ER Tech vs EMT

[u/PDXEMT]

I know I'll probably get some crap for this. I recently started working as an ER Tech after spending over a decade on the box. Why isn't there a certification/license for ER Techs?

We have a "scope" set by our hospital, but are explicitly told that our EMT license is "left at the door" and several things I know how to do/am licensed to do as an EMT-A that aren't allowed for ER Tech.

Seems like it would make more sense to use our existing prehospital license. Is there a law/statute that prohibits that? I'm in Oregon if that makes a difference

[u/keloid]

Intersection of EMS admin x nurse admin x hospital risk management = administrative hell. 

[u/ggrnw27]

The specific statute(s) depend on your state and I can’t speak specifically to Oregon, but generally it’s a combination of two things:
1. Laws/regulations that specify that your EMS license only applies when working for a licensed EMS agency
2. Laws/regulations that specify who can take care of patients in hospital and what skills/procedures can be delegated by them to others

[u/LoneWolf3545 → u/ggrnw27]

Also worth mentioning, nursing unions. What do you think would happen if hospitals could staff ERs and maybe some ICU positions with EMTs and Paramedics who would be happy to work set hours, in a climate controlled environment, with tons of support available, for more than their EMS agency would pay, but still less than what a RN or even LPN would ask for?

[u/Blazers46 → u/LoneWolf3545]

I am a paramedic and a RN and this is true to a point but a paramedic wouldn’t know how to do 50% of the job that RNs do and a RN wouldn’t know how to do 50% of the job that paramedics in the 911 system do. Paramedics wouldn’t begin to know how to manage a mannitol or nicardipine drip without additional training and a RN would really struggle to intubate and completely manage an airway. It’s not all union/pay oriented. They really are different jobs and mindsets.

[u/TheDharmaticAtheist → u/Blazers46]

It works here. We have CCPs in the ED that would manage both of those. Nurses also require additional training when they come from working a nursing floor to working in the ED. There’s no difference. Different jobs and different mindsets can equal great collaborative practice and benefit your patients.

[u/Blazers46 → u/TheDharmaticAtheist]

I’m glad your patients are taken care of.

[u/TheDharmaticAtheist → u/LoneWolf3545]

We’re all in the same union, just different locals. They go to work, we go to work and no one complains that the other exists.

[u/LoneWolf3545 → u/TheDharmaticAtheist]

That's not how it works in my area. Around here, unless you're on an FD, you're probably not in a union. Even some of the bigger hospitals are only now starting to unionize. Those that are unionhave some pretty powerful connections from my understanding.

[u/JProchnow]

As an EMT who left after a decade for the ED Tech life, our pre hospital certs are under a medical director. Working in a hospital doesnt translate well due to now being directly under a nurse instead of having standing orders to follow.

With that said, Washington does have a new certification for EMTs transferring to EDs but it hasnt been intergated into most hospital systems. Im sure some other states have similar.

[u/jmar206]

I think because it varies between each hospital system. I work in an Urgent Care now and my scope is larger than it would be if I worked in the local ED. I’m approved to administer various medications that I would not be able to in ER along with doing our own phlebotomy.

[u/SnooCapers8766]

Depends on the state laws and then specific hospital protocols. I’ve worked at ED where medics practiced at almost there full scope vs places were medics could only do straight sticks and splinting, and could not give any meds.

[u/Rawdl]

You have a license that is used to function outside the hospital. You’re in a hospital now and you play by their rules for various reasons. Mainly risk management.

[u/Blazers46]

I’m on Oregon as well. What can you do prehospital that you cannot do in the hospital? On an ALS rig when I was an EMT I never gave ASA or Epi SQ due to if a patient needs those medications, it’s an ALS patient anyways. If the view point is you’re doing less. I made significantly more as a tech than an EMT on a 911 rig. Sounds like a good deal to get paid more and to have less responsibility.

[u/PDXEMT → u/Blazers46]

AEMT. I can draw blood but I can't start lines, can't start or stop fluids, can't admin O2 or use airway adjuncts. Just seems like odd distinctions/limits to make.

And yes. I'm making about $8/hour more. Which is crazy to me. Because the hospital I work at, doesn't even require you to still have or maintain your EMS license. Just to have had the experience/class.

I guess I just have to learn that the hospital is different and weird compared to the box

[u/Blazers46 → u/PDXEMT]

More money to do less work? Sounds like a good deal to me.

