Paramedics in the Cath Lab?

Question:

We are in the beginning phases of hiring paramedics in our cardiac cath lab here in Mercy Hospital Fort Smith in Arkansas. As you know, staffing is a major issue everywhere and we are hoping to supplement our lab with trained paramedics. I actually started in the cardiac cath lab in 1993 when I was a paramedic; at that time, I was only able to perform advanced cardiac life support (ACLS) assistance, according to state law.

Now that paramedics are licensed, we are able to (by law) to have them perform all of the skills as long as the Medical Executive Committee, and ultimately the Board, approves their skills. Currently, we have them approved for all of their skill sets, including intubation (emergent-only in the cardiac cath lab), as well as sedation.

Are there any cardiac cath labs currently using paramedics and allowing them to completely use their skill sets within the confines of their cardiac cath lab?

Would you like to respond? Email Clifford L DeBruce, RN, at clifford.debruce@mercy.net

Responses:

There are no paramedics in the cardiac cath lab in the Pacific Northwest, to my knowledge.

Darren Powell, RCIS, FSICP, Spokane, WA

There are no paramedics in UPMC Presbyterian Cardiac Cath Lab. To the best of my knowledge, there are no paramedics in the other Pittsburgh cardiac cath labs.

Marshall Ritchey, MS, MBA, RCIS, CPFT, Pittsburgh, PA

Interesting proposal. We use EMTs and the equivalent of paramedics in the South American locations (less wealthy countries) that I frequent and they do perform the functions of cath lab techs apart from radiologic technologists (RTs) and registered nurses (RNs). Probably doesn’t help the question as it applies here in the United States, but resources and skillsets are different in other geographies.

Laura Minarsch, RT(R), CVT, CCRP, Laguna Beach, CA

We use EMTs and paramedics in our lab. They function in the scrub, x-ray, and monitor roles. They are not allowed to push meds or intubate. With the ongoing staffing shortage, the utilization of EMT and paramedics in the lab has been very helpful.

Bailey Ann Estes, BSN, RN-BC, RNFA, CNOR, RCIS, Hendrick Medical Center, Abilene, TX

I have seen and used paramedics and EMTs in the cath lab before. They all have varying scopes of practice based on state, locality, and facility allowances. I have seen cath labs that allow them to administer meds and many other functions, but not intubate.

Mark Baker, MHA, BA, RCIS, EMT-P, FACVP, Healthcare Administration Leadership Consultant

Currently we do not utilize paramedics or EMTs in our cath lab.  Our techs have to be either a registered cardiovascular invasive specialist (RCIS) or American Registry of Radiologic Technologists (ARRT) certified, but with that being said, if they are a paramedic and have the RCIS certification, they could work in the lab.

Todd D. Sorenson, RT(R)(CV), RCSA, CTAE, Rapid City Regional Hospital, Rapid City, SD

I have also seen and utilized EMTs/EMT-Ps in the role of cath lab technician with great success. During the current healthcare crisis, I have not had to utilize them at the facilities where I have been contracted. The salaries being offered for travel RNs and technologists have decimated staffing at many facilities.

As an Interim Leader and consultant, I am well aware that money talks, and staff walk. I have several contract RNs and technologists at my current facility.

While states have in place administrative codes, scopes of practice, and licensure rules and regulations, several emergency declarations from governors and health departments have allowed these to be superseded. As an example, some hard-hit states have brought in the National Guard at critically staffed hospitals to assist in delivering patient care.

Kenneth A. Gorski, BSN, RN, RCIS, FSICP, Cleveland, OH

In most cases, the National Guard staff is doing security and transport duties, rather than technical licensed or professional duties.

In Massachusetts, only an RN can administer medication and an RT is required to operate the x-ray equipment.

Georgann Bruski, RT(R), CRT, ARRT, Steward Health Care, Boston, MA

Before moving into the cath lab, I was a paramedic for 20 years. I am now 22 years into my cath lab journey on top of that. Because of that, I feel the need to reply.

First — I believe that paramedics can be essential in the cath lab.  Being able to understand and deliver cardiovascular care is one of the primary purposes of what paramedics do. With technology and education, paramedics thrive ‘in the streets’ where they are the ones to provide life-saving care, along with other first responders. Paramedics have an inherent capacity to create calm out of chaos. That is developed through experience and attitude, and should be part of the selection process when hiring individuals.

Second — the paramedic has to understand their surroundings. In many states (including Texas), the paramedic may have limited abilities. Even in Texas, some facilities will allow paramedics to be an integral part of the cath lab team. However, each facility must interpret its regulations. My first job transitioning from EMS to the cardiac cath lab was at Clear Lake Regional Medical Center in Webster, Texas. I started as a transporter in the department. While in-between transporting patients, I watched everything, asked questions, practiced on my own, and most importantly, learned the supplies and where they are. I befriended a physician, Dr. Nadir Ali, who allowed me to absorb all the knowledge I could get from him. I was able to step up to the table about 4 months into my new journey and obtained full-time status as a cath lab technician. I would not have been able to pivot my career without the learning experience of being a paramedic. That’s a crucial crossroad for most paramedics…being able to let go of what is performed ‘in the streets’ and adapt to the confines/regulations of the hospital.

Third — as earlier mentioned, Texas has guidelines that may prevent a paramedic from performing their skills inside the hospital. This likely varies from hospital to hospital. However, at Methodist Hospital in San Antonio, we DO hire nationally registered emergency medical technicians (EMTs) and paramedics into the cath lab to work at the scrub table and the monitor position. Even if they are unable to administer medications, they still have just as crucial of a role in patient care as nurses. They provide critical support with devices (CardioMEMS [Abbott], Impella [Abiomed], intra-aortic balloon pump [IABP], extracorporeal membrane oxygenation [ECMO], etc.).

To answer your last question (Are there any cardiac cath labs currently using paramedics and allowing them to completely use their skillsets within the confines of their cardiac cath lab?) No, Texas does not allow that.  I know there is a continual movement to change this. Thanks for asking the question and I hope you can accomplish your goals.

Todd Ginapp, RN, MSN, RN-BC(CV), RCIS, Methodist Hospital – San Antonio, TX

I heartily support. The individuals have likely brought the patient to the lab and EMS continuity may add to care.  Using paramedical staff as ‘fill in’ in the cath lab schedule is also fine, and requires appropriate policy though the hospital ER committee (in addition to) the cath lab.

Jackson Thatcher, MD, FACC, FSCAI, Cardiologist, retired, St. Cloud, MN

I started as a paramedic in the cath lab in 2002. We could do almost everything except hang blood. We were hired because we were expected to intubate during codes. This all changed in 2010 and we were not allowed to do anything. For a minute, we questioned if we could give nitroglycerin and contrast. Over the tincture of time, we could give those drugs. Some labs in metro Atlanta are now circulating again and are probably giving the range of drugs except blood.

That said, paramedics are a natural for the cath lab. They are used to handling emergencies and are very adaptable. I believe in the RCIS standard for the cath lab. All techs should be trained to that level. If you are going to hire paramedics, you need to have a plan to get them to the RCIS level in two years. That would require some significant commitment to education, time, and money.

Neil Holtz, Cardiovascular Technician, Cath Lab/Cardiovascular Educator, Emory University Hospital, Norcross, GA; Owner, Emergency Medical Training Academy