ER tech

Stevenmac85 · Jul 25, 2013

Hi I'm a technician in the uk , were called emergency department techs .

We can do much the same as an RN can apart from drug administration but can under direction administer nebs, 02 and entanox and topical creams for numbing skin before needle insertion .

We cannulate , carry out phlebotomy , 12 lead ECGs , accu check blood glucose checks , urine dip , dressings/ wound closure ( after checked by doc / RN), plaster of Paris application , give out crutches and ensure patient can use them safely and work in resus ( trauma ) and help out with arrests ( codes ) .

Amongst the hands on clinical stuff we ensure the department is tidy and well stocked and perform admin/ reception duties and act as a porter / orderly too ....

Our salary is around £18,000 basic and we get enhanced pay for weekends and nights .

We work. 37.5 hrs a week and usually work this by 3x 13 hour days a week .

funtimes · Jul 26, 2013

How did you come up with the idea that working on the road as an EMT is nothing like the ER? I have been working as a tech for seven years and some of the best ER techs and RN's I work with all have prior or current field experience. Many ER managers look for tech as well as RN candidates with thier EMT (basic or medic) and field experience. The reason is that EMT's and RN's with field experience tend to have better critical thinking skills and have the ability to multi task effeciently when it gets busy. At the level one I worked at I helped train the CNA's that came down to the ER from the floors. I noticed that most were very hard workers but just by the nature of thier CNA education and training they think differently than people I trained with thier EMT and field experience. Rather than trying to think ahead or act alone during traumas and codes they rely on being directed by an RN or other provider.

Well you're talking about two different things. One is thinking independently and making decisions, which I agree EMT field experience would be of some valuable, as CNAs pretty much do what their told and if something unexpected comes up, they report it to the RN and they make the decisions, BUT when it comes to taking care of multiple patients at once, EMT field experience would be of almost no value. CNAs take care of multiple patients all shift long, sometimes up to 20 or 30 at a time. As an EMT the closest I ever come to that is doing a quick triage on scene.

I found my EMT experience to be of little value in a hospital. Paramedic is different because Medics do a lot of the things RNs do, but EMTs pretty much have to be taught from scratch how to do everything besides check vital signs, do CPR and maybe some basic airway management.

funtimes · Jul 26, 2013

How did you come up with the idea that working on the road as an EMT is nothing like the ER? I have been working as a tech for seven years and some of the best ER techs and RN's I work with all have prior or current field experience. Many ER managers look for tech as well as RN candidates with thier EMT (basic or medic) and field experience. The reason is that EMT's and RN's with field experience tend to have better critical thinking skills and have the ability to multi task effeciently when it gets busy. At the level one I worked at I helped train the CNA's that came down to the ER from the floors. I noticed that most were very hard workers but just by the nature of thier CNA education and training they think differently than people I trained with thier EMT and field experience. Rather than trying to think ahead or act alone during traumas and codes they rely on being directed by an RN or other provider.

Not sure I agree with you on this one. You're claiming a tech or CNA from the floors don't know how to multi task? Have you ever worked on a floor? Multi tasking is 90% of the job, if you cant multi task you better learn quick or find another job. I've worked as an EMT and I agree with you about the critical thinking and decision making the job requires. People who cant think for themselves or cant improvise aren't going to go very far in EMS at any level, but EMT school itself isn't going to remotely prepare someone for taking care of 15 patients at once, and for that matter neither is working the road. A CNA from on an inpatient unit does that all shift long.

If a CNA or tech from the floor does poorly in the ER, it probably has more to do with the fact they simply aren't taught the type of skills needed and its not easy to learn things like that on the job. Same thing with Nursing school. Nursing students don't really learn these skills either, they are expected to learn it on the job apparently, which is why new grads with an EMS background will have a much easier time starting out. An EMT student practices this stuff over and over again in class on manniquins and other students before they ever have to do it for real.

green34 · Jul 26, 2013

Personally, I think EMTs with firefighting experience do better than CNAs. I worked in the ER as a tech as an EMT and nursing student. It's a different feel. It also depends on the ER. If all the ER tech does is stocking and helping patients to the bathroom, then a CNA may do better. It really depends on the ER environment. I know my last job, my manager eliminated the CNAs and the nursing students. She interviewed EMTs, paramedics, LPNs, and medical assistants.

