Table of Organization of an Emergency Department?

[penta]

OK, this is an odd question, but worth asking.

For the same universe as my last post: My character's mom, ICly, I have decided is some sort of ER person. Not sure if Nurse or Doctor just yet. (Dad is a cop who just made it onto the SWAT team.)

To help me decide, I'm looking for position descriptions (and how many there are at each position, particularly per-shift....Also, how many shifts are there per day in an ER usually?) for the Emergency Department of a major metro area hospital - ICly, the character's from Boston, so I figure one of the major trauma centers up there like Mass General, but I'll take source info from anywhere in the US.

Sources searched:

Google (though I'm not sure how to structure the query)
Wikipedia (looking through links from the ER article)

Comments

[kate]

Hi there.

I worked at an ER, not in a big city but in a mid-sized town. I can tell you that we had two twelve hour shifts per day and most people worked three days or nights in a row to be full time. You sometimes got a group of folks that worked together all three shifts, but mostly schedules didn't overlap.

The positions in an ER are:

Doctors: at Mass Gen, there are probably at least two on every shift, maybe more, with additional personnel at the busy times (pretty much from sun-up to midnight). The doctor sees the patients, confirms the patient's history and symptoms, provides a diagnosis and treatment, and provides medication (if called for). If the treatment is to be done at home, he's done. If there are diagnostics (x-rays, bloodwork, CAT scans, MRIs) or treatements (sutures, putting dislocations back in, setting broken bones) that need to be done in the ER, they will perform those.

Nurses: At MGH, likely to be a whole lot of these. At least ten and possibly up to twenty. It depends on how many rooms they have in their ER. One nurse usually handles anywhere from two to six rooms. The trauma rooms and major issues rooms share fewer nurses and the rooms for smaller injuries and less serious maladies may share a nurse up to one nurse for six rooms. A nurse has a fair amount of education and does a lot of the hands on care, including administering medications and smaller procedures. There is also at least one triage nurse (this shifts between available staff - no one is triage all the time) who triages the walk-ins and organizes them from most urgent to least.

Paramedics: Often there are paramedics in the ER as intermediary personnel for extra hands. If they are full paramedics (likely), they can pretty much do anything a nurse can do, including administer medication. A lot of paramedics pick up shifts in hospitals as a complement to their shifts in ambulances. (MGH may have their own ambulances, but they will also get other ambulances in their ER; occasionally paramedics will work for more than one ambulance company if they need extra shifts.)

Clinical techs: These folks are helping hands, do a lot of cleaning and non-medical duties, though they will occasionally help with simple tasks (taking blood pressures, doing orthostatics, stretching a patient's muscles) if the nurses are super-busy. Often these guys are on eight hour shifts instead of twelve.

Unit Coordinators (this position has several different names, but that's a common one): Usually there's only one or two of these. If there are two, they each coordinate half of the ER, and they work very closely with all the other staff. They are the ones that coordinate flow of care for all the patients, keep the staff on track, answer phones in the back (not a common occurrence), call in additional staff for traumas, and do pretty much anything and everything the rest of the staff might need.

Front desk folks (this may actually be in another part of the hospital - these folks don't have tons of interaction with the rest of the ER staff): These (usually women) greet walk-ins and check them in, taking their personal and insurance info (if there is any). ERs ARE NOT ALLOWED TO REFUSE PATIENTS. This is an important note. They are required by law to see anyone that comes in. These guys usually work in 8 hour shifts with several (up to maybe five) during the day, at least two or three in the evenings, and likely one or two at night.

Cleaning folks: these guys and gals will come in and help sometimes if the ER needs quick turnovers, or to clean up messes in the hallways (the medical personnel mostly take care of the patient rooms), and do maintenance cleaning during the wee hours of the night shift (floors, mostly).

Flight nurses and pilot: If MGH has a helicopter paramedics (likely, if they're a trauma center), there is a crew of people on staff at all times that can be called out to traumas or medical emergencies. There is usually a person or two on ground crew (keeps an eye on weather and the radio lines, answers calls and informs the crew when they're going out), the pilot, and nurses, which are always full RNs and also have additional training to be part of the flight crew. I am not sure if they work 12 hour shifts like the rest of the staff in the ER; they might work 8s due to the more extreme stress of their work.

Other staff that are around the ER but not part of it:

X-ray techs, CAT scan techs, MRI techs: these people hang around the ER a fair amount as our diagnostics are not scheduled and need to be fitted around the scheduled diagnostics from the rest of the hospital.

Phlebotomists (possible; sometimes the nurses just draw their own blood - phlebotomists often work for the whole hospital and spend their whole day running here and there to do blood draws all over the place): person who draws blood. If they do phlebotomists (common because they're cheaper than nurses), then it's likely there's one stationed in the ER for most of the day unless it gets super slow and the other ones need help.

Respiratory therapist: people specifically training in giving breathing treatments, monitoring oxygen output and anything to do with breathing. They're usually like phlebotomists, who serve the whole hospital but come down to the ER urgently if necessary (and there might be one stationed in the ER during the busy times).

Trauma blue personnel: a trauma center is required to have doctors of all specialties on call at all times. If a trauma blue comes in, the on-call surgeon is required to come in, and other docs are called in as necessary for anything that requires their expertise. Most commonly called docs for traumas: neurosurgeons, orthopedists, plastic surgeons. Orthopedists get called in a lot because there are a lot of ortho injuries in the ER and psych folks get called in a fair amount too, especially at night. For some reason, the mental health issues tend to come out at night. (ETA: it's been nine years since I worked in the ER, but I started an SGA fic that was basically a trauma blue in our ER and names all the folks here, if that helps (also charge nurse, which is just the nurse in charge of the nurses for that shift): Untitled, unfinished ER ficlet.

Um. I'm a little worn out from typing that all out; if you need other info let me know - I think I covered everything you asked for there. I'm happy to talk about this stuff, I loved my time in the ER (and my sister works in the ER where I worked, so I can ask questions if there's stuff I don't know).

[penta]

Immensely grateful for the effortpost. Thanks.:)