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Proposed New Law: Only Medics For Cct's


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#101 JLP

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Posted 03 April 2009 - 03:49 PM

I'm with ya, we both work for the same grand exalted leader. However our world seems to be vastly different than the majority, hence the "World leader..." title B)


Don't forget to bow to the ground when you say that. "same thing we do everyday, Pinky - try to take over the world...."
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#102 FloridaMedic

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Posted 03 April 2009 - 04:51 PM

In my small microcosm of the world no one offered a degree in EMS, some of this was due to RN's protecting turf, money and volume of students. Another cruel irony in our neck of the woods is all of the original medics were RN's who did EMS in the 60's and early 70's in the volunteer system. Frank Poliafico (http://www.etx911.com/bio.htm) being the grand father of modern EMS in our area and the first "Nurse Fire Medic" and chief. So until the education problem gets changed I don't think much else will change. Last is you can not cry lack of experience when RN's are the ones controlling the game. So as always I just hate the game not the playa.........


Yes, it is so much easier to blame others or another profession for the faults of EMS and the status of Paramedic education in the U.S.

Colleges (U.S.) started initiating a degree in EMS in the early 1970s which was the time nursing started making the transition from diploma to degree. At that time it was actually thought that the Paramedic programs would pull it together to achieve professional status before the RN. This attitude came about with EMS consisting mostly of men and this was the early 70s. However, it was also decided that they wanted to be "unique and different" from nurses so the education and statutes were written in many states to make the Paramedic as a PREHOSPTIAL provider. Thus, this limited the opportunites for EMTs and Paramedics later for hospital work. In many states, prehospital providers are not called by their state certification, nor is it recognized as a scope of practice inside the walls of a hospital. They are called by given hospital titles with prehospital cert being recognized as skills training. They will work under the job description of their hospital title. Nursing did not write those statutes that still exist in several states. Those in EMS wrote them. However, many schools did have RNs with college degrees to run the Paramedic programs. Several programs still exist where RNs are in the adminstration of these programs simply because it is difficult to find EMS providers who have advanced their education enough to become professional educators. EMS has largely existed with the instructor/training votech mentality rather than the educator/education concept. EMT(P)s have largely been trained by those at the same level of certification and rarely with any education beyond that especially for the role of educuator.

In the 1980s, the FDs and ambulance services wanted to train their own to get Paramedics on the street quicker. Several administrators and medical directors from these groups were arguing that it only takes 200 hours of training to make a Paramedic, not 2000 or 2 years. Thus, the idea of developing more degree programs was scrapped in many areas. Again, RNs had little say at that time about how a FD was ran so they did not play much of a role in determining how long the Paramedic program would be. FDs and ambulance companies did the petitioning to their states for the amount of education or training that was to be done. That is why we still list education standards as hours and not degrees. A couple of states still only require 500 hours for Paramedic training with Florida at only 700. With another 120 for teh EMT-B, that is a whopping 820 hours for both levels. Other professions do almost 2x that for clinicals alone. Nursing actually was responsible for the other healthcare professions acchieving degree and professional status. RNs told the others who were considered "techs" or minimally educated to go to college and get an education if you want to be part of the healthcare teams. So, they did...all except EMS. EMS had to think of itself as too unique and different from all the rest.

Those of us, who were around in the 1970s to see when EMS was actually thought to be a bright profession about to evolve into something great, did get college degrees in EMS. The classes were full at several colleges and the Paramedics were coming out well educated and well prepared. The states that did have a large number of colleges offering the EMS degrees also had an extensive scope of practice. When the 1980s came and brought the medic mills, many of the earlier Paramedics moved on since there were more in favor of a PDQ training program than 2 years of college. They saw that companines would pay the wage for the least educated and the idea of petitioning for professional status with the insuring agencies would be lost.
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#103 JLP

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Posted 03 April 2009 - 07:10 PM

Yup, I'd be the first to agree that medics have shot themselves in the foot on this one. Too many medics want to do the skills but not put the effort in to have the right knowledge base. And even here, the amount of effort the EMS unions have put in to keeping a professional college out is appalling. Laziness has been our worst enemy. The days of ALS medics being the elite fanatics is just as gone here, which is a lot of the reason why our land-to-air transition program is such a crusher.
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#104 gradyambulancedriver

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Posted 14 April 2009 - 04:15 AM

But, when someone else who makes statements like you have and then refers to Paramedics as glorified ambulance drivers, that gets me disgusted. Are you happier now with yourself for hijacking another thread to make it all about YOU...again?


