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#1 CVICURN

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Posted 22 May 2012 - 11:52 PM

Hey all, I just accepted my first position in transport. I'll be doing inter-facility CC transports as a RN. I've never worked outside of a hospital before, any advice for me? I worked a couple years in a CVCIU and am currently working in shock trauma. I've not earned my EMT yet, but class starts in August. I'm hoping that this experience will be a good stepping stone into rotorwing or fixed wing transports. Thanks for the help.
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#2 old school

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Posted 04 June 2012 - 02:50 PM

Take the time to learn your protocols and policies well. Even once you know those things, keep references handy and know what to look up where. A smartphone or tablet is perfect for this, but a plain old binder with a calculator stuffed in the pocket works fine, too.

Make it a point to get to know your medical director and/or medical control docs a little. Not to kiss up, but because when the time comes for you to use your judgement in a complicated scenario, they need to know your not an idiot.

Take the time to learn your ambulance and equipment inside and out. This sounds like a no-brainer, but you'd be surprised how many in transport can't find things in their own vehicles and can't troubleshoot their vents or pumps or onboard air conditioners and oxygen systems and stretchers. Don't be that guy.

Know when going lights & sirens will save time and when it won't. This requires you to know the routes and traffic patterns in the area where you transport pretty well, as well as keeping in mind that even with L&S on, you still can't really drive faster than normal, and you still have to stop completely at every intersection. Even when it will save time, consider the clinical necessity of getting to the receiving hospital slightly quicker. Is saving 5 or 10 minutes really going to improve your patient's outcome? Is it really worth the reported (something like 40x) increase in odds of being involved in an MVC during transport? Rapid transport is what helos are for. Slow and deliberate movement of critically ill, fragile, complicated ICU patients who require a lot of equipment but who aren't particularly-time sensitive is what ground CCT is for.

Your won't learn much clinically in your EMT course, but the "operations" sections will be helpful. View the course as a very basic, general, "Intro to out-of-hospital-care". Much of it will be very boring and not relevant to CCT, but try to get as much out of it as you can. It's a networking opportunity, an intro to your new career, a chance to learn a little about EMS operations and backboards and splints, a chance to represent RN's and transport RN's to a bunch of new EMT's, and a chance to maybe share some clinical knowledge. Be positive about it.

As a RN with a lot of ICU experience, you have a lot of knowledge to share with others who also work in transport but don't have the clinical background that you do. Teaching and sharing your knowledge is very important, but too many people can't do it without coming off as a know-it-all. Don't be that guy.

We have enough cocky, high-strung flight-suit-model prima donnas. Don't be that guy, either.

Finally, ground CCT is a specialty in itself, with lots to learn and lots of interesting stuff to do. It's totally cool if you want to eventually get into flying, but don't treat the job and the people you work with as mere stepping stones. It's just bad form. Remember, you gotta dance with the one that brung ya'.

Enjoy your job and appreciate it. Be laid back. Be a resource to others. Be someone others want to work with. Be someone the referring hospital staff is glad to see wheeling his stretcher and equipment through the entrance to their unit an hour after they call for transport.

Good luck, and congrats on the new job.
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bring it in for the real thing

#3 CVICURN

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Posted 27 June 2012 - 03:02 AM

Take the time to learn your protocols and policies well. Even once you know those things, keep references handy and know what to look up where. A smartphone or tablet is perfect for this, but a plain old binder with a calculator stuffed in the pocket works fine, too.

Make it a point to get to know your medical director and/or medical control docs a little. Not to kiss up, but because when the time comes for you to use your judgement in a complicated scenario, they need to know your not an idiot.

Take the time to learn your ambulance and equipment inside and out. This sounds like a no-brainer, but you'd be surprised how many in transport can't find things in their own vehicles and can't troubleshoot their vents or pumps or onboard air conditioners and oxygen systems and stretchers. Don't be that guy.

Know when going lights & sirens will save time and when it won't. This requires you to know the routes and traffic patterns in the area where you transport pretty well, as well as keeping in mind that even with L&S on, you still can't really drive faster than normal, and you still have to stop completely at every intersection. Even when it will save time, consider the clinical necessity of getting to the receiving hospital slightly quicker. Is saving 5 or 10 minutes really going to improve your patient's outcome? Is it really worth the reported (something like 40x) increase in odds of being involved in an MVC during transport? Rapid transport is what helos are for. Slow and deliberate movement of critically ill, fragile, complicated ICU patients who require a lot of equipment but who aren't particularly-time sensitive is what ground CCT is for.