My current job has a variety of roles in the ER. We have PCTs, nurse externs, phlebotomists, and paramedics.

funtimes · Jul 27, 2013

If all the ER tech does is stocking and helping patients to the bathroom, then a CNA may do better.

What I disagree on is that an EMT Basic with no other training is going to be much better, regardless of field experience. An EMT's scope is so limited that they aren't going to have any experience with the type of things an ER tech would do that go beyond basic CNA stuff. Starting IVs and doing blood draws? An EMT has no more experience with either than a CNA. Starting a foley catheter? Nope. Doing 12 lead ECGs? Many EMTs can work in the field for years and never do one. Knowing what labs need to be drawn? Nope. Dressing changes? Nope. Managing multiple patients at once? Nope. An experienced inpatient PCT probably has experience with all of these things.

Yes I get that working the road as an EMT means you have to be quick thinking and make good decisions, but what decisions is an EMT Basic ER tech going to be making in an ER? The doctors and RNs will be making the decisions. It's nice to have someone who will take the initiative and not be told what to do, but that's expected of PCTs on the floors as well.

Aside from probably having more experience working a code(at the BLS level), the only real advantage I see for an experienced EMT(notice I'm not saying Paramedic), is maybe the EMT will be better acclimated to the culture of the ER(and even that depends on the particular ER). That and they'll have more war stories to tell during down time.

green34 · Jul 27, 2013

I have a few questions:

Do you work in an ER?

What is the scope of practice for EMTs in your state?

In all honesty, my state may be more forward in what they let EMTs do. They let them intubate in a code situation, give aerosol treatments, a few medications, and require them to know how to place 12 leads. I think there are a few more things they changed but it didn't really affect me as I am not a basic.

That simple training is one less thing that people need to cover with a CNA. A CNA here has no idea how to do 12-leads properly. They do not cover lead placement. They do not know what a laryngoscope is.

Also, the floor CNAs do not do 12 leads in any of the hospitals I've been in. We have EKG techs that do them during the day and respiratory covers at night and if respiratory is busy, it falls to the RN and not the CNA. The CNA would rarely do one ever whereas an EMT on an actual 911 ambulance can do them weekly or more depending on whether they are volunteer or not. Heck, we've had it where all 3 ambulances were on calls and our engine had to do 12 leads while we wait for an ambulance to come.

As for saying an EMT needs someone to tell them what to do, that is a misunderstanding of the protocol system. A good EMT knows how to make their protocols work for them. It's similar to how an RN is.

Initiative is a personal trait, not a skill. I am curious as to what kind of initiative that a CNA will have that an EMT will not when it comes to working in an ER. Please, elaborate. The only thing that comes to mind is stocking and helping a patient to the bathroom, which an EMT can easily do. Maybe a CNA will take the initiative to give the patient a bath while the patient is waiting to see the doctor? Seriously though, I am at a loss as to what initiative a CNA can have that an EMT does not.

I am very glad that the ERs are choosy with who they hire into the ERs.

funtimes · Jul 28, 2013

No I don't work in an ER. I've been an EMT for over 5 years and worked in two different states, so I've seen a lot of ERs.

The scope of EMTs in my state is pretty much the same as the NREMT standard, which is to say we cant do much. We definitely cant intubate under any circumstances, I think there's only like one state in the whole US that allows that. Where I work now we use Combi tubes, and we had king airways at my last job. We don't do neb treatments. I work on a BLS truck so we don't do 12 leads or have a monitor. Just an AED. We don't even carry a pulse ox on our Basic rigs. The only needles we are allowed to play with are for doing glucose checks, and I know some Basics aren't even allowed to do that. The company I work for staffs their ALS rigs with Paramedics and Specialists, no EMTs.

The hospital I used to work at used Paramedics as ER techs, and would occasionally have PCTs from the floor work in the ER if they were really swamped, they never had any EMTs working as techs. When I started working as a PCT on Med/Surg and ICU I had a big learning curve coming from working the road as an EMT, it was a lot bigger adjustment than I expected and I developed a lot of respect for the CNAs. The comment one person made that a CNA or PCT from the floors doesn't have the same experience with time management an EMT does just seemed hilarious to me. I started working as a PCT after a couple years as an EMT and I can tell you the time management skills required were on a whole different level from what I'd experienced as an EMT. I guess it varies, I worked at a hospital that was very demanding of its PCTs.

green34 · Jul 28, 2013

That's too bad that the EMTs are underused in your state. It is also sad that you can't do the same things. I am licensed in another state that is backwards (it could very well be the same state since you use the word specialist, something that they use). It is so annoying, but my former job loved the fact that I was licensed there. Pulse ox is kind of standard now too. As a basic truck, is it a truck that is involved in primary 911 or is it a private ambulance company?