Eh? Someone calling me? I have no delusions about myself LOL!
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#105 LearRRT-CCEMTP

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Posted 18 April 2009 - 02:08 PM

I am a very large supported of CCEMT-P's and strongly feel they have a place in this world but in the argument of CCEMT-P's being able to perfrom CCT's without any other level such as RN's and RRT's, I would like to add the following. Yes, a paramedic can be educated to perform CCT's but what everyone seems to be forgeting is you CANNOT replace EXPERIENCE with only education! No matter how much education you provide to paramedics, very few will ever have the opportunity to practice their full scope of care in an actual ICU careing for critically ill patients for hours and hours, seeing the many ways no two critical patients are alike. There is just NO way possible to replace years of ICU experience that RN's and RRT's get! If it was me or my loved one that was critically ill and we have to be moved, there better damn well be at least one person in that transport vehicle with years and years of ACTUAL ICU experience! Our patients deserve no less either! It's not about the paramedic profession, it's not about the nursing profession, it's not about the respiratory therapist profession, it is about what's best for the patient and that we seem to keep forgeting about! They are the reason we are all here so lets just start doing whats best for them and not what's best for our pride!
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#106 safltrn

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Posted 02 May 2009 - 05:27 AM

True in many ways. Interesting, that many of the physicians that I have flown with prefer paramedics. In fact, at first many of the docs though I was educated as a paramedic. Nurses in the HEMS role is virtually nonexistent in countries such as South Africa. So, clearly, paramedics can be educated to provide advanced care in the transport environment and excel in such a role.

As an advocate for EMS, I would love to see paramedic education advance to the next level and begin to provide serious competition for the nurses. However, as a nurse I also advocate having nurses move into the pre-hospital environment. A curious conundrum; however, the day that I am forced to choose between my respect for EMS and support for my profession, will be the day EMS is finally educated and respected as true profession. That will be a good day.


Gila,
For the sake of honest debate; get the facts straight. I am a South African trained RN and I'll have you know that HEMS and Flight medicine in South Africa was pioneered by Nurses and Doctors. I flew as a Flight nurse for the countries oldest and most established Flight Program (still very much in existance today) The South African Red Cross Air Mercy Service. Johannesburg General Hospital's Flight For Life Program was staffed by "Joburg Gen's" Trauma Unit RN's (called Sisters in South Africa when they were mostly females) and Trauma surgery and Anesthesia Registrars (Residents). I flew as a Flight Nurse for the SkyMed I program owned and operated by Trauma Link/ Clinic Holdings and later Netcare and then for Med Rescue International. Both were HEMS programs. I also flew for the SA Red Cross Air Mercy Service, both fixed wing and Rotor wing programs. While it is true that RN's are not working ground units or CCT there, they were the ones who started most of the original flight programs. Incidently, when I was still in High school there, there was a specialised ground rapid response unit based out of the provincial hospital in Port Elizabeth called "Echo 1" and it was staffed by a CCU RN and EMT.Paramedics at that time were an unheard of entity.The RN's were the ones who provided the Advanced Life Support measures out in the field.
I'm going to write an article on this as it is something which to date has remained unpublished. I worked with amazing paramedic colleagues in the Aviation environment who taught me a lot about EMS, but they learnt as much about managing Critically ill patients from me. The "I'm better than you" debate did not happen there in the years that I worked on helicopters and aeroplanes. We served the patient as a team. Ego's do the patient no good and breakdown solid team structure and effectiveness in the end.
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Andrew Veitch CFRN

#107 safltrn

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Posted 02 May 2009 - 06:10 AM

Last but not least on this matter.
I actually WORK in Orange County , California at a HEMS program and my paramedic partners cannot even get a paramedic County license from the Orange County EMS agency at this stage. All they can operate under is an "Air Ambulance Attendant". There is no protocol or scope of practice for them as there are no paramedics functioning outside the juristiction of the Fire Departments. I was reading this post (as it relates to the county that I actually operate in) and for starters it is clearly evident that the person who initally posted this thread had no idea of what they were talking about and if anything, picked up on something they saw or heard somewhere and jumped to their own conclusions.Secondly I realised how old this thread really was and lastly, to the best of my knowledge, things are "business as usual" in the County of Orange. The FD paramedics handle the ALS/ 911 calls and utilise us (HEMS) when appropriate to medevac patients to the appropriate facilities. The Interfacility calls are handled by the helicopter program and the ground CCT units which are staffed by 2 EMT-B's and 1 RN. On a RARE occasion, the 911 ALS system will be called upon to transfer a patient from the initial receiving facility to a more appropriate facility if there are no ground CCT units available and the helicopter is also not available or the patient's condition dictates immediate continuation to another facility.This has been spelled out to be the exception rather than the norm.
All speculation aside. This is how it works at present and I do not see any change happening at any great pace in the near future.The state of EMS is sad in CA as opposed to the rest of the country but only EMS here can change that themselves.
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Andrew Veitch CFRN

