Jump to content


Photo

Paramedics As Neonatal Transport Primaries


  • Please log in to reply
42 replies to this topic

#21 NCRRT

NCRRT

    Newbie

  • Members
  • Pip
  • 6 posts

Posted 02 April 2009 - 05:02 PM

I don't think anyone is stating that Neonatal transports are beyond the scope of practice of paramedics but rather beyond the scope of practice of RN's, RRT's and Paramedics that DO NOT work or have worked a significant amount of time (> 2 years) in an ICN/NICU. Neonatal Critical Care is way too specialized for the average adult provider. For example: We have a nameless local program that is RN/RN that utilizes their regular adult team for all three populations. They take adult ICU/ED nurses and train them for a few very short weeks and then send them out to transport 24 weekers and above. I have seen some real horror stories with them! You just CANNOT replace years of actual experience and I find it hard to believe anyone will argue with that!


I have the same feelings about the nameless program, my program referred a mutual aid transport to said team a few years back because all of our teams were out and almost lost the referrals from that facility, we havent used them since. Neonatal and Pediatric transports should be handled be the most experienced in that arena. The RRT/RN combo is the goldstar in my opinion in the small patient world.
  • 0

#22 LearRRT-CCEMTP

LearRRT-CCEMTP

    Advanced Member

  • Members
  • PipPipPip
  • 272 posts

Posted 02 April 2009 - 06:41 PM

I have the same feelings about the nameless program, my program referred a mutual aid transport to said team a few years back because all of our teams were out and almost lost the referrals from that facility, we havent used them since. Neonatal and Pediatric transports should be handled be the most experienced in that arena. The RRT/RN combo is the goldstar in my opinion in the small patient world.


I know exactly how you feel!
  • 0
David W. Garrard, BHS, RRT, RCP, CCEMTP, PNCCT, CFC
Vice President and Program Director
AeroMD
Dedicated to the Speed of Life!
Charlotte Amalie, St. Thomas, United States Virgin Islands
Toll Free: 1-844-AeroMD-1

#23 safltrn

safltrn

    Advanced Member

  • Members
  • PipPipPip
  • 103 posts

Posted 02 April 2009 - 07:37 PM

While our flight program responds to request for patients of all ages; I would still have serious reservations about transporting a really ill premature infant, despite years of experience in ICU and Trauma/Emergency Nursing. I have never worked for any great length of time in a NICU and while I work alongside the REAL NICU specialists (NICU Transport Teams who we fly) I will never consider myself a great proficient in this speciality. I think that care of this population is left up to dedicated and highly experienced professionals from the Children's Hospitals.
Too often ego's and arrogance have resulted in poor outcomes.
  • 0
Andrew Veitch CFRN

#24 randyl

randyl

    Advanced Member

  • Members
  • PipPipPip
  • 30 posts

Posted 02 April 2009 - 07:53 PM

A little slow in posting, thanks to others for bringing BC up. As discussed we have had our neonatal transport program running for over 30 years. It started out as a program that had one identified station of PCP (EMT) paramedics providing driver services for the Childrens Hospital. In 1976 an adhoc training program began for the individuals which quickly turned into a transport program as a specialty team. Currently the team does all neonatal, maternal and pediatric transports within the province. At present on the neonatal calls, a physician accompanies on about 20% of the transports. A number of team members have also completed the ECMO transport training as well. The training program is close to two years with a significant amount of both clinical and didactic training completed onsite at BC Childrens and Womens. They then move into a mentorship piece that provides a lot of exposure given the volume (2200+). One of our issues is there is actually no designation for the team as they are different than Critical Care Paramedics. For now we call them the Infant Transport Team but that does not really reflect their scope and responsibilities.
  • 0

