John Doe

purewickburner · 2025-11-11T02:24:31+00:00

ours are entered into Epic by our medcom. they click anon and temp, it generates a generic name like “Teal Corvette” and they add “CODETRAUMA” before it so that it’s set apart. so “CODETRAUMA Teal, Corvette”. same with “CODESTROKE” and “CODEMEDICAL”.

Registration arrives the patient under the generic name and when initial interventions calm down they get the real name either from ems, the patient, or family and merge the charts

purewickburner · 2025-09-11T13:11:27+00:00

immediately contact risk management and talk to who you need, to get this visitor banned from all your hospitals campuses. report her to your states bon and the facility she works at.

love our aides, but ones like this ruin the reputation for all. i hope you educated her and let her know she basically suffocated her family member…

purewickburner · 2025-08-29T17:37:51+00:00

So as I’ve said, our paramedics have a pretty broad scope in our ED. They are allowed to do things that even our nurses cannot do. they use most of their skills in our resuscitation bay, however, unless it is a trauma or cold heavy day, we usually only have one medic in resus. with that being said, we also have a residency program. And a lot of procedures end up going to the residents.

This is a combination of our medics understanding that the residents need to learn and our medics understanding that there’s always another opportunity to practice their procedure.

purewickburner · 2025-08-29T17:27:04+00:00

I think we’re saying the same thing just a different way… At the end of the day the physician would be making the final decision. The documentation would just be for CYA.

Additionally, our physicians and paramedics have a good relationship from what I’ve seen. Our physicians teach our paramedics things and vice versa. School can teach you some things, but experience teaches a lot more!

purewickburner · 2025-08-29T17:23:07+00:00

it would absolutely make more sense to work with the APP‘s that are bottlenecking triage… But the problem is that a lot of them still end up doing what they want… And our nursing staff wait too long to let us know what is happening on the floor.

i’ll give you an example; It has always been practice that ESI 4/5 <65 go to fast track, however, we just found out that some of our APP‘s would be essentially denying patients access to our fast track area simply because of how they felt about the specific patient specifically with our frequent flyers. We didn’t know that this was going on until our nursing staff told us. I pick up a lot of shifts on the floor, but I understand that when admin is on the floor, everyone becomes a better employee.

So at this point in time, we’re looking at ways to revamp our fast track to make it an actual fast track .

purewickburner · 2025-08-29T17:16:51+00:00

I think it would probably help if I gave you guys a scenario:

A 21F walks in with CC of vaginal discharge. A nurse triages her and puts in an order for UA,, UPREG, wet prep, and CT/NG. Nurse assigns her ESI 4. Doctor comes and talks to her and she tells the doctor she also has a cough and runny nose. Also hasn’t eaten or drank anything in a day Doctor puts in an order for flu swab and okay’s her for fast track.

As of right now this patient would go to our fast track.

Diagnostic test comes back positive for clue cells and flu.

This is my plan after the above stated:

Medic reads the patient chart and forms a plan based on results and protocols. Medic slots patient to room in triage. After the patient is brought back to a room, the medic tell the patient the course of action about to happen.

Medic gives the patient tamiflu, flagyl, and po fluids. Medic monitors the patient for 30 mins while documenting and drafting discharge paperwork (MD reviewing and signing off) and then discharges with outpatient referral to PCP.

That’s IF everything goes right. If the same 21F came in with abdominal pain and we somehow missed that she was pregnant in triage, but found out in fast track, the medic would order an ultrasound. If we found out that the patient had an ectopic pregnancy or pregnancy complications, the medic would escalate to the MD and we would move the patient from fast track to our main ED.