#108 MI_medic

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Posted 17 May 2009 - 06:36 PM

I'm glad here in Michigan paramedics are looked on with a bit less disdain. Oh wait, no we're not. Nurses and Medics are NOT interchangeable and either can do either's job if properly trained. Can nurses work in the back of trucks in CA?
Terry Ragaller
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#109 FloridaMedic

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Posted 17 May 2009 - 06:53 PM

Can nurses work in the back of trucks in CA?



In CA as well as many other areas, the helicopters for HEMS are usually staffed RN/RN.

As well, you do realize that many of the RNs on this forum do scene response?

In CA or in Florida as well as many other states, RNs can also challenge the Paramedic exam and get a job with the FDs which happens occasionally for slightly better pay and benefits.

For nurses, they know their education is not the end all to everything there is to know. They do have an excellent foundation to train for many different specialities. You must also consider the additional education for some of their nursing specialty programs is much longer than many paramedic programs.

Several states now have the PHRN cert and many nurses do work on 911 ambulances especially in smaller communities. If you are interested in more info about this, I can put you in touch with nurses who are functioning with their RN license in prehospital EMS.
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#110 Gila

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Posted 18 May 2009 - 01:56 AM

Some states such as Nevada even have a pre-hospital RN license. Nevada has what is called an EMS RN license that you apply for separately from the RN license.
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#111 justlookin

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Posted 18 May 2009 - 05:27 PM

Some states such as Nevada even have a pre-hospital RN license. Nevada has what is called an EMS RN license that you apply for separately from the RN license.

West Virginia has a similar designation for EMSA-RN. There is a structured process for an RN to obtain EMS training and precepted ALS runs prior to receiving the EMSA-RN title. This seems to work well in very rural areas where EMT-Ps may be few and far between and RNs may be living in communities and can work with volunteer agencies. This helps to get ALS services to areas thay may otherwise not have them.
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#112 JPatterson

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Posted 29 October 2010 - 11:32 PM

OK, I'm gonna give both of you half a "right on" and half a "what a load o'bollocks". As a medic in a system that does true critical care based on (heavily-educated) paramedics, I see both sides. Most paramedics are certainly not capable of managing ICU-level patients without a lot of extra education, and probably only 10-20% of paramedics have the aptitude to be any good at critical care even WITH the extra education. Notice, as well, I don't say "training" - I think the quickie "training" approach to creating medics is a big part of the problem. New medics are right out there with new med students as having vastly over-inflated senses of their importance and infallibility combined with far too little knowledge or experience to know how scary they actually are - and I say this having been a perfect example of that myself. True critical care paramedics require a long educational process, and many locales likely can't make them because the short initial training means they don't have the base knowledge to "get" what and WHY they are doing. However, a system that picks the top medics and pounds critical care into their skulls for a good long time can produce very high level people that can do the job out there as well as or better than all but a few "higher" level providers.

On the other hand: I can tell you from my own experience, the same is true of the majority of RN's to a large degree. Most RN's have a better base knowledge foundation, but probably 90% of the RN's I have seen in practice could not function well in the transport environment without just as long a lead-in period as a good ALS medic - and that includes quite a few ICU nurses. In the north we routinely fly RN's from small hospitals as escorts for our lower level flight crews (not all our a/c are critical care, because it simply isn't possible given the vast size of our province), and many of those escorts are, putting it mildly, unimpressive. I have also had the experience of running or assisting "letter courses" for a great many RN's, and a depressingly large number are staggeringly incapable of managing a critically ill patient without someone telling them what to do - no independent initiative or ability to critically think under pressure at all. Not a shot at you flight nurses, but if you look back at many of your general RN's you know what I'm talking about - you guys are all drawn from the 10-15% of RN's who are at all capable of doing independent critical care transport.

