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#1 Thinking

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Posted 20 May 2009 - 03:11 AM

Greetings,

I am wondering who else does ground CCT with a two person crew? Our land side (we run RW, FW and land) runs a two medic critical care transport model, with interfacility transports ranging from 25 minutes up to 2+ hours, often with complex patients. Both medics package the patient and prepare them for the transport, however, the truck can't drive itself, so it is a single provider in the back. Is this common? Does CAMTS have a position on this? I look forward to hearing about other programs and how they run in this regard.

Thanks
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#2 Flightmedic317

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Posted 20 May 2009 - 11:03 PM

Greetings,

I am wondering who else does ground CCT with a two person crew? Our land side (we run RW, FW and land) runs a two medic critical care transport model, with interfacility transports ranging from 25 minutes up to 2+ hours, often with complex patients. Both medics package the patient and prepare them for the transport, however, the truck can't drive itself, so it is a single provider in the back. Is this common? Does CAMTS have a position on this? I look forward to hearing about other programs and how they run in this regard.

Thanks


Hello,

It honestly does depend on the state in which you reside. You are from Canada so I am not sure how the set-up would work. I came from a state that had the same set-up as you described with 2 paramedics who worked on a critical care truck. If you were to ask CAMTS or even UMBC, they suggest an EMT driver, Paramedic and RN composition in the back. It offers the best of both worlds.. I honestly wouldn't pass up the idea of having an RT for any patient on a vent. Thats just for regular adult transports.. now if you are going to talk neo, its a whole other ball game!

Hope that helps...

-J
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Justin, NREMT-P, CCEMT-P, EMS I/C
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#3 Macgyver

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Posted 21 May 2009 - 05:31 AM

Greetings,

I am wondering who else does ground CCT with a two person crew? Our land side (we run RW, FW and land) runs a two medic critical care transport model, with interfacility transports ranging from 25 minutes up to 2+ hours, often with complex patients. Both medics package the patient and prepare them for the transport, however, the truck can't drive itself, so it is a single provider in the back. Is this common? Does CAMTS have a position on this? I look forward to hearing about other programs and how they run in this regard.

Thanks


I'm guessing you're with ORNGE. In Alberta this is common - as we don't really have designated CCT rigs, any ALS rig has medics trained to the CCP level although few will run CC IFT's with an EMT/Medic crew many will do so with a dual medic crew as you describe. Occasionally a RN or RT (small pede's) may come from sending facility - less now with OT restrictions and in-hospital staff shortages.
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#4 KingAir vs. PolarBear

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Posted 21 May 2009 - 04:59 PM

I'm guessing you're with ORNGE. In Alberta this is common - as we don't really have designated CCT rigs, any ALS rig has medics trained to the CCP level although few will run CC IFT's with an EMT/Medic crew many will do so with a dual medic crew as you describe. Occasionally a RN or RT (small pede's) may come from sending facility - less now with OT restrictions and in-hospital staff shortages.



It is my experience in Alberta that most "critical care" type patient transports are taken by air, regardless of the distance. The method of transport is typically RW via STARS with a RN/EMT-P crew +/- a MD, or FW with a EMT-P/EMT-P or EMT-P/EMT crew. Obviously the closer in to a major center (Edmonton or Calgary) the more likely the RW route would be used. There is almost always at least 2 people caring for these sick patients during the transport phase of their journey.

While the Alberta EMT-P is prepared to handle critical care type patients, I find that most ground services don't provide their staff with the equipment to really pull it off. You simply won't find any invasive pressure monitoring capability, any complex transport vent capability, nor any multi-channel infusion capability on an average ground ambulance in Alberta. There are of course exceptions (Banff EMS for example has access to a Newport HT50 vent and multi-channel pumps) but for the most part, your regular ALS rig in Alberta does not have the tools to really manage the sickest of the sick for a long period of time. Your air programs however, do.

Hence the well developed, robust air transport system.
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Further north than you!