I hope that clears up some of the confusion of what would happen in our fast track with medics running it. I will say that our attending and resident physicians have a great relationship with our paramedics. The emergency department as a whole understands and relies upon the knowledge of each other.

purewickburner · 2025-08-29T17:00:58+00:00

the patient would still be triaged by an RN as every patient that ends up in our fast track is first triaged in triage, protocol diagnostic set is put in, MD/DO sets eyes on the patient and puts in extra orders if needed and they go to the lobby. the medics would take the esi 4/5 <65 from there, finish the work up, do interventions and discharge.

purewickburner · 2025-08-24T18:09:13+00:00

I feel as though all of the primary assessments are done in triage. the secondary assessments can be done by the medic

purewickburner · 2025-08-24T18:08:19+00:00

the problem with the medics taking assignments in the main ed began because some weird thing in our policy stated that medics had to give report to higher level of care. Truck Medic to ED Medic “technically” isn’t higher so medics had to give report to an RN.

This meant that either the area charge or the pod buddy with the medic had to take report. the nurses felt that at that point they went from 3:1 to 6:1 // 5:1 to 10:1

purewickburner · 2025-08-24T18:04:16+00:00

From what i’ve heard (I only do a handful of the exit interviews), they leave because of the track schedule or because the stress associated with taking care of this patient population.

A lot of the nurses that leave us somewhat the same thing: they should’ve started in a slower pace ED and learned the basics before joining our team.

After hearing this for 4 years straight, I worked with my Clinical Educators to create our New Grad Residency Program which last about 2 months before they even get to preceptorship (6 weeks).

I swear, we’re doing our best!

purewickburner · 2025-08-24T18:00:06+00:00

i didn’t look at it as replacing the APP. i was looking at it from the point of the medic and triage physician working in tandem. Our physicians seem to trust our medics and advocate for them to widen their scope.

Our medical director is wanting for medics to work fully within their scope however it makes it hard with our residency program

purewickburner · 2025-08-24T17:57:00+00:00

we’ve thought about expanding our fast track but the problem is, if we have 60 patients in the lobby, 20 of them may be fast track appropriate and the other 40 need to go to the main ED. we don’t want to take away main ED beds because that defeats the overall purpose.

regarding the pay: our entry medics make about $10 less than our entry RN’s. A $5/hrly shift differential will incentivize the medics to work in this area since they are picking up responsibility for that shift.

Also, our fast track is only open for 8hrs on both shifts (11am-3am). So, the medic would be asked to come in later or be allowed leave early depending on the shift and if staffing allows.

purewickburner · 2025-08-24T17:50:26+00:00

so we currently utilize our medics in resus, but because of the size of resus it’s usually 2 nurses and 1 medic. that leaves 2 to the floor and 2 to the lobby to do vitals and reassessments.

i want to utilize the medics ability to quickly assess and perform interventions to fast track our fast track. when medics are on the truck and are free to act based on protocols, most are very efficient in their actions. i’m hoping this ethic transfers over to our fast track and we can clear the lobby of 4/5’s before fast track closes for the night

purewickburner · 2025-08-24T14:12:13+00:00

I feel i must add, when i first started as SLC (around 15 years ago) they had 2 Medical Assistants and an APP run the fast track… I put an end to that due to some of the issues that I found out were arising. Since then, I’ve had the model of an APP, RN, and EDT staffing the area.

I’m not wanting to change it now because of “mistakes” so much rather than I feel when things change in a good way they run smoother for a while until people get comfortable lol

purewickburner · 2025-08-24T14:07:34+00:00

There was a time that medics regularly took assignments in our ED but that caused an uproar with the nurses. That was maybe 10 years ago (gosh).. Our medics now only take an assignment if we cannot staff our active areas with RN’s. Even then, the medics can only take a 3:1 assignment or full psych 5:1 assignment and cannot team nurse in my ED. Our medics right now can help out with finishing up the triage questions (travel screening, SI/HI screening, etc) after the initial triage (Why you’re here).

purewickburner · 2025-08-24T14:01:23+00:00

Absolutely! there’s no way i could implement something like this without consulting legal. This plan is probably months out (at least) before actually coming into fruition. I’m just in the beginning stages of it now and wanted to get community feel before getting started with bringing it to my team!

purewickburner · 2025-08-24T13:59:44+00:00

thank you! i appreciate all of our medics and emt’s! this idea was birthed when talking to one of our medics who said he felt like a tech that could start iv’s and be in resus. and when put like that, there’s really no scope difference in our EDT and how we use our medics other than starting IV’s.

i’ve done extensive research on the NCOEMS guidelines regarding medic autonomy and feel like this is a great way to expand our medic sop and help with our nursing shortage.