#25 Patrick Small

Patrick Small

    Newbie

  • Members
  • Pip
  • 7 posts

Posted 08 October 2009 - 07:02 PM

Our team currently consists of a medic, nurse and physician. In January we are going to be running a nurse, nurse, medic team. Obviously, when we do the ground transports the medic deals with driving the MICU and is only active in patient care during the stabilization process at the outside hospital. During flights the plays an important role throughout all aspects of patient care. Now, it is true that our team is lead by the highest level of care present, and as of January 1, that will be the nurse. The medics on our team do however play just as an important role. We are required to be proficient in the same skill sets as the RN, to include advance line placement, advanced airway, xray interpretation, medication certification, etc... It is really an amazing team, and the role of our medics has been evolving over the years. When I started on the team, the medic was little more than a driver and bag carrier, but now we are active members of the team. It all comes with forward thinking supervisors and medical directors as well as some dedicated medics and nurses. The team works great together, and I feel that it is a great combination. Each member, the medics and nurses, bring a totally different set of skill and experiences to our team which make us a very well rounded team. This is very important as we do both pediatric and neonatal trips. The only time that we actually will use an RT is when we are dealing with a child on Nitric. Obviously, at that point in time their experience well out-weighs ours as the medic and it is better for patient care, that they go as a team member. Hope that helps!
  • 0

#26 medic1988

medic1988

    Newbie

  • Members
  • Pip
  • 5 posts

Posted 22 January 2010 - 01:45 AM

We are doing research on programs that allow there paramedics primary neo transports, just like a neo nurse. Please help..

I work as a primary care paramedic for Nationwide Children's Hospital Transport Team in Columbus, Ohio. We are trained in all aspects of neonatal and pediatric advanced life support. We intubate, surf, uac/uvc insertion, abgs, chest tube insertions, etc all all neonates and pediatrics. Just email me if you would like more info.
  • 0

#27 old school

old school

    Advanced Member

  • Members
  • PipPipPip
  • 1121 posts

Posted 22 January 2010 - 02:27 PM

A little slow in posting, thanks to others for bringing BC up. As discussed we have had our neonatal transport program running for over 30 years. It started out as a program that had one identified station of PCP (EMT) paramedics providing driver services for the Childrens Hospital. In 1976 an adhoc training program began for the individuals which quickly turned into a transport program as a specialty team. Currently the team does all neonatal, maternal and pediatric transports within the province. At present on the neonatal calls, a physician accompanies on about 20% of the transports. A number of team members have also completed the ECMO transport training as well. The training program is close to two years with a significant amount of both clinical and didactic training completed onsite at BC Childrens and Womens. They then move into a mentorship piece that provides a lot of exposure given the volume (2200+). One of our issues is there is actually no designation for the team as they are different than Critical Care Paramedics. For now we call them the Infant Transport Team but that does not really reflect their scope and responsibilities.


Some of the Canadian provinces really do it right, in terms of having designed solid paramedic-led critical care transport systems....I think they really set the standard for paramedics who want to do CCT. To my knowledge there is no place in the US that even comes close to this.

Why in the US do we think it is OK to put clinicians in roles where they transport patient populations with whom they have little or no training and little or no clinical experience? Sorry, but sitting through NRP and spending a 12hr shift in the NICU just doesn't count as "a significant amount of training and experience". PNCCT is probably better but still not even close. Re: the highlighted text above.

I'd say (as would most who have actually worked with neonates) that if you don't have several years of NICU experience, and you haven't completed a training program like what is described above, and you are acting as a primary clinician on a NICU transport team, then you are placing your patients (and yourself, legally) at unnecessary risk...plain and simple.

The same thing can be said about PICU teams (and probably even adult critical care, to be honest...but that's another discussion entirely..).
  • 0
bring it in for the real thing

#28 medic1988

medic1988

    Newbie

  • Members
  • Pip
  • 5 posts

Posted 22 January 2010 - 03:04 PM

Here in Columbus, we, there are 6 of us primary care paramedics, have went through over a year of classroom, didactic, and mentorship, to become primary care paramedics on the transport team. Our job descriptions are the same as the nurse, we administer all meds and perform all necessary procedures like intubation, uac and uvc placement, chest tube insertion, surfactant, and nitric and oscillators. The nurses are always the team leader, which means they do the majority of paperwork and talk to the med control, where we get to do many of the procedures. In fact are skill levels are very good, we tend to get much more hands on then the nurses many times. Our nurses trust us and know we can do the job. Our neonatalogists and ER docs have every confidence in us. As paramedics on this team, our skills and knowledge are equal to any neonatal or pediatric transport nurse. I think that paramedics also have the critical thinking ability that is necessary for transport, something you dont always get with NICU nurses who are used to taking orders from docs and never have to really act quickly and make decisions without the back up of additional help, docs, pharmacy, etc. We are CAMTs accredited and transport both neos and peds, as well as select adults.
  • 0

