includes Phlebotomy as part of their license for clinical work (not field only) are usually exempted from Phlebotomy cert requirements.

Licensed staff such as RNs and RRTs can do phlebotomy usually after a refresher or additional hours of training. At my hospital, all RNs go through a course with an RT before they do ABGs and all RRTs go through a course with lab or an RN before they do phlebotomy or IVs.

Paramedics are not taught to draw the many labs that an RN or even an RT will draw. How many Paramedics draw for cultures? How many know the proper prep for all of the samples? Usually a Paramedic is given a few tubes to draw while starting an IV which are the most common tests. Fewer areas are now accepting blood draws from Paramedics in the field after some treatment errors concerning mislabeling or mishandling which actually fell back to the RN who accepted the blood which she did not draw. Even drawing blood alcohols in the field are controversial and not allowed for several reasons in several areas even though the PD would like them to. You also must remember venipuncture for IVs and that for phlebotomy require different techniques.

The 140 hours is strictly for phlebotomy and hours for EMT training such as first aid is not included. The phlebotomy student may get over 100 venipunctures in that time easily. Believe it or not but many of the Paramedic students in some areas only require 5 IV sticks during their entire clinicals.

The scope of practice for any profession can sometimes be misinterpreted. Even if it is in your scope of practice, if you have not been trained for it, you probably should not do it. If a supervisor says "can you do phlebotomy" the answer might be yes but that person might be referring only to their scope of practice and not their actual practice. In many states an RN can intubate per their scope of practice but that does not mean they can inside the hospital or should without proper training.

NO WAY would I want someone digging for my hard to find veins who has no idea which tubes, what needle or how and who has never actually done phlebotomy even if they did start an IV once. It does not matter if it is in your scope of practice if you have not be properly trained, educated and supervised at least on a few sticks by a person who knows the rules, regulations and proper techniques of the lab. What if it was your child they were attempting to draw blood from?

jimmy0562003 · Jul 23, 2011

Hi, I am a Paramedic in an ED. I have been a Paramedic for 12 yrs. First and foremost look at job descriptions. There have been problems between myself and other techs I work with. Like nurses there are various skill levels in the whole EMS world. In Texas Paramedic and EMT I's can do IV thphy. In some other states this isnt so. In the hospital world aside and apart from the EMS world some things are not under a Physicians direction. As an EMS provider we work directly under a physician not a nurse. Just like like EMS providers dont exist in the nursing world you as a nurse dont exist in ours. You need to see what your hosp policy will allow. Believe me my hospital risk mangr has been well educated. She see things sometimes she doesnt want to see.

akulahawkRN, ADN, RN, EMT-P · Jul 23, 2011

i'll do some responses inline, in red to make it easier to see what i'm responding to...

licensed staff such as rns and rrts can do phlebotomy usually after a refresher or additional hours of training. at my hospital, all rns go through a course with an rt before they do abgs and all rrts go through a course with lab or an rn before they do phlebotomy or ivs.
while i'm not disagreeing that this is a good idea, the requirement of sending the rn or rt through a refresher or other additional training could very well be a facility requirement, not a legal one. they may want the personnel doing draws all "their" way.
paramedics are not taught to draw the many labs that an rn or even an rt will draw. how many paramedics draw for cultures? how many know the proper prep for all of the samples? usually a paramedic is given a few tubes to draw while starting an iv which are the most common tests. fewer areas are now accepting blood draws from paramedics in the field after some treatment errors concerning mislabeling or mishandling which actually fell back to the rn who accepted the blood which she did not draw. even drawing blood alcohols in the field are controversial and not allowed for several reasons in several areas even though the pd would like them to. you also must remember venipuncture for ivs and that for phlebotomy require different techniques.
the big issue with field draws is that the field personnel doing the draws are not subject to the facility's qa/qi processes for ensuring that the draws are done correctly. simply because of this, many facilities won't accept field draws, even if they were done well within established standards for doing the draws. i am also well aware that the techniques for doing an iv start and simple venipuncture are different. was it hard to do? no... not really. the hardest thing for me to remember was which tests needed which tubes, and which order the tubes are used.
the 140 hours is strictly for phlebotomy and hours for emt training such as first aid is not included. the phlebotomy student may get over 100 venipunctures in that time easily. believe it or not but many of the paramedic students in some areas only require 5 iv sticks during their entire clinicals.
i am well aware that the hours for phlebotomy and for emt (and above) are separate. you should be well aware that first aid training is not emt training either... while 5 iv sticks may be the minimum in some places, and in others 40 is minimum, in actual practice, a paramedic can easily get hundreds during their internships and later, on their own.
the scope of practice for any profession can sometimes be misinterpreted. even if it is in your scope of practice, if you have not been trained for it, you probably should not do it. if a supervisor says "can you do phlebotomy" the answer might be yes but that person might be referring only to their scope of practice and not their actual practice. in many states an rn can intubate per their scope of practice but that does not mean they can inside the hospital or should without proper training.
again, i'm not disagreeing that someone shouldn't do something they're not adequately trained for. it's entirely possible that someone could be actually adequately trained to some given procedure, but having not gone through a particular facility's own education for that procedure, may not be authorized to perform that within the facility.
no way would i want someone digging for my hard to find veins who has no idea which tubes, what needle or how and who has never actually done phlebotomy even if they did start an iv once. it does not matter if it is in your scope of practice if you have not be properly trained, educated and supervised at least on a few sticks by a person who knows the rules, regulations and proper techniques of the lab. what if it was your child they were attempting to draw blood from?
what if it was my own child? i call that an emotional red herring. i would feel uncomfortable with that stuff as well... if someone didn't know what they were doing, regardless of the provider level.