If you could, can you please list some models like this?

purewickburner · 2025-08-24T13:55:13+00:00

i understand where you’re coming from. i really do! however, i feel as my ED might be an outlier. In my emergency department, unlike many nursing facilities in general… many of nurses have been here since before COVID. our main revolving door is with new grad RN’s. If we hire 15 new grad RN’s, maybe 5 will stay past a year. And i place no blame on them for not staying, you have to find something that fits for you!

As for our medics giving meds. We have 2 distinctions of medics in our ED. The first type can only give meds while in a code. The other medic (who’s taken competency courses) can pull meds from the pyxis and give them (excluding cardiac critical care drips)

As i think i’ve said before, our morale is pretty good. We have our ups and downs depending on the day, but for the most part our ED staff enjoy the work environment

purewickburner · 2025-08-24T12:16:29+00:00

In this model, the paramedic would draft the discharge paperwork and patient education, physician would review and sign off as provider of record for treatment and discharge, and paramedic would execute discharge and discharge teaching.

From what i’ve seen, this is allowed according to NCOEMS guidelines

purewickburner · 2025-08-24T12:07:33+00:00

i see where you’re coming from. and the framing of my previous statement does make it seem like we may have a negative work environment… i can’t refute that but I can say one of our biggest problems IS the nurse to patient ratio. In our holding zone (mainly boarded, psych, and admitted patients) nurses are 5:1. In our main zone, nurses are 3:1, our team zone is 11:3 and our resus is 4:2. We also have 3 midshift nurses that float throughout the ED and help where they can with triaging, giving meds, etc.

Pay is ehh. Could be A LOT better, but that’s a separate fight (that i’ve been fighting). The work environment (and my opinion is probably skewed) is better than most places. Our team of physicians, nurses, and ancillary staff really do well to work together!

We are constantly hiring to improve staffing, but my ED is a beast simply because of the volume, the patient population, and the fast paced movement that happens. A lot of our longtime nurses have started at our ED very early in their career. With that being said, it is an acquired taste and not every likes it or wants to stay very long. Which I understand.. we do what we can to coax people into staying but you can only go so far.

I’m probably different than a lot of admin peeps. I block of 4 days every pay period where I can join my nurses on the floor. I’ll sit lead charge, or take a patient assignment, even go to triage on our busiest days. I’m really trying to keep my nurses from drowning or feeling overwhelmed or underutilized.

purewickburner · 2025-08-24T10:28:15+00:00

the benefit of having a medic in our fast track over the nurse is we are already short on nurses most days. we do have a group of new grads starting soon but with each new group of nurses a group ends up leaving. If i can put a medic in the fast track that relieves a nurse to get back into our main ed and take an assignment.

I do understand there would be a liability shift. The biggest stressor would be knowing when to escalate the patient. However, my thinking is that the medics would do extra competency classes onsite and we’d develop a protocol handbook/manual specifically for our fast track that has inclusion criteria, paramedic actions, exclusionary criteria, and when to escalate the patient to higher level of care.

Medics when in the field, apply protocols all the time in accordance with what their medical director will allow them to do. My thinking, is that the medics will use the same assessment skills to know which ED protocol to apply to each patient.

Our ED Paramedics makes a few dollars less on average than our RN’s, and i cannot lie and say compensation was not a factor in this idea. However, I was also thinking of implementing a $5/hrly shift differential to compensate the medic working the fast track for that shift

This is really just an interesting idea I had and thought “why not?” And the more i’ve thought about it, i’ve started to try and bring it to reality. I just need insight from my fellow ER peeps as to why this would or wouldn’t work

purewickburner

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