Question about Emergency Techs

SpnshEyes1975 · May 15, 2004

I am an ER Tech, and have worked in two different ER's. In both of them, the nurses had to do the initial triage, however, when I worked at one of them, they had one of us techs in there helping get vital's while the nurse interviewed the patient/family. In the one I work at now, the nurse is in the triage by herself because 9 times out of 10 there is only one or two techs in the back. We do blood draws, EKG's, splints, transports, and we respond to all the codes for CPR, as well as helping with IV's and such when the nurses need. Depending on how busy the nurse is, and what kind of things are ordered, it is possible that you do see the tech more than the nurse, at least in my experience.

Trauma Columnist · May 15, 2004

The ENA advocates RNs at triage at all times. In our level one ER - we have two RNs and one EMT-P (paramedic) who combine to do all the triaging. However, you are always greeted by an RN who gives you the "across the room assessment" that is so vital. ER techs (in my hospital) are EMT-Bs and they do a wonderful job.

PA-C in Texas · May 20, 2004

The board recently implemented a new position in our hospital policies called Paramedic Clinical Specialist. They recently hired two LP's (licensed paramedics, which requires an Associate's Degree or higher) to provide care for patients in consultation with the attending physician.

The rationale provided was that these individuals are qualified to provide an independent physical exam to compliment that of the attending physician/PA/NP and initiate an extensive range of invasive treatments on direct physician consultation as well as under standing orders if the need arises.

I am really thrilled about this because I don't have to perform all of the advanced procedures every time a critical patient comes in. I can start a femoral while the Paramedic intubates (or vice versa).

I wasn't sure how it would work at first, but we had a CP patient come in last week and I happened to be getting dinner in the cafeteria. By the time I had gotten back, the LP had already viewed the ECG and given nitro, ASA, MSO4 and metoprolol, AND pre-screened for thrombolytics. Its what they do in the field all the time.

These people are far too educated to be doing blood draws and changing bed pans.

maryrosern · May 20, 2004

Our Triage is done by RNs with assistance from tech doing things such as taking vitals and placing patients in rooms assigned by RNs. Most of our Techs are EMTs, and do basics like moving patients, drawing labs, putting patients on the monitor. We reserve the decision making for the RNs. :uhoh21:

EMT/MEDIC · Jun 7, 2004

:angryfire

EMTs are not the masters of triage. Triage is taught by MDs and RNs in NY and most other states. There is a difference between triage in the field and triage in a clinical setting. I have taught and done both. Seen it from almost all sides. I have worked as an EMT, Paramedic, Army 91C and RN.

Sorry jailhouse RN but you are wrong there, EMTs are the masters of of triage not RNs or MDs in most cases, Dont get me wrong though I know alot of super RNs that can work in the field, but alot can't or will not and most of the MDs are to slow to handel on site MVA or GSW calls because the forget how to. Around here in the ER paramedics and EMTs do the triage because we can and do know how to. As a paramedic I handel IVs and cover almost all of the same duties (within my scope) as the RNs.., RNs and LPNs are great but don't down play the efforts or skills of others, because without them you will change the bed pans and make the ambulance runs buy yourself........

Medic946RN · Jun 7, 2004

:angryfire
Sorry jailhouse RN but you are wrong there, EMTs are the masters of of triage not RNs or MDs in most cases, Dont get me wrong though I know alot of super RNs that can work in the field, but alot can't or will not and most of the MDs are to slow to handel on site MVA or GSW calls because the forget how to. Around here in the ER paramedics and EMTs do the triage because we can and do know how to. As a paramedic I handel IVs and cover almost all of the same duties (within my scope) as the RNs.., RNs and LPNs are great but don't down play the efforts or skills of others, because without them you will change the bed pans and make the ambulance runs buy yourself........

Not to cause a "measuring contest" to erupt here. But as an EMT and Paramedic for the last 25 years, I can say that EMT's are NOT the masters of triage, at least in the sense of ED triage which is an entirely differently animal from MCI traige that we as Emergency Medical Providers practice.

It semantics, you are still sorting, but the people we would classify as one thing in the field are going to be something else when presenting to the ED.

And no I haven't forgotten where I came from. I still work a single provider paramedic unit part time and love every minute of it.

Good luck with school and stay safe out there!

redheadindixie · Jun 7, 2004

Not to cause a "measuring contest" to erupt here. But as an EMT and Paramedic for the last 25 years, I can say that EMT's are NOT the masters of triage, at least in the sense of ED triage which is an entirely differently animal from MCI traige that we as Emergency Medical Providers practice.
It semantics, you are still sorting, but the people we would classify as one thing in the field are going to be something else when presenting to the ED.
And no I haven't forgotten where I came from. I still work a single provider paramedic unit part time and love every minute of it.
Good luck with school and stay safe out there!

I agree with the above.

I am an RN who has worked triage for years, and am also a Paramedic.

It is a different kind of triage.

And I think you become a master at ER triage, by working the triage area.