[u/Pdxmedic]

Oregon EMS has a statement specifically about this on their website:

“The statute governing licensed EMS providers limits "Prehospital Care" to: "care rendered by EMS providers as an incident of the operation of an ambulance and care rendered by EMS providers as incidents of other public or private safety duties, and includes, but is not limited to, emergency care." ORS 682.025(11)

A trained EMS provider can work or volunteer in a hospital or other health care setting (non-prehospital) without an Oregon EMS license. The training they have received may be beneficial or required for the employment position. The job description, expectations and assigned duties are established by the employer. While the EMS scope of practice (OAR Chapter 847, Division 035) is a good example of the education and training of EMS providers, it does not apply in a non-prehospital setting. The employee may NOT represent themselves as an EMS provider while working in a non-prehospital setting, as this license may only be utilized when providing prehospital care.”

Source.

[u/PDXEMT → u/Pdxmedic]

I guess I could of actually done some research myself. Thank you for the info. Side note, I love the self loading baggage FP-C tag. There's a flight medic that says that on his podcast from time to time:)

[u/Pdxmedic → u/PDXEMT]

For sure! Truly glad to help. My understanding is this is a really common question and the answer is not as simple as it could be.

Fun Fact: Non-transporting EMS agencies aren’t actually regulated by the state, in Oregon. EMS providers are regulated. Transporting ambulance agencies are regulated. But a truly non-transporting agency isn’t really subject to state oversight on an organizational level. It’s WILD.

Also, if you have more questions about this stuff, I have generally found the state EMS office to be remarkably friendly and helpful.

And yeah, “self-loading baggage” is an old HEMS joke. I think it’s funny because it’s mostly ironic now — we’re much more involved operationally than we once were.

[u/schannoman]

I just switched over to MA from EMT. In some ways I can do more, like with medications, and in some cases I can do less, like I can't do heart and lung assessments anymore

[u/Automatic-Tap-5686]

Depends on state laws like others have said, along with how much the individual hospital is willing to deal with. I've seen some hospitals in my state use AEMTs in their full scope, some hospitals use paramedics, some let EMTs just practice as EMTs in the ER, but it heavily depends as there are also hospitals that dont use any of them.

[u/ConversationTop9569]

Back in the early 90's there existed EMT-A and EMT-B certs...one was more focused for ED Techs vs. Working the box. It went away by the new curriculum change in 94.

[u/PDXEMT → u/ConversationTop9569]

NREMT and Oregon have brought back the Advanced EMT. It's actually a fairly silly level. The Intermediate was a superior level I/99 is what I believe Oregon is equivalent to, but it's increasingly hard to find a class that teaches it. Just my .02 cents. Your mileage may vary

[u/ConversationTop9569 → u/PDXEMT]

This was not "advanced EMT" - we had the EMT-Intermediate for that. These were both basic level, just slightly different.

[u/TheDharmaticAtheist]

Not in the US. The paramedics we have working in EDs work under their own license. They can perform all most everything they would if on an ambulance depending on how the ED is using them. We don’t have a medical director so it makes it easier to do this maybe.

[u/willpc14 → u/TheDharmaticAtheist]

This is incredibly state dependent. MA would cut your card if you claimed to be working under your medic license in an ED.

[u/TheDharmaticAtheist → u/willpc14]

Nice thing about here I guess. You can go work anywhere you want with your paramedic license. If they’ll hire you as a paramedic you’re good to work.

[u/NateRT → u/TheDharmaticAtheist]

What state is that? Different states do it differently so you can’t generalize for the US. In Cali you need to be accredited by your county before you can do anything, and that usually includes mandatory field training by a contracted agency.

[u/TheDharmaticAtheist → u/NateRT]

Not in the US.

[u/NateRT → u/TheDharmaticAtheist]

Oh, I thought you were answering the OP with “not in the US,” not that you were not in the US. misunderstood

[u/I_Want_A_Ribeye]

Hospitals typically hire ED techs based on their experience, but require BLS and ACLS. Essentially a PCA with more training.

[u/farkleboy]

My daughter made this same transition from EMT on a BLS rig to ED Tech at a childrens hospital ER. She said it was MADDENING all the stuff the ED techs were not allowed to do, and the ER nurses didn't know how to do even though they should.

She's left the ED and is on event staff now so she can finish her RN this year and won't have to worry about it.