#29 old school

old school

    Advanced Member

  • Members
  • PipPipPip
  • 1121 posts

Posted 22 January 2010 - 08:44 PM

[quote name='nchmedic' date='22 January 2010 - 10:04 AM' timestamp='1264172694' post='20822']
Here in Columbus, we, there are 6 of us primary care paramedics, have went through over a year of classroom, didactic, and mentorship, to become primary care paramedics on the transport team. Our job descriptions are the same as the nurse, we administer all meds and perform all necessary procedures like intubation, uac and uvc placement, chest tube insertion, surfactant, and nitric and oscillators. [/quote]
That is interesting. If your training program itself is actually over a year long, that is very impressive and may be unique among all the programs in the US. Has there been anything published about your programs' experience?

Do the RN's go through the same training program? I would be interested in the rationale that was used when your program decided to utilize paramedics in this role rather than a second RN or an RRT, which is much more common for NICU transport teams.

[quote]chest tube insertion, surfactant, and nitric and oscillators
[/quote]
You operate nitric and HFOV without an RRT? Do you transport patients on oscillators?

[quote]
I think that paramedics also have the critical thinking ability that is necessary for transport[/quote]
I absolutely agree. I have always been an advocate for paramedics in CCT.

One serious roadblock that paramedicine keep running into though, is that paramedics as a group tend to over-estimate their own capabilities. I know I did before I became a nurse and seriously broadened my clinical experience. Whether one is an EMT-P, an RN, an RRT, or even an MD, we need to recognize when someone else is better prepared to manage a certain patient because we just don't have a background in that population. Unfortunately over the years I've seen very little of this type of candor among paramedics, and frankly I think that is a big part of the reason why the paramedic profession still hasn't gained the credibility that it desires within the greater healthcare community.

[quote]...paramedics also have the critical thinking ability that is necessary for transport, something you dont always get with NICU nurses who are used to taking orders from docs and...[/quote]
This is a common misconception that paramedics have about ICU nurses. Sure there is something to be said for the "street smarts" that you acquire when working as a paramedic, but I know when I worked full-time in an ICU, not only was the acuity of my average patient far, far higher than the average patient I saw on the streets, but I also did far more trouble-shooting and critical thinking than I did on the streets. The actual autonomy was pretty comparable, and I could write a book on the stuff I saw and did and had to think about in the unit that I never saw once on the street. And I don't think my experience is unique - there are many paramedic-turned ICU nurses who would relate similar experiences.


Paramedics certainly have a place in CCT, but it seems as though with the amount of training and education it takes to properly prepare a paramedic for something as specialized as NICU transport, why not just hire a NICU RN or RRT?
  • 0
bring it in for the real thing

#30 GravyMedic

GravyMedic

    Advanced Member

  • Members
  • PipPipPip
  • 165 posts

Posted 22 January 2010 - 11:58 PM

Here in Columbus, we, there are 6 of us primary care paramedics, have went through over a year of classroom, didactic, and mentorship, to become primary care paramedics on the transport team. Our job descriptions are the same as the nurse, we administer all meds and perform all necessary procedures like intubation, uac and uvc placement, chest tube insertion, surfactant, and nitric and oscillators. The nurses are always the team leader, which means they do the majority of paperwork and talk to the med control, where we get to do many of the procedures. In fact are skill levels are very good, we tend to get much more hands on then the nurses many times. Our nurses trust us and know we can do the job. Our neonatalogists and ER docs have every confidence in us. As paramedics on this team, our skills and knowledge are equal to any neonatal or pediatric transport nurse. I think that paramedics also have the critical thinking ability that is necessary for transport, something you dont always get with NICU nurses who are used to taking orders from docs and never have to really act quickly and make decisions without the back up of additional help, docs, pharmacy, etc. We are CAMTs accredited and transport both neos and peds, as well as select adults.


What is the breakdown in hours between classroom vs didactic vs mentorship? How often are you transporting nitric/oscillators? How often are you placing CT's?