At our hospital only RN's can triage. But we do use triage assistants to do vital signs and assist. Sometimes it is a Paramedic, but most often an ER tech, trained on the job.

veetach · Jun 7, 2004

:angryfire
Sorry jailhouse RN but you are wrong there, EMTs are the masters of of triage not RNs or MDs in most cases, Dont get me wrong though I know alot of super RNs that can work in the field, but alot can't or will not and most of the MDs are to slow to handel on site MVA or GSW calls because the forget how to. Around here in the ER paramedics and EMTs do the triage because we can and do know how to. As a paramedic I handel IVs and cover almost all of the same duties (within my scope) as the RNs.., RNs and LPNs are great but don't down play the efforts or skills of others, because without them you will change the bed pans and make the ambulance runs buy yourself........

maybe we are battling semantics here. "Triage" as referred to by this RN means being triaged into the emergency department. This MUST be done by an RN. Its the law. No way to get around it, even if the hospital doesnt want to, it has to if it wants any type of federal reimbursements for services rendered. As I stated before, EMTALA requires it.

As far as EMT's being "masters of triage", I had a 3 man BLS crew (all EMT's) call in for a release on a patient just last week. 46 yr old man with sudden onset of SOB, resolved on arrival EMS. PMH shoulder surgery 3 weeks prior, satting 90% on room air. The med commander said "Uh...NO!" call a paramedic and transport the pt immediately..(the crew arrived miffed and very PO'd) The guy ended up with bilateral PE's and went to ICU. :rolleyes: I am not in any way bashing EMT's but there is something to be said for my RN degree, and after 10 years of experience (8 of those in the ED) I feel like I am a bit more qualified than any EMT that crosses my path. just My opinion..... :)

Medic946RN · Jun 7, 2004

As far as EMT's being "masters of triage", I had a 3 man BLS crew (all EMT's) call in for a release on a patient just last week. 46 yr old man with sudden onset of SOB, resolved on arrival EMS. PMH shoulder surgery 3 weeks prior, satting 90% on room air. The med commander said "Uh...NO!" call a paramedic and transport the pt immediately..(the crew arrived miffed and very PO'd) The guy ended up with bilateral PE's and went to ICU. I am not in any way bashing EMT's but there is something to be said for my RN degree, and after 10 years of experience (8 of those in the ED) I feel like I am a bit more qualified than any EMT that crosses my path. just My opinion..... :)

I didn't want to go there, but yes, there is great difference in education (and a heck of lot to be said for experience) and training and type of pt contacts between EMT, Paramedic, LPN, RN, NP, PA, MD etc. I was one of those Paramedics who thought nursing school was going to be a breeze, and in someways I was ahead of the pack, I could out assess everyone in my class, cause I had done it for 20 years. But what was I assessing, I was finding out in true EMS fashion if my pt had anything was going to kill him in the next few seconds. There was an entirely different depth of assessment I had to learn for becoming an RN. I'll be the first to admit it. I also had a great leap of insight when I went from EMT to EMT-Cardiac to Paramedic. I've had plenty of calls where the EMT's were cancelling me on scene, thank god I could see the pt through the back windows of the ambulance. And I;ve had plenty of pt's with no emergent condition that I was called in to "check out."

This is not a slam. It has to do with knowledge. It doesn't mean you're dumb.

It means you have different or limited perspective. In the ED there are pts I diagnose dead-on and then there are some where I go to the MD and ask why he's ordering all the meds and tests. The docs I work with are great and they'll explain to you what they are thinking and what they are treating. And there is the occasional time when I spot something the doc missed. It's called collaboration and when it works right everyone benefits, most of all the pt because he's got so many different perspectives observing his case.

Bottom line, EMT is the entry level to emergency medicine, doesn't mean there's anything wrong with being one.

veetach · Jun 8, 2004

VERY good reply Medic946. I totally agree. I do not mean any offense to EMT's, my husband, the paramedic, has a button that reads "Paramedics save lives, EMTs save paramedics". It really is a collaborative effort, and I am the first RN in my ED to stand up for all EMS crews. As RN's we have to take a different mindset and that critical thinking is more important than we would have ever imagined in nursing school.

I applaud each and everyone who works pre-hospital. For without you, my job would be much much more difficult. And our patients would sometimes not have a chance for survival. :)

hogan4736, BSN, RN · Jun 8, 2004

...And I think you become a master at ER triage, by working the triage area...

It's as simple as that...I worked (as a tech) alongside an RN for a year in an urban ER (in triage) (while I was a 4th and 5th semester nursing student) as a member of the dedicated "triage team"

I actually got to the point where the RNs allowed me to triage alone (relax VT, I had an RN cosign )

I became as good as them...

Experience is the best teacher...

sean

veetach · Jun 8, 2004

It's as simple as that...I worked (as a tech) alongside an RN for a year in an urban ER (in triage) (while I was a 4th and 5th semester nursing student) as a member of the dedicated "triage team"
I actually got to the point where the RNs allowed me to triage alone (relax VT, I had an RN cosign )
I became as good as them...
Experience is the best teacher...
sean

no reason for me to "relax". we used to let our ED techs triage also. With an RN cosign of course. What I am saying is that now, there are certain requirements that EMTALA and JCAHO has set forth and one of those involves having a patient triaged by an RN first. (As a matter of fact we have some ED techs whom I would trust to triage alone now, I would have no problem signing for them, if we were able to still)

In my opinion, EMT's are not the "masters of triage". Simple as that. :)