[flightmedic07]

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

[medicRT]

flightmedic07, on Mar 30 2009, 09:08 AM, said:

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

One of Canada's larger provinces (Bristish Columbia) uses a Paramedic staffed "Infant Transport Team". I think that is how they phrase it. I don't know too much about the program personally but have heard it referred to positively.

[x-dhart11]

It is quite rare. STAT Flight, Valhalla NY had paramedics as part of the neonatal team. (RN/PM for ALL populations). It worked quite well, all it takes is training and experience, which they were good enough to offer to us. I learned to like the neo transports on some levels, though they were a pain in the but logistically. But, that's what we do, right?

[yourAVERAGEmedic]

We use a medic as a part of the team, but not as a primary team member. Essentially we become the bag carrier, set up the IV line, and perform the intubation when necessary. The primary team is the typical RN/RT we add the transport RN or medic to the picture on all transports air or ground.

[MSDeltaFlt]

yourAVERAGEmedic, on Mar 30 2009, 09:01 AM, said:

We use a medic as a part of the team, but not as a primary team member. Essentially we become the bag carrier, set up the IV line, and perform the intubation when necessary. The primary team is the typical RN/RT we add the transport RN or medic to the picture on all transports air or ground.

I agree.

[FloridaMedic]

Here is a link to the AAP site which lists all the Specialty Teams for Neo/Peds.

https://www.aap.org/.../DatabaseTM.pdf

If you look lower on the list, you will see the additional services each team/hospital can provide.

The AAP also provides the guidelines for the personnel on a neo/pedi team and the role each performs.

Each state may then use these guidelines to write their statutes for transport. Check your own state's laws pertaining to neonatal transport.

These are the transport guidelines for the state of Florida.

http://www.doh.state...rtStandards.pdf

Here's a link to the teams in the Northwest part of the U.S. Some do have Paramedics on the teams but probably not as a primary.

http://egov.oregon.g...ltyfinal726.pdf


While skills are important, it is the knowlege, education and experience that makes up a great team. Working daily as a bedside primary in the NICU helps prepare you for almost any situation. Since RRTs and RNs work together in these situations everyday, it is easy to do that same care together as a team.

It largely depends on the Level of NICU you are transporting for and the services you want to offer. Level 3 NICUs require more expertise and may offer a variety of specialty treatments that can be done during transport. If the baby or child is low acuity and the sending/rec'g hospital knows that, a specialty team may not be required for transport. Many ALS or even BLS teams do transport babies and children from point A to point B.

The base education for the Canadian Paramedic is much greater than the U.S. and at 3 years it gives them a good foundation to make the transition for more training/education for a neonatal team.

[M Maples]

I'm a ground medic and a flight RT that does neonatal transport and I work in the NICU as a RT. My paramedic experience would never be sufficient to function in the neonatal environment. The education nor the experience gives the paramedic (speaking for the majority of us, but not all of us) a leg to stand on in this environment. How many medics get exposed to Nitric, HFOV, jet ventilation, neonatal intubations, etc., etc,....? This takes years of experience and education, topics that are not covered in a paramedic curriculum or seen on the streets. Unless you have a paramedic that is doing a significant amount of time in an aggressive NICU, I would be careful about placing one on a neonatal team, particularly a paramedic that will play a large role in patient care.

[FloridaMedic]

M Maples, on Mar 30 2009, 09:56 PM, said:

I'm a ground medic and a flight RT that does neonatal transport and I work in the NICU as a RT. My paramedic experience would never be sufficient to function in the neonatal environment. The education nor the experience gives the paramedic (speaking for the majority of us, but not all of us) a leg to stand on in this environment. How many medics get exposed to Nitric, HFOV, jet ventilation, neonatal intubations, etc., etc,....? This takes years of experience and education, topics that are not covered in a paramedic curriculum or seen on the streets. Unless you have a paramedic that is doing a significant amount of time in an aggressive NICU, I would be careful about placing one on a neonatal team, particularly a paramedic that will play a large role in patient care.

And that doesn't even address all the things the RN must also know for titrating the drips to allow the advanced technology or meds/gases to do their intended purposes for specific disease processes and the quick actions that must sometimes be taken. This is accomplished by years of experience and taking care of hundreds or thousands of babies. It must become second nature to you. You can compare it to running through the ACLS protocols many times but with infants, each disease process will vary and each protocol has guidelines to deviate from some protocols as the baby's condition warrant. Stabilizing some infants just defy whatever is written in the textbooks. Only your advanced knowledge and experience will get the baby transported alive to the receiving hospital.