And you sound incredibly uneducated by stating that paramedics possess some innate ability to critcally think during transport that not all NICU nurses have. Do you really believe what you write? Please inform us what it is that paramedics possess that allow them this special ability. You imply that there is a lack of consistency from nurse to nurse, but that there is complete uniformity in paramedics when in comes to critical thinking abilities, RUBBISH!. You discredit the enormous amount of hours that nicu nurses spend with their patients, constantly assessing, acting faster than you can probably think, making decisions about things which you have no clue, and then doing it all again, with their other two patients. You sound incredibly new and naive. You seem to lack understanding about what teamwork is. When you havent been there and put in the time, you dont realize what you dont know.
  • 0

#31 medic1988

medic1988

    Newbie

  • Members
  • Pip
  • 5 posts

Posted 23 January 2010 - 03:36 AM

What is the breakdown in hours between classroom vs didactic vs mentorship? How often are you transporting nitric/oscillators? How often are you placing CT's?

And you sound incredibly uneducated by stating that paramedics possess some innate ability to critcally think during transport that not all NICU nurses have. Do you really believe what you write? Please inform us what it is that paramedics possess that allow them this special ability. You imply that there is a lack of consistency from nurse to nurse, but that there is complete uniformity in paramedics when in comes to critical thinking abilities, RUBBISH!. You discredit the enormous amount of hours that nicu nurses spend with their patients, constantly assessing, acting faster than you can probably think, making decisions about things which you have no clue, and then doing it all again, with their other two patients. You sound incredibly new and naive. You seem to lack understanding about what teamwork is. When you havent been there and put in the time, you dont realize what you dont know.



I didn't mean to offend anyone, at least not enough to be called incredibly uneducated. I have several years of experience as a paramedic in the field and as a member of our transport team. So I have been there, and put in the time. So I'm not going to try to justify myself with that. Im not trying to discredit anyone's ability, just was trying to convey what I felt paramedics can bring to this environment. We transport more than 1800 patients per year, one of the busiest teams in the nation. We deal with critically ill neonates on a daily basis. Our nurses, who come from both ED and NICU backgrounds, are the best. I was just trying to state my opinion of what paramedics bring to the table in additon to our nurses. You feel that I discredit NICU nurses, seems to me that you did the same about paramedics. I believe, as do our nurses, that our paramedics assessment and clinical skills that are equal to any of our nurses. It seems as though you have a problem with that concept. And to answer your specific questions..we transport several nitric/oscillators per month, I personallly intubated over 15 neonates last year, perfomed 4 chest tubes, countless abgs, several IO's, amoung other procedires. But its not about that, its about knowing when to do it and doing it quickly and accurately, this is what I feel paramedics can bring to the table. I know thats a hard pill for you to swallow. Take care and feel free to ask anything else, I wont personally attack you, Ill help to educate you.
  • 0

#32 TexRNmedic

TexRNmedic

    Advanced Member

  • Members
  • PipPipPip
  • 257 posts

Posted 23 January 2010 - 04:05 AM

I didn't mean to offend anyone, at least not enough to be called incredibly uneducated. I have several years of experience as a paramedic in the field and as a member of our transport team. So I have been there, and put in the time. So I'm not going to try to justify myself with that. Im not trying to discredit anyone's ability, just was trying to convey what I felt paramedics can bring to this environment. We transport more than 1800 patients per year, one of the busiest teams in the nation. We deal with critically ill neonates on a daily basis. Our nurses, who come from both ED and NICU backgrounds, are the best. I was just trying to state my opinion of what paramedics bring to the table in additon to our nurses. You feel that I discredit NICU nurses, seems to me that you did the same about paramedics. I believe, as do our nurses, that our paramedics assessment and clinical skills that are equal to any of our nurses. It seems as though you have a problem with that concept. And to answer your specific questions..we transport several nitric/oscillators per month, I personallly intubated over 15 neonates last year, perfomed 4 chest tubes, countless abgs, several IO's, amoung other procedires. But its not about that, its about knowing when to do it and doing it quickly and accurately, this is what I feel paramedics can bring to the table. I know thats a hard pill for you to swallow. Take care and feel free to ask anything else, I wont personally attack you, Ill help to educate you.