If it were the same state, they weren't up to NREMT standards. I think they are making some changes to it though. Do you guys have county protocols and almost every county has a different drug box that looks like a tackle box or some crap like that? I never fully understand that state. Even as a paramedic, the drugs we had in my drug box on the fire department compared to their drug boxes is shocking. They barely carry anything.

I have respect for what CNAs do. I couldn't do it and I openly admit it. I tell pcts that I couldn't do what they do. However, the ER is a different ball game and I think where I live that PCTs are better prepared. Our CNAs is actually usually a 2 week class where most EMT classes is 3-4 months.

I think a better word for time management would be prioritization. In a serious situation, the CNA does not seem to have that same priority. They may develop it in time. The other day, we had three critical patients come in. It was me checking in, getting a 12-lead, and getting info for a patient while everyone else was involved in an intubation. Then I had to get IV access.

funtimes · Jul 28, 2013

Ultimately I guess it depends on what A particular ER expects out of their techs. That and what previous experience someone applying might have, regardless of what certs they have. I think some ERs use CNAs or PCTs from other units because they are a known quantity and they can verify if the person is a good employee in house, and it saves money not having to hire someone new. I've worked with CNAs that are better at handling a stressful situation than some EMTs I've worked with(and some RNs).

I know one ER that only uses CNAs as techs and they cant do a whole lot, and I have heard RNs complaining about how some of them seemed shocked when they have to deal with an actual emergency lol, so its not like I don't understand at all why some ERs prefer EMTs.

In this state CNAs have to pass a class that's at least 75 hours, and do something like 12 hours of clinicals, and pass a state written and practical exam and a background check. CNA requirements seem to vary more by state than EMT. EMT school used to be a minimum of 120 hours and I think they upped it to 160. Neither school is going to prepare someone for anything other than an entry level position that requires plenty of OJT.

I work as an EMT for a private that does IFTs and 911. They use a two tiered system here and Basics respond mainly to priority 3 calls, although we'll get a priority 1 or 2 from time to time if no ALS units are available or we're right near the scene. We don't have a pulse ox on our Basic trucks because the company is cheap and figure they'd continually get lost or broken(or stolen). At least thats the excuse they use. I personally keep my own on the truck I work.

green34 · Jul 30, 2013

Our STNAs take a class that is at least 75 hours per our state rules. They can cram it into 2 weeks though.

It sounds very similar to one of the states I am a medic in.

cauru · Oct 7, 2013

I have a few questions:
Also, the floor CNAs do not do 12 leads in any of the hospitals I've been in. We have EKG techs that do them during the day and respiratory covers at night and if respiratory is busy, it falls to the RN and not the CNA. The CNA would rarely do one ever whereas an EMT on an actual 911 ambulance can do them weekly or more depending on whether they are volunteer or not. Heck, we've had it where all 3 ambulances were on calls and our engine had to do 12 leads while we wait for an ambulance to come.

The CNA's on the floors at my hospital do 12 lead EKG's and draw blood. We frequently get floated to the ED if the census is low or if the ED is slammed. The first time I got floated it was a little scary because I wasn't acclimated to the environment, but in general I find it easier then the floors. Lots of blood cultures and ekgs, way less patient care stuff. The ED techs have always been really good to work with.

studentnursemon86 · Oct 10, 2013

The CNA's on the floors at my hospital do 12 lead EKG's and draw blood. We frequently get floated to the ED if the census is low or if the ED is slammed. The first time I got floated it was a little scary because I wasn't acclimated to the environment but in general I find it easier then the floors. Lots of blood cultures and ekgs, way less patient care stuff. The ED techs have always been really good to work with.[/quote']
I am currently a Tech in the ER. All the techs in my hospital do EKGs and phlebotomy. In the ER we also do urine dips and urine pregnancy tests, as well as venous blood gas tests. We can also do simple dressing changes and assist doctors with procedures like LPs and pelvic exams. The ER techs have extra training beyond that of the floor techs or CNAs.
I'm applying to nursing school so all of this is a great learning experience.