[JLP]

The base education for the Canadian Paramedic is much greater than the U.S. and at 3 years it gives them a good foundation to make the transition for more training/education for a neonatal team.
[/quote]

As much as the kudos are nice, the reality is that most of the curriculum time (2 academic years) for "paramedic" here in Canada refers to Primary Care Paramedic, which is really a better-educated BLS/SAED/special skills level, and much of this time is not, in my opinion, well spent. Land ALS training is quite short, which is why transitioning to air is a long process in Ontario at least - transforming skills-trained reactive medics to, hopefully, critical thinking clinicians. While I suspect that more of our ALS medics have the basic education to at least be able to start the process than yours, simply due to more time spent on basic theory as you say, I sincerely doubt that more than 10-20% of medics here are remotely ready to be educated up to a neonatal team level, although I would like to think that a good percentage of our critical care medics could make the transition. I would sure want a lot of re-education and NICU time before I took on critical care neonate transport.

[Macgyver]

FloridaMedic, on Mar 30 2009, 08:32 PM, said:

And that doesn't even address all the things the RN must also know for titrating the drips to allow the advanced technology or meds/gases to do their intended purposes for specific disease processes and the quick actions that must sometimes be taken. This is accomplished by years of experience and taking care of hundreds or thousands of babies. It must become second nature to you. You can compare it to running through the ACLS protocols many times but with infants, each disease process will vary and each protocol has guidelines to deviate from some protocols as the baby's condition warrant. Stabilizing some infants just defy whatever is written in the textbooks. Only your advanced knowledge and experience will get the baby transported alive to the receiving hospital.

As mentioned earlier, BCAS runs a dual paramedic Infant Transport Team - and has done so for well over a decade. Dual medic, no RN, ovccasionally an MD may choose to accompany. Great outcomes documented in research (Dr. Andy McNabb I think authored several)

All it takes is an absence of politics and proper educational background, training, ongoing education and ICU experience. Of course it helps to start with AD prepared medics that have 3 years or more of ALS experience and 6+ years on the road before being accepted for the 12-18 months of additional training...
Randy (MedicWest) can fill in and correct me here I am sure.

[Macgyver]

JLP, on Mar 30 2009, 08:52 PM, said:

As much as the kudos are nice, the reality is that most of the curriculum time (2 academic years) for "paramedic" here in Canada refers to Primary Care Paramedic, which is really a better-educated BLS/SAED/special skills level, and much of this time is not, in my opinion, well spent.

True for Ontario and Quebec, not so in the west. Their 2 year college programs require you to be a practicing EMT-I/PCP (US term/CDN term) which in turn require you to be a practicing EMT/EMR which in total takes at least a year. Many require actual work experience as well at a given level (especially in BC) So 3 years to ACP/EMT-P (6 in BC) The Alberta programs end up between ACP and CCP so the CCP upgrade is more a matter of obtaining hospital clinical experience as the education (ground and flight) is already completed. The advantage is that every ground 911 medic has the educational background to become a CCP if they want to go that route. Maybe 10-15% actually do so eventually.

JLP, on Mar 30 2009, 08:52 PM, said:

Land ALS training is quite short, which is why transitioning to air is a long process in Ontario at least - transforming skills-trained reactive medics to, hopefully, critical thinking clinicians. While I suspect that more of our ALS medics have the basic education to at least be able to start the process than yours, simply due to more time spent on basic theory as you say, I sincerely doubt that more than 10-20% of medics here are remotely ready to be educated up to a neonatal team level, although I would like to think that a good percentage of our critical care medics could make the transition. I would sure want a lot of re-education and NICU time before I took on critical care neonate transport.

I misspoke earlier - the BCAS Infant Transport Team (which also does pediatrics) has been around for almost 33 years. Looking at some of their pics, seems most of the medics are well past their 30's which also speakes to experienced clinicians with critical thinking skills...

http://www.bcas.ca/a...bg-bcas-itt.pdf
http://www.bcas.ca/E...-milestone.html
http://www.bcas.ca/a...s-milestone.pdf
http://www.bcas.ca/E...sport-team.html
http://www.bcas.ca/E.../resources.html
http://www.bcas.ca/E...sport-team.html

[FloridaMedic]

Macgyver, on Mar 30 2009, 11:02 PM, said:

As mentioned earlier, BCAS runs a dual paramedic Infant Transport Team - and has done so for well over a decade. Dual medic, no RN, ovccasionally an MD may choose to accompany. Great outcomes documented in research (Dr. Andy McNabb I think authored several)

I already gave my kudos to the Canadians. See my eariler post and that was also my comment that JLP was referring to.

My comments are toward the U.S. system which is very different in its educational preparation.

However, I don't know how advanced in technology your equivalent of our Level 3 NICUs are either. That has a great influence on the type of providers used.

[Macgyver]

FloridaMedic, on Mar 30 2009, 08:34 PM, said:

However, I don't know how advanced in technology your equivalent of our Level 3 NICUs are either. That has a great influence on the type of providers used.