Well NCHMEDIC, welcome to the big leagues. There are some very bright folks around here that are very passionate about CCT. The best advice I can give is that we need to be at the top of our game in three areas: technical skills, critical thinking skills and interpersonal skills. It sounds like you may have a little work ahead of you in one or more of these areas. Good luck. I can tell you that there is a significant difference in the depth of critical thinking ability and experience level of a paramedic who's vast majority of experience is shuttling patients from point a to b with a team for a couple of hours at a time versus an ICU nurse who consistently takes care of two train-wrecks 12 hours straight, day in and day out. I’m sure your employer has plenty of confidence in you and your team. Just make sure you don’t alienate the other “experts” in the field of CCT. FlightWeb has a tremendous pool of expertise and excellent educators. MDs, RNs, RRTs and EMT-Ps. You could probably learn a hundred things for every one thing you may be able to teach.
  • 0
Wes Seale
Houston , TX

#33 medic1988

medic1988

    Newbie

  • Members
  • Pip
  • 5 posts

Posted 23 January 2010 - 04:12 AM

Well NCHMEDIC, welcome to the big leagues. There are some very bright folks around here that are very passionate about CCT. The best advice I can give is that we need to be at the top of our game in three areas: technical skills, critical thinking skills and interpersonal skills. It sounds like you may have a little work ahead of you in one or more of these areas. Good luck. I can tell you that there is a significant difference in the depth of critical thinking ability and experience level of a paramedic who's vast majority of experience is shuttling patients from point a to b with a team for a couple of hours at a time versus an ICU nurse who consistently takes care of two train-wrecks 12 hours straight, day in and day out. I’m sure your employer has plenty of confidence in you and your team. Just make sure you don’t alienate the other “experts” in the field of CCT. FlightWeb has a tremendous pool of expertise and excellent educators. MDs, RNs, RRTs and EMT-Ps. You could probably learn a hundred things for every one thing you may be able to teach.

I know I can always learn, and look forward to it each day. As im sure you can too. So i see your minimizing what a paramedic does, very professional of you.
  • 0

#34 TexRNmedic

TexRNmedic

    Advanced Member

  • Members
  • PipPipPip
  • 257 posts

Posted 23 January 2010 - 05:07 AM

I know I can always learn, and look forward to it each day. As im sure you can too. So i see your minimizing what a paramedic does, very professional of you.


Bud I'm not going to get baited into a debate on professionalism with you. I suggest you reread what I said. I was a medic long before I was a nurse. I've worked with and learned from some pretty amazing paramedics. However there is a clear difference in the education, experience, scope of practice between a EMT-P versus an RN versus an RRT. Of course with enough education and work each of these areas can cross-train, but one is unlikely to obtain the same level of proficiency without having walked in the same shoes. That is one of the big reasons why so many programs out there use RNs, RRTs and EMT-Ps. Also a big reason why you see so many folks around here that are dual certified/licensed, and I would not hesitate to say why your employer has an RN riding with you. Please be careful how you come across on the forum. There are others around here who will not be as diplomatic with their replies.
  • 0
Wes Seale
Houston , TX

#35 Macgyver

Macgyver

    Advanced Member

  • Members
  • PipPipPip
  • 868 posts

Posted 23 January 2010 - 06:52 AM

Paramedics certainly have a place in CCT, but it seems as though with the amount of training and education it takes to properly prepare a paramedic for something as specialized as NICU transport, why not just hire a NICU RN or RRT?


One reason may be that it can take longer to train a NICU nurse to be a transport provider acting autonomously than to train a medic to work in a NICU and follow standing and direct orders.

Please note that this is a GROSS generalisation, sharp clinicians and dimwits in both professions. But there is a manner of 'cutting to the quick' and isolating essential information and deciding quickly on a course of action / performing invasive skills that is common to good transport clinicians of any background.

And I've met as many ICU nurses who can't make the transition to 'the street' as I have medics who can't transition to 'the unit'

So how about we end the slagging?
  • 0
Ken BHSc, RN, REMT-P

#36 old school

old school

    Advanced Member

  • Members
  • PipPipPip
  • 1121 posts

Posted 23 January 2010 - 01:57 PM

One reason may be that it can take longer to train a NICU nurse to be a transport provider acting autonomously than to train a medic to work in a NICU and follow standing and direct orders.

