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...