‘Greasing the wheels’: How emergency services techs keep EDs running smoothly

If you tune into TV medical dramas, you’re likely to see doctors and nurses performing all the tasks necessary to take care of patients in a hospital setting.

What you don’t see is the whole team of allied health professionals who — in reality — routinely work alongside doctors and nurses to ensure patients get the care and treatment they need.

One of those allied health professionals is Raymond Fugate, an emergency services technician at MultiCare Auburn Medical Center. His role doesn’t traditionally receive much fanfare in the media, but Fugate, along with his fellow technicians, are critical to the smooth functioning of the emergency department (ED).

Inspired by family

If you ask Fugate to describe what an emergency services technician does, he’ll tell you they “grease the wheels” of the ED — they notice what needs to be done and they do it. That could mean checking a patient’s vital signs, cleaning a wound, performing an electrocardiogram (EKG), setting up a suture tray, running to the lab or pharmacy, or getting an initial summary of a patient concern in the triage area.

Fugate has been an emergency services technician for 20 years — eight of those at Auburn Medical Center — and he credits his family, including his great grandmother and mother, for helping launch his career.

“My mom was the first Black nurse at the hospital where she worked,” Fugate says. “She helped me get a volunteer position there, and that’s when I knew that working in a hospital setting was what I wanted to do professionally.”

Emergency services technician Raymond Fugate

Preparing for the unexpected

Fugate starts each 12-hour shift by meeting with one of the emergency services technicians on duty to discuss the status of patients on the unit.

Rather than being assigned a specific number of patients, Fugate is in charge of a particular zone in the ED. On any given day — depending on how busy it is and how many technicians are on duty — Fugate’s zone could include seven or more of the 30 private treatment rooms in the ED, as well as patients in the 12-chair fast-track area — for those with minor injuries or concerns, such as a sore throat or sprained ankle.

One of the zones includes the four enhanced patient safety (EPS) rooms in the ED. These rooms are designed for people experiencing severe mental health crises who may harm themselves or others.

The Auburn ED has experienced a 26.6 percent increase from 2021 to 2022 in psychiatric holds — patients who must stay in the ED until they can receive a psychiatric evaluation.

“These types of situations can be difficult for patients,” Fugate says. “There’s a lot of steps we have to take to ensure our mutual safety. I put myself in their shoes — when patients are combative, it’s often because they’re afraid. I try to be a really good communicator by explaining exactly what’s going to happen so they know what to expect and we’re on the same page.”

Fugate has to be prepared for any number of emergencies on his shift, so after he meets with the technician on duty, he checks to ensure all equipment and supplies — from crash carts to EKG machines — are stocked and ready for use.

As the lead emergency services technician, Fugate is also in charge of ordering and organizing many supplies in the ED, in addition to training new employees.

“The best part of my job is just playing a part in helping someone who is sick or injured get better. I’m not a carpenter — I can’t walk by and point to a house that I built, but I can say I helped that person breathe or I helped that person feel more comfortable.”

A day on the unit

While Fugate may start and stop each shift with a routine, that’s where the predictability ends — no two shifts are alike. The Auburn ED averages about 120 patient visits a day, and so far in 2023, more than 35,000. Patients come in for a range of ailments and illnesses, from strokes to chest pain to bone fractures.

One particular day, Fugate starts his shift at 11am. There are about a dozen patients on the unit. His co-workers duck in and out of rooms at a steady pace to answer call lights and administer care while others sit in front of computers coordinating care behind the scenes.

The vibe could be described as calm — one might even be tempted to call it “quiet,” but that is not how Fugate, or his teammates, ever describe it.

“When it’s like this, we say ‘It’s appropriate,’ because you never know when it’s going to change,” he says.

And just like that, it does.

Fugate is performing his usual checks of equipment and supplies when a hospital staff member calls a code over the announcement system — someone is experiencing a life-threatening medical emergency and may need to be resuscitated.

Fugate, part of the rapid response team, grabs a pair of gloves and a stretcher and rushes to another floor of the hospital, along with other team members, to help.

“In these moments, I just take a deep breath and head to the scene,” Fugate says. “The patient is already in need of my help, and the best thing I can do for them is get there quickly and stay calm.”

This situation has a positive outcome; once the team stabilizes the patient, Fugate returns to his regular duties in the ED. After a quick check-in with the charge nurse and his colleagues, he attends to the needs of patients both coming and going.

For one patient, he removes an IV, facilitating their discharge home. For another who has just been admitted, he helps them into bed and hooks them up to telemetry equipment. A short while later, Fugate helps that same patient out of bed so they can use the restroom.

Next, he heads to one of the ED’s two trauma rooms. These rooms are used to treat patients with severe injuries, such as gunshot wounds or injuries sustained in a car accident. The previous patient in this room has been transferred, so Fugate cleans and prepares it for the next person.

Wiping down surfaces and ensuring all the equipment is ready for use, he performs each task with thoughtfulness and care.

“I ask myself, is this how I would want the room to look if one of my family members were to be treated here?” Fugate says.

Finding joy in patient care

By now the pace of Fugate’s shift has picked up, and no surprise — it’s not out of the ordinary for Auburn Medical Center to be at or over capacity.

In 2022, the facility was at full capacity for 319 out of 365 days. When there are no inpatient beds available, patients who need to be admitted must remain in the ED until a bed opens up.

But regardless of the situation, Fugate carries on — he alternates between providing patient care at the bedside and keeping treatment rooms prepped and ready, all the while checking in with teammates to see what they need and how he can help.

At 11pm, he will meet with the technician coming on duty before saying goodbye.

“The best part of my job is just playing a part in helping someone who is sick or injured get better,” Fugate says. “I’m not a carpenter — I can’t walk by and point to a house that I built, but I can say I helped that person breathe or I helped that person feel more comfortable.”

Life in the emergency department is often marked by uncertainty and sometimes stress. To get through those times, he relies on the trust he’s fostered with his teammates.

“No matter how chaotic or challenging a situation may seem,” Fugate says, “I can just look at the people I’m working with and know that we can do this together.”