Please note that this is a GROSS generalisation, sharp clinicians and dimwits in both professions. But there is a manner of 'cutting to the quick' and isolating essential information and deciding quickly on a course of action / performing invasive skills that is common to good transport clinicians of any background.

And I've met as many ICU nurses who can't make the transition to 'the street' as I have medics who can't transition to 'the unit'

So how about we end the slagging?


So you assume also, that paramedics have some innate ability to react to crises quickly and adapt to new environments that other clinicians do not?

I know this idea is commonly agreed upon among paramedics....but it is highly dismissive of the expertise of others and shows ignorance to the autonomy and critical thinking skills that are required to work in an ICU. As I said in a previous post, this hubris/ignorance is a big part of the reason paramedicine has never gained an equal footing in the greater healthcare community in the US.

No one is saying that just because someone has an ICU background then they will automatically make a good transport provider, but this idea that paramedics are always the best choice just because "they can think on their feet better than ICU nurses" is beyond ridiculous.

The typical paramedic "education" in the US is very brief (less than one year) and very focused on the emergent, pre-hospital setting. They learn nothing about neanoates outside of PALS or (maybe) NRP. They do NO clinical in the NICU. Then they go to work in the field and probably never see a single neonate in the field, or maybe they deliver one at some point.


And we have people who are seriously willing to argue that this background, combined with some special, unique ability to "think outside the box" makes them equally qualified to transport neonates from ICU to ICU as an experienced NICU nurse or NICU therapist?

As I said before...I have no doubt that a good paramedic can be trained to do NICU transports, but it would probably take months of specialized training in the NICU and the classroom to get their knowledge even close to where it need to be to do NICU transports, and after all that they still wouldn't have nearly as much experience as the RN or RRT who has worked in the NICU for years.

So if a program wants to invest that kind of time and money to bring a paramedic up to speed so that they an do NICU transports, more power to them, and good for the paramedic, that is a great opportunity!

But personally, I just don't see the point, and so far the only explanation has been "because paramedics think on their feet better". That's great. Highly logical and professional of us.
  • 0
bring it in for the real thing

#37 scottyb

scottyb

    Advanced Member

  • Members
  • PipPipPip
  • 248 posts

Posted 23 January 2010 - 06:27 PM

I know I can always learn, and look forward to it each day. As im sure you can too. So i see your minimizing what a paramedic does, very professional of you.

First things first, my neonamedic friend. I think some English Composition review (i.e. spelling, sentence fragments, dangling modifiers, etc. etc.) should be towards the top of your learning list...
  • 0
Scott Bild RN, FP-C

#38 Macgyver

Macgyver

    Advanced Member

  • Members
  • PipPipPip
  • 868 posts

Posted 23 January 2010 - 09:41 PM

So you assume also, that paramedics have some innate ability to react to crises quickly and adapt to new environments that other clinicians do not?


No one is saying that just because someone has an ICU background then they will automatically make a good transport provider, but this idea that paramedics are always the best choice just because "they can think on their feet better than ICU nurses" is beyond ridiculous.


The typical paramedic "education" in the US is very brief (less than one year) and very focused on the emergent, pre-hospital setting. They learn nothing about neanoates outside of PALS or (maybe) NRP. They do NO clinical in the NICU. Then they go to work in the field and probably never see a single neonate in the field, or maybe they deliver one at some point.


As I said before...I have no doubt that a good paramedic can be trained to do NICU transports, but it would probably take months of specialized training in the NICU and the classroom to get their knowledge even close to where it need to be to do NICU transports, and after all that they still wouldn't have nearly as much experience as the RN or RRT who has worked in the NICU for years.


Actually, my point was more along the lines that just as their are medics with minimal training (like CA and AZ) that know nothing beyond NRP/PALS, there are diploma RN's only suited for nursing homes. And at the other end of the bell curve there are high functioning medics with 2 year AD's (like the whole state of OR) and high functioning nurses (with BN's and clinicals in ICU during training).

Generalisations are not the way to win the argument in any direction - I think we both agree that with appropriate training and experience paramedics can function well, safely and autonomously in the neo/pede transport role. They have been doing so for 30+ years in British Columbia with nary a RN or RRT on the flights, and MD's on only a small percentage.