as to whether or not an emt can work as a tech of some sort, that completely depends upon hospital policy and state law. it's entirely possible that an "unlicensed" person be allowed to perform many procedures in a clinical setting while under supervision and yet be illegal to do them outside that setting. really, on a personal level, if someone is competent to do something i need, i have no problem with allowing them to do that service, whether it be tile work or drawing blood.

jimmy0562003 · Jul 23, 2011

sadly some of the " phlebs ask me to draw their pts" again we are getting into the ******* contest of titles. this is so stupid thats why I hate this site. if im an er tech please dont ask me to do any kind of neuro surg. hello we are looking for a vein. Simple hint if it blow your vaccutainer against the wall its arterial might want to pull out and look otherwise. oops ambulace driver common sense.

netglow, ASN, RN · Jul 23, 2011

In the end, like all healthcare it's just crazy confused and ineffective for everybody involved. All you can do is find out for each and every facility what they require for you to get a job there - and then on top of that, there is what they REALLY hire, you have to dig deeper:

1. People without adequate skill/intellect/edu - but who know the right people

2. People overqualified really for the job because of the economy and desperation for work (not going to pay you a decent salary)

3. People who they pretty much know will not try to advance themselves, eg will most likely stay for several years.

GreyGull · Jul 23, 2011

while i'm not disagreeing that this is a good idea, the requirement of sending the rn or rt through a refresher or other additional training could very well be a facility requirement, not a legal one. they may want the personnel doing draws all "their" way.

in a hospital there are mandates at both the state and federal levels to have certain competencies on file. the agencies that concern lab procedures want things done their way and the hospital will have no say in the matter but must comply. failure to show proof of trianing or competency is a violation for which the hospital can be cited for.

i am well aware that the hours for phlebotomy and for emt (and above) are separate. you should be well aware that first aid training is not emt training either... while 5 iv sticks may be the minimum in some places, and in others 40 is minimum, in actual practice, a paramedic can easily get hundreds during their internships and later, on their own.

we can not assume all emts and paramedics will have done 100s of sticks or that they have done so in the best practice according to the standards of an employer. surely ambulances companies have some type of training or protocol to ensure competency for their new employees and to make sure they are following some stanard to meet the needs of those who only got 5 sticks or those who may have gotten 100 sticks by whatever means which may have been under poor supervision. sometimes 100 sticks with poor technique and bad habits is much harder to correct than only 5 with excellent technique influenced by good habits.

even experienced staff in a hospital as a new hire will undergo a few days of training with a preceptor to ensure they understand the policies of a hospital and to have their competencies checked off. there are some where the competencies will hold that they do x amount of witnessed procedures regardless of how many they have done in their experience and this may also be a yearly thing as well. every year they will also do the time consuming computer based knowledge competencies as well. these will all go on file for the state and federal inspections. hospitals don't always like it. staff may hate it. but, those are the requirements from the state and federal agencies to see hospitals can stay in business with a safe environment for their employees and patients as well as be eligible for reimbursement.

i see you are in california. here are a few examples of inspections.

http://www.cdph.ca.gov/programs/lnc/pages/lnc.aspx

jcaho

http://www.jointcommission.org/

there are of course other accrediting agencies besides jcaho but it is the best known.

clia

http://www.cdph.ca.gov/programs/lfs/pages/cliafederalcertifiedlaboratory.aspx

cms is requiring more certications to insure competency. although you are from california, you may not be aware of how this affected the dialysis industry even though california has required certification for their dialysis technicians for a long time. until the cms mandate (2008), some states were still using ojts in their dialysis units.

times are changing with a demand for more accountability especially from the consumers. healthcare can be frightening.

as to whether or not an emt can work as a tech of some sort, that completely depends upon hospital policy and state law. it's entirely possible that an "unlicensed" person be allowed to perform many procedures in a clinical setting while under supervision and yet be illegal to do them outside that setting. really, on a personal level, if someone is competent to do something i need, i have no problem with allowing them to do that service, whether it be tile work or drawing blood.

i have stated cna which is a certified and not a licensed provider. (yes, a couple of states interchange the words with "licensed".) however, they bring the most value to our ed since they can provide the general care over 90% of the ed patients may need. even first aid techniques (which i thought emts were taught but was corrected by you) will not be utilized in the same manner in a hospital and different immobilization techniques will be used. if the emts are willing to be training for a cna certificate and are willing to provide patient care other than just ivs or working a code, then by all means the could work in an ed. we have just not had much luck in the past with emts wanting to do all the tasks involved in patient care which are non-emergent and the paramedic students have all stated it is not for them which is why they chose ems. it is to our advantage to hire people with the most flexibility not only for the hospital's benefit but for the employees' also so they can be fully utilized and not be canceled or limited to only one area.