What Do You Think?

Readers answered the following two questions from the April issue: 1. Paramedic Use I’m interested to know if cath labs are utilizing paramedics. If so, what duties are they allowed to perform? I’m particularly interested in knowing if any cath lab in Missouri currently uses paramedics. Dona Hoffman, RN, CCL Coord St. Mary’s Health Center, St. Louis, MO Email: Dona_Hoffman@ssmhc.com Cc: CathLabDigest@aol.com Recommendations for training paramedics Due to the shortages of technologists (RTs and RCISs), four EMT-Ps have been hired into our cath lab system here at Emory. All have worked out well. Two are ACLS instructors. One is a co-author of the top-selling text on ECG interpretation. None have ever seen a cath lab prior to arriving on the scene. With excellent preceptorships, each has become an asset to our intense medical-technical environment. My recommendations are: (1) Provide cardiac angiography anatomy review classes for the first 3-4 weeks; (2) Provide excellent classes on all the medications used in ultramodern cath labs especially if they are trained to circulate. All of our team members are trained in conscious sedation; (3) Provide hands-on classes with simulators; when they are trained to use cardiac-hemodynamic monitor systems. My suggestion is to have clinical specialists from the manufacturers do the hands on tasks before they are introduced to the actual settings of patient care; (4) Provide classes to them on cardiac calculations such as EFs; Fick cardiac outputs and thermodilution cardiac outputs; stenotic valve areas; and vascular resistances; (5) Encourage them to take their RCIS examination with CCI within the appropriate time frames. (6) One other suggestion is to provide classes on sterile technique during the first few weeks of employment. If you have any other questions, please do not hesitate to contact me. Chuck Williams, RPA(G), RT(R)(CV),RCIS,CPFT, CCT Cardiac Cath Lab Emory University Hospital Atlanta, GA cowrpa@yahoo.com Past paramedic shares his experience Your request regarding information about paramedic use in the cath lab is of great interest to me, as I started in the cath lab in 1994, after leaving a career as a paramedic for 15 years. I worked at Morton Plant Hospital in Clearwater, Florida. The lab there did, and still does, train team members with critical care experience (from RNs, LPNs, RTs, Rad Techs and paramedics) on the job. I began my career circulating. The medical director allows any tech to circulate as long as they have ACLS, and pass a clinical competency in pharmacology and conscious sedation. I then learned to record and then scrub. I took and passed the RCIS exam three years after I began working in the lab. I received my MBA and was promoted to Clinical Coordinator after six years. I had worked my way through the tech ranks of Tech I, II, and III. Eighteen months ago, I was promoted to Manager of Cardiology Services for two of our four hospitals. I am not tooting my horn here; I feel that giving you some history of my own career in the cath lab will show that yes, paramedics can be a successful resource, and good team members. There are two other paramedics that still work in the lab and they are doing very well in their careers. Sincerely, Jeffrey Roberts jeff.roberts@baycare.org 2. Turnaround Time I am looking for a published standard for turnaround times. Can anyone help? Thank you! Patricia C. Wessell, RN Nurse Manager, Cardiac Cath Lab Email: PWessell@Christianacare.org Cc: CathLabDigest@aol.com Extensive cost analyses best I have never seen a policy and procedure written on turnaround times. My experiences over the past 30 years have seen several cath lab systems do a QI study on such subjects as time on the table, time physician arrives, length of procedure, etc. There are several places that have policies stating a patient will be removed from the procedure table, if the physician does not arrive within 20 minutes after he (she) has been paged that the patient is setup for the procedure. Several years ago, I did two extensive cost analyses studies on procedure-related costs, which included the cost of the all the equipment spread over depreciation periods, support staff costs, and overhead costs. When the data was presented to hospital administration, cardiologists, and support staff, the turnaround times decreased significantly. Doing an initial extensive cost analysis takes about six months. It requires several members on a committee to review every aspect of costs. Both times that I performed the analyses for two different hospital operations, third-party medical insurance representatives were part of the committee. I have the original forms if you are interested in using them. Chuck Williams, RPA(G), RT(R)(CV),RCIS,CPFT, CCT Cardiac Cath Lab Emory University Hospital Atlanta, GA cowrpa@yahoo.com

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