Same-Same. NO, Heliox (rare), HFOV, ECMO etc etc - biggest difference seems to be since fewer level 3's and all tertiary regionalised referral centers there are not as many IFT's of the sick-sick. IE: ECMO transfers etc. However pickups of newborns from outlying hospitals that require high frequency or NO are relatively common.

[JLP]

[quote name='Macgyver' date='Mar 30 2009, 11:22 PM' post='16988']
True for Ontario and Quebec, not so in the west. Their 2 year college programs require you to be a practicing EMT-I/PCP (US term/CDN term) which in turn require you to be a practicing EMT/EMR which in total takes at least a year. Many require actual work experience as well at a given level (especially in BC) So 3 years to ACP/EMT-P (6 in BC) The Alberta programs end up between ACP and CCP so the CCP upgrade is more a matter of obtaining hospital clinical experience as the education (ground and flight) is already completed. The advantage is that every ground 911 medic has the educational background to become a CCP if they want to go that route. Maybe 10-15% actually do so eventually.
I misspoke earlier - the BCAS Infant Transport Team (which also does pediatrics) has been around for almost 33 years. Looking at some of their pics, seems most of the medics are well past their 30's which also speakes to experienced clinicians with critical thinking skills...

You are correct of course - typical Toronto boy I am, forgetting that there actually is a Canada outside of Ontario. I have long said that the Alberta model of ACP education is better than ours here in Ontario, which is likely part of the reason that our ALS land-to ALS flight and then to CCP transition is so long. Thanks for clarifying.

[LearRRT-CCEMTP]

M Maples, on Mar 30 2009, 08:56 PM, said:

I'm a ground medic and a flight RT that does neonatal transport and I work in the NICU as a RT. My paramedic experience would never be sufficient to function in the neonatal environment. The education nor the experience gives the paramedic (speaking for the majority of us, but not all of us) a leg to stand on in this environment. How many medics get exposed to Nitric, HFOV, jet ventilation, neonatal intubations, etc., etc,....? This takes years of experience and education, topics that are not covered in a paramedic curriculum or seen on the streets. Unless you have a paramedic that is doing a significant amount of time in an aggressive NICU, I would be careful about placing one on a neonatal team, particularly a paramedic that will play a large role in patient care.

I completely agree with this statement. You need significantly more experience than the average paramedic has. I don't care how much training a person receives you CANNOT replace years of critical care experience! The average paramedic does not work in a NICU obtaining the skills and knowledge needed. I don't know the actual percentages but I would guess that >70% of the neonatal teams out there are RN/RRT.

[medicRT]

LearRRT-CCEMTP, on Mar 31 2009, 09:59 AM, said:

I completely agree with this statement. You need significantly more experience than the average paramedic has. I don't care how much training a person receives you CANNOT replace years of critical care experience! The average paramedic does not work in a NICU obtaining the skills and knowledge needed. I don't know the actual percentages but I would guess that >70% of the neonatal teams out there are RN/RRT.

I will add my name to this list as well.

There are many interventions that are not part of street medic practice. Chest tubes, Therapeutic Hypothermia, HFOV, NO, Cerebral Function Monitors as well as whole new vasoactice and niche medications (prostaglandin, surfactant).

This is not a knock against medics. " You do well that which you do often " is one of my top five medical quotes ever and I think the learning curve would be almost as steep for critical care RNs and RRTs from non-neonatal / pediatric environments but clearly it can be done (BCAS as an example) if you dedicate enough resources.

[intub8]

I am not going to join the debate. I think that everyone has valid points and can argue both sides of the coin. I will just say that our program uses an RN/EMTP team for all of our transports. This includes mico-premi and pediatric.

I would hate to think that any of us really thought that neonatal transport was really beyond the scope of a paramedic...

Fly Safe,

[scottyb]

intub8, on Apr 1 2009, 08:03 PM, said:

I am not going to join the debate. I think that everyone has valid points and can argue both sides of the coin. I will just say that our program uses an RN/EMTP team for all of our transports. This includes mico-premi and pediatric.

I would hate to think that any of us really thought that neonatal transport was really beyond the scope of a paramedic...

Fly Safe,

When you REALLY look at the history, scope and purpose of paramedics (paramedicine), yes, neonatal transport is beyond the scope of a paramedic. Period. Neonatal nurse and RT specializing in neonates is the essential crew/expertise needed.

[LearRRT-CCEMTP]

intub8, on Apr 1 2009, 08:03 PM, said:

I am not going to join the debate. I think that everyone has valid points and can argue both sides of the coin. I will just say that our program uses an RN/EMTP team for all of our transports. This includes mico-premi and pediatric.

I would hate to think that any of us really thought that neonatal transport was really beyond the scope of a paramedic...

Fly Safe,

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!

[flygirl]

flightmedic07, on Mar 30 2009, 08:08 AM, said:

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

Our designated neonatal/pediatric transport team consists of a RN and a RRT.