Most of the time, emergency departments are much calmer places than the medical shows on TV would have you believe. But when an ambulance pulls up with a critically ill or injured patient, the excitement can quickly outdo anything you’d see on the small screen.
RTs who work in this fast paced setting love the dynamic nature of the care delivered there and will tell you it’s their favorite place in the hospital.
Physicians Rely On Their Expertise
“I am a coordinator, but when I staff, which is four days a month, I prefer to be in the ER,” says AARC member John Olsson, RRT-ACCS. His hospital is a level 1 trauma center and sees a lot of blunt trauma in the ED. RTs are involved in every trauma that comes in the door, assessing the airway and running VBGs and ABGs, and they also provide education to all respiratory compromised patients.
“We are often the first to see patients that require our services. The physicians rely on our expertise when it comes to airways, vents, bipaps, and nebulizer treatments,” says Olsson. He emphasizes it’s not a place for therapists who aren’t well trained or confident in their skills.
“I like to work down there because I get to use my assessment skills, the physicians respect me, and the RNs trust me to do the right things.”
Real Life Drama
Steven Klyce, RRT-NPS, has been in the profession for 42 years, and while he’s currently on assignment in an adult facility, he’s spent considerable time in pediatric EDs, including one at a large urban facility associated with a medical school where he says, “You would have to tax your imagination to come up with a scenario we did not see or deal with.”
Routine RT duties ran the gamut from basic nebulization and MDI/DPI therapy to respiratory assessments and patient/family education. Therapists responded to all trauma and code arrivals and assisted in airway management, intubation, ventilation, noninvasive modalities, monitoring, and in-house transports.
“God bless the EMS crews that are first responders and ‘package’ the patients to travel to the ED bay doors,” says the AARC member. “But once they arrive, they’re ours to take over while a highly trained, coordinated team launches into motivated action like a ballet, with real life and death drama that TV producers have never been able to adequately portray.”
Working under these circumstances, he continues, takes “lightening judgment, critical cooperation, keen observation, and a humility to stand aside and ask for advice.”
Protocols Improve Flow of Care
AARC member Laura Hastings, RRT, spends about 60-70% of her shifts working in the ED and agrees it’s a place where fast thinking is paramount. “My advice to RTs who would like to work in this setting would be to plan ahead for every situation. Plan for the worst and hope for the best.” She reviews all supplies at the beginning of her shift — even those that may be the responsibility of another department to stock. “If it is something that I may need to use in a code, I want to know I have it available at a moment’s notice.”
ED RTs at her hospital manage airways during CPR, seizures, or difficult airways, and they also check equipment to ensure it is functioning properly. Therapists utilize protocol driven care to manage bronchiolitis, asthma, and croup.
“The MDs have begun to rely on our input to improve patient care and speed the LOS in the ED,” says Hastings. “Our protocols have allowed the flow of care to improve and RNs will often request our input in patient care for patients with complex issues.”
Expect The Unexpected
As a clinical lead specialist at his pediatric hospital, Michael Treut, RRT-NPS, AE-C, spends about 90% of his time working in the ED and says the RT’s role is extremely valuable. “We staff RTs 24 hours a day and at least two during peak times — 11 a.m.-11 p.m.,” says the AARC member. ”Many of our protocols and pathways, such as Asthma or Croup/Stridor, are time sensitive, and having respiratory present in the ED allows us to meet our time goals and improve our standard of care.”
Treut thrives on the unpredictability of the work environment. “What I enjoy most about working in the emergency department would have to be working with different patient populations and scenarios each and every day,” he says. “Rarely is your day planned out or on a set schedule.”
His advice for other therapists who would like to give the ED a try: “Keep an open mind, expect the unexpected, and don’t be afraid to step out of your comfort zone — always look for the opportunity to learn something new!”
