sedation protocol

[DogLovingPA]

New to the ER (and surprisingly not really liking it, but that's another post) and wondering what sedation protocols are like at other places.  Have only had 2 cases so far where sedation was needed (both kids with complicated lacs that would not cooperate) and frankly, it's a giant PIA.  For deep sedation (eg. ketamine, propofol, etomidate) protocol requires RT, 2 nurses, pharmacy, 2 providers (one to monitor the sedation and 1 to do the procedure) in the room.  These seems insane to me, but maybe it's normal?  It brings the ER to a grinding halt and the provider doing the sedation must stay in the room until patient fully alert.  In a small ER where there are only 2-3 providers at any one time this is difficult.  Moderate sedation (eg. versed) is similar protocol but only requires 1 provider.  Unfortunately, the PA can be the provider doing the procedure but can not be the provider doing the sedation (at least that is my understanding so far).  Last night plastics was trying to repair a lac and we ended up just sending the kiddo to the OR because we didn't have the staff in the ER to manage a sedation per protocol.  

Is the the norm most places?   I asked yesterday what happens when only 1 provider is in the ER (1 MD only 0200-0700 every day) and they said they have to either call in anesthesia to assist or wait until another provider comes on shift.  

[EMEDPA]

I work at small rural places. I can order the sedation and do the procedure, but need at the very least an RN or RT in the room to monitor the pt during the procedure. If the pts airway became unstable during the procedure, I would abort the procedure and manage the airway. During the day we sometimes have a CRNA around and I ask them to take the place of the RT. 

[LT_Oneal_PAC]

Solo coverage. I get RT for the airway and a nurse or paramedic to document vitals/give drugs. In residency though it was one provider monitoring airway, one doing procedure, and paramedic documenting/giving drugs.

[ohiovolffemtp]

For mild sedation - think 1 round of IN versed for peds - 1 nurse was sufficient.

[kargiver]

This is overkill IMHO.  Have worked across the gambit of ER types (academic, rural, suburban, etc) and what I have consistently encountered (if other services available at hospital) was 1 provider for sedation, 1 for procedure, RT for airway and nurse for nursing.  In facilities that do not have all these capabilities (where I currently work for example) I do the sedation and procedure with RN at bedside managing rest.  If third set of hands available, great.  If not, meh.  Of course, if complication occurs - procedure aborted.  

Most limitations I have come across for sedation policies and procedures have been anesthesia department driven and/or larger facility bylaw-based.  All nonsense IMHO...

G