This is the real problem: whether you run PM, RN, RT, PA, MD or graduates of the tooth fairy school of fix'em up, the flight environment requires that we get the sharpest of the bunch b/c they're gonna work in a world that is NOT 911 response, NOT the ICU in a hospital where there are lots of helping hands, but a crazy hybrid of both. The closest equivalent is remote medicine, like working in the rigs, staffing a clinic in McMurdo base, or working in a battlefield hospital. I don't think ANYBODY should be allowed to work critical care transport without [a] a tough selection process to weed out the weak and the cocky, and [b] a six-month to a year or more CCT course (depending on your base knowledge and your experience). (this is also my answer to the whole "PA's on HEMS" thread currently going on). A 40 hour critical care paramedic program? Give a ******* break. That's the tinker-toy model of medicine, teach them a few tricks and they're masters of the universe! A quickie RN-to-PM crossover without real road experience? equally bogus. Hell, most MD's are not remotely capable of working in our world without a few months of lead-in, or back-up from good medics or flight nurses (I've taken a lot of hospital docs on flights too, and the results are pretty mixed). Now that I've pissed everybody off...



After reading every post on this thread, this is the only one that really had true validity to it in my personal opinion. Everyone seems too focused on RN or Paramedic, not proper education and experience. Being a Paramedic or RN doesn't make you a great SCT provider. Having the proper exposure, education, determination, and opportunity to practice in this field makes you a great provider. I work for an interfacility critical care transport service as a Paramedic. I am hospital based and have access to all of the same educational opportunities as my RN counterparts. We share the same protocols, same scope of practice, same schedule; but we are NOT interchangable. I have been providing CCT for almost 9 years and have built a comfort level with complex ventilatory strategies, vasoactive medications, IABP's, insertion and use of A-lines, Lab values, etc. I didn't lean this from a 2 week course...I learned it by exposure and working with extremely qualified partners. The 12 week orientation we put our new medics and nurses through is just scratching the surface. It takes 1-2 years before Medics and RN's become really competent CCT providers...Some never do. I support Paramedics providing CCT, but they have to have the constant exposure, education, QA, and mentorship in order to do it properly. I also feel that single provider CCT is a horrible practice. Two overqualified heads are better than 1.

Any service that takes a 911 medic and puts them on a CCT is doing the entire profession a disservice. Same goes for a Hospital that puts an RN on a CCT without proper training. ANYONE doing CCT needs to be doing that as thier FULL TIME JOB. That is the only way to maintain proficiency. I support having both specialties work together on CCT and see a great benefit. I also see a benefit of having RRT's. Bottom line...your certification/license/etc. doesn't make you the best person to transport critically ill ICU patients, it is your experience, knowledge base, and understanding. Basing competence on Certification or licensure alone is a set up for failure.

There should be a single test and practical for anyone wanting to do CCT, in the air or by ground, that has to be passed by any level provider (RN, Medic, RRT, MD, PA, NP, XYZ) Lets have some sort of standard that we can hold everyone to.

Sorry for the rant...
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Jeff Patterson NREMT-P

#113 FloridaMedic

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Posted 30 October 2010 - 01:39 AM

As far as I know, Orange County, CA is operating basically the same with RNs (and RRTs) still on CCTs. The major difference is that the EMT-Basics are being allowed an expanded scope of practice in that county to where thay can take some IVs and trachs. In fact, they are now allowed to "deep" suction a trach in that county where as in other counties and prior to this change in OC, they could only suction as far as a yankauer could be pushed (oh horrors!) into the trach. Thus, they do not need the nurses on every transport.

New training for the OC EMT-Bs:

http://www.ochealthi...tion_Manual.pdf

Paramedics are at a disadvantage for CCT with high acuity patients since they get very little to no experience inside an actual ICU. Some schools are having a difficult time finding ED experience for their students.

RNs also should not attempt to do CCT with just ED experience. There have been numerous discussions from both RRTs and RNs in the units who are worried about turning a patient over to someone who appears to be not so knowledgeable about the meds and/or the technology attached to the patient.

RRTs are the critical care specialists from their initial training but even with a 2 year degree and over 1000 hours of clinicals, mostly in the ICUs, they too probably should not transport on high acuity teams until they have two years of experience at the bedside. It was also recently made known that some states are dropping the lower RT credential for licensing and just going with the higher RRT. There will also be another Critical Care credential available through their national board next year. And, they are now on track for the Bachelors as their entry level education. It is a 10 year plan but that goes quickly when it comes to covering all the bases to get all 50 states ready. Take notes RNs.

I don't even want to think about the Paramedic education since it took 15 years to come up with the new levels. Most of what they expanded could easily have been obtained through college level A&P and pathophysiology classes. The medic mills will continue to do well if they get the CoAEMSP accreditation. A few states may choose to drop the NREMT or continue with their own state test to avoid the accreditation and testing levels.

http://www.ems.gov/e...dardandncs.html

For those just wanting to see the overview of the levels: (Chart: pages 11 - 60)

http://www.ems.gov/pdf/811077a.pdf
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