#5 ST RN/PM

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Posted 31 May 2009 - 03:07 AM

Thinking,
Hey! To give you some perspective, we in New Jersey (USA) have been known to do two person transports. Depending on the program that you work for here in the Garden State, crew configuration (by ground) is either RN/PM, RN/PM/EMT, RN/RN.....the minimum requirements are an RN and 2 EMTs......if the RN is either an EMT-Basic or EMT-Paramedic, then the crew can be RN/EMT. Often, there are two person crews. For Critical Care transport in NJ, an RN is required to be in the back with the patient. For two of the projects that I work, we mostly move relatively stable patients, but a few times/week, are managing complex patients. Programs usually have a plan for meeting the needs of these sick patients....plans that sometimes fail (an example would be that, on paper, when a patient is complex, an additional provider (EMT/paramedic/RN) will be pulled from "somewhere" to complement the crew). I say on paper because, in reality, we are often told by dispatchers that "there is noone available". This results in one of three situations: The RN is doing the call by themselves, the call is delayed until additional personnel are assembled, or the run is turned down. Definitely an imperfect system.
There are projects that run the EMT driver, RN/PM in the back, and this wirkes out the best for all in my opinion. All rotor-wing programs in this state are RN/PM to the best of my knowledge. There are no single or dual paramedic units that operate within this state doing critical care transport. The NJ regulations do not allow this.
As far as CAMTS goes, I am unsure, and don't want to speak out of school. Any input from other Jersey peeps?
Hope this helps..... Steve
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#6 Tmed725

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Posted 31 May 2009 - 04:38 PM

Thinking,
Hey! To give you some perspective, we in New Jersey (USA) have been known to do two person transports. Depending on the program that you work for here in the Garden State, crew configuration (by ground) is either RN/PM, RN/PM/EMT, RN/RN.....the minimum requirements are an RN and 2 EMTs......if the RN is either an EMT-Basic or EMT-Paramedic, then the crew can be RN/EMT. Often, there are two person crews. For Critical Care transport in NJ, an RN is required to be in the back with the patient. For two of the projects that I work, we mostly move relatively stable patients, but a few times/week, are managing complex patients. Programs usually have a plan for meeting the needs of these sick patients....plans that sometimes fail (an example would be that, on paper, when a patient is complex, an additional provider (EMT/paramedic/RN) will be pulled from "somewhere" to complement the crew). I say on paper because, in reality, we are often told by dispatchers that "there is noone available". This results in one of three situations: The RN is doing the call by themselves, the call is delayed until additional personnel are assembled, or the run is turned down. Definitely an imperfect system.
There are projects that run the EMT driver, RN/PM in the back, and this wirkes out the best for all in my opinion. All rotor-wing programs in this state are RN/PM to the best of my knowledge. There are no single or dual paramedic units that operate within this state doing critical care transport. The NJ regulations do not allow this.
As far as CAMTS goes, I am unsure, and don't want to speak out of school. Any input from other Jersey peeps?
Hope this helps..... Steve

So Steve,
No love for Pennsylvania your other home away form home??
In the keystone state no specific license is available for critical or specialty care transport, just ALS and BLS. With that said If you throw a RN on your ALS unit you may do all the stuff above the paramedic level that the RN practice act allows. Also a sending facility could toss a RN and or Doc on a BLS unit and do the transport. If the RN is also a PHRN only a EMT is required to fill out the crew for ALS. The specific drug list and scope of practice for EMT, Medic, and PHRN is available at http://www.dsf.healt...c...70&q=236204. Most places that I know of would not do a truly complex (unstable, IABP, etc) sick patient with just one provider in the back. Our program has both a 24-7 ALS (EMT/Medic only) and SCT (EMT/Medic/RN) Complexity and stability dictate who does what...
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#7 azflyer74

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Posted 29 June 2009 - 02:11 AM

I work for private ambulance in NV as a CCT medic and we run with one medic & one EMT-I. When we encounter a patient on an IABP, ECMO etc, then a perfusionist will come along for the ride. We are not CAMTS but we are CAAS certified, but not sure how they fall into place???
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#8 Michael Berrier

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Posted 05 July 2009 - 12:30 PM

Regarding CAMTS, you only need worry about them if you are/want to be accredited, which is completely voluntary. Having said that, they offer a tiered accreditation based on your capabilities, configuration etc. The two levels that concern this issue are ALS and Critical Care. According to them, a Critical Care transport team has to meet two criteria: 1)Anchored by an RN, and 2), staffed by a second caregiver who is either an RN or some other advanced care provider (EMT-P, RT, PA, MD, NNP) and a driver/pilot). This assures two clinicians providing care at all times and a third party handling transportation. An ALS transport according to CAMTS is anchored by a paramedic and may be single paramedic and a driver or two medics, but by their standard, is not defined as Critical Care. The caveat here, of course, is that you are under no obligation to seek this accreditation unless compelled by local law or your own organization.

Hope this helps,
mb
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#9 Macgyver

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Posted 08 July 2009 - 09:29 AM

According to them, a Critical Care transport team has to meet two criteria: 1)Anchored by an RN


Actually - not any more. can have a dual paramedic team as long as the training and education is at a specified level (see their website and download the standards for more info)
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Ken BHSc, RN, REMT-P