Having worked both as a medic and a RN, on the street and in the PICU/NICU transport role, it has been my (limited) experience that there is a higher percentage of medics that are willing to undertake the education required to function in that role than there is of RN's who are willing to take on the risks of transport (personally, clinically and profesionaly).

Of course there is a much higher number of RN's to choose from than medics. So it is easy to form the impression that there is no role for / point in training medics when there are more available staffing choices amongst the huge number of ICU nurses who work in the PICU/NICU already.

To simplify the argument (apples to apples): even from a dedicated Pede ER perspective - we'd rather have an adult ER nurse with no ICU experience to train than a PICU or espeially NICU nurse with no ER experience. Not as much to do with knowledge or skill, but the way they think and priorize and keep the flow happening. But a transport nurse (adult or specialty team) rarely takes more than showing them the layout and where stuff is...

As was said in another post:

Keep in mind, I've sat on a hiring panel or two, and what I have learned is; you hire for personality and train for skill.


Any RN or medic with the good critical thinking skills and the appropriate mindset/attitude can be given the necessary didactic, clinical or psychomotor skill training to do the job well. But not just "any medic or RN". Only the small percentage of either group that has the appropriate background and desire.
  • 0
Ken BHSc, RN, REMT-P

#39 GravyMedic

GravyMedic

    Advanced Member

  • Members
  • PipPipPip
  • 165 posts

Posted 24 January 2010 - 02:15 PM

I dont think any of disagree that certain paramedics can function safely in this environment, but is it ideal? I would say no. I dont believe the paramedic brings anything unique or ideal to the table when transporting neo's. Scene calls are a different story, but not IFT's with neo's. Medic0005 cant be more wrong and it's hard to take his post serious when he claims that "But its not about that, its about knowing when to do it and doing it quickly and accurately, this is what I feel paramedics can bring to the table". This isnt something you learn in paramedic school, or passing the NREMT. It's something that is learned through spending countless hours at bedside, constantly assessing your patient, which paramedics simply dont have the oppurtunity to do. Maybe a mentorship and some clinicals, but this does not replace years of bedside experience.

Assuming a nurse is FT working three 12-hour shifts/week, thats 1872 hours/year of bedside experience, performing procedures (intubations/ABG's/IV's), hearing opinions of the docs, watching trending, etc... Most nicu nurses get anywhere from 1-3 pt's, depending on acuity. Also, they help out other nurses, so they get the experience of seeing many patients in one 12-hour shift. This is valuable experience, much more that classroom learning or a mentorship program.

RT's are the same, 1872 hours minimum for FT work. They are often responsible for the whole nicu, which varies but is probably no less that 8 per unit. So, they're seeing roughly 8 pt's/shift for a minimum of 156 shifts/year. Paramedics simply cant get this type of experience, this is what makes the RN/RRT an ideal team for neo's.

These numbers also dont take into account OT shifts and the fact that most nicu rn/rrt's on transport teams probably have a minimum of five years experience.

Im not bashing paramedics, it would make no sense for me to do so. It's just common sense to put the most experienced, highly trained personnel on the transport teams, which is easily the RN and RRT.
  • 0

#40 old school

old school

    Advanced Member

  • Members
  • PipPipPip
  • 1121 posts

Posted 24 January 2010 - 04:36 PM

Just for the record, I am very much in favor of a system where the paramedics receive the type of education and experience that allows them to independently do the specialized critical care transports, like the way it works in some of the Canadian provinces. We just need to be willing to do the education.

I would like to see a masters-level "Critical Care Transport Specialist" degree option become a standard for paramedics or RN's who already possess a 4-year degree and several years of clinical experience, and want to make a career out of CCT and really take the specialty to a whole new level. The program would include not only some didactic science and clinical courses, but would focus on several thousand hours of structured clinical in cath labs, CCU's, NICU's, PICU's, and on RW, FW, and ground ambulances. Completion would grant eligibility to test for certification and to seek state licensure as either an advanced-practice nurse who is intended to be highly autonomous both clinically and legally (very similar to a CRNA) or as a non-nurse advanced-practice provider who is also intended to be autonomous (like a PA).

I think the transport specialty is worthy of this type of structured education. Given the clinical knowledge and competencies that should be possessed by a CCT provider, I think requiring education on par with a PA or ACNP make sense. But I'm getting a little off topic here...
  • 0
bring it in for the real thing