Your won't learn much clinically in your EMT course, but the "operations" sections will be helpful. View the course as a very basic, general, "Intro to out-of-hospital-care". Much of it will be very boring and not relevant to CCT, but try to get as much out of it as you can. It's a networking opportunity, an intro to your new career, a chance to learn a little about EMS operations and backboards and splints, a chance to represent RN's and transport RN's to a bunch of new EMT's, and a chance to maybe share some clinical knowledge. Be positive about it.

As a RN with a lot of ICU experience, you have a lot of knowledge to share with others who also work in transport but don't have the clinical background that you do. Teaching and sharing your knowledge is very important, but too many people can't do it without coming off as a know-it-all. Don't be that guy.

We have enough cocky, high-strung flight-suit-model prima donnas. Don't be that guy, either.

Finally, ground CCT is a specialty in itself, with lots to learn and lots of interesting stuff to do. It's totally cool if you want to eventually get into flying, but don't treat the job and the people you work with as mere stepping stones. It's just bad form. Remember, you gotta dance with the one that brung ya'.

Enjoy your job and appreciate it. Be laid back. Be a resource to others. Be someone others want to work with. Be someone the referring hospital staff is glad to see wheeling his stretcher and equipment through the entrance to their unit an hour after they call for transport.

Good luck, and congrats on the new job.


High quality advice as always old school. I am taking your advice to heart. Each day, I run through my equipment check offs, then I sit in the seat and mentally run through some scenarios. Pt needs suctioned, where is that equipment? Pt is arresting, what drawer is the epi in? Pt is going to throw up, where is the emesis bag? It's helped me to become more familiar with the environment and therefore more comfortable. I just got off orientation and my first solo call is a full arrest. Not an easy start, but it allowed me to face some of my fears about transport. What I didn't expect was to gain such a respect for prehospital professionals and what they do. I'm also learning about dealings with sending and receiving facilities. It pays to be polite and appreciative in all the dealings with them. Many times when you enter the room of a sick patient, the nurse will look to you for guidance. If I roll in panicking and freaking out, that sets the tone. Likewise, if I roll in ticked off that they woke me up at 2am, it leaves them with a negative impression. If you roll in with a smile, free pens, and doughnuts though, you are a saint! Anyway, thank you for the advice. I'll be sure to pay it forward.
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#4 CVICURN

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Posted 04 March 2014 - 05:02 AM

I saw my old post and I thought I'd type a quick follow up with lessons learned.

Know your protocols! Seriously saved my behind so many times!

Check your equipment! I'm not afraid to admit I've trusted others to check things and been caught empty handed. Lesson learned! There is no central supply room to run to on the road.

Trust your partner, but do not be afraid to question them. We ran a medic/RN configuration. Many of my coworkers had 10+ years experience on me, so I had a lot of trust in them. Regardless, there were times when I had to challenge their calls on things. Sometimes I was right, many times I was wrong, but I spoke my mind.

If something feels unsafe or you are uncomfortable with it, stick to your guns and say NO! I had the unfortunate experience of having to tell my superiors no to a transport due to unsafe conditions. It did not go over well and led to me eventually leaving the company on my own accord. Despite this, I never have regretted my decision. No job is worth your life.

These are a few of many lessons I learned in my time in transport. Hopefully I will get back into the field in the future. I hope these tips help someone out there in a similar position.
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#5 mcknis

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Posted 13 June 2014 - 12:33 AM

I just started with a local EMS company who also does MICU. It is a family run organization, but I have quickly realized this is not always what it is cracked up to be. The owners are disorganized and the rest of the members appear to be just as unorganized. I am only working with them as an on-call employee and there are 2 other nurses who work at the same company (they are in the family, however), but the turnover at this company is very high. Most employees stay less than a year. I have also seen this same company allow their employees to do MICU runs with only a medic and an EMT driver with blood or insulin infusing when it was specifically ordered by an MD to have an RN on board. There are also no professional uniform standards. I understand some of these are minimal issues, but some of the others are too big to overlook. I am hoping that some of these issues will resolve/change, but I am trying to give the company the time of day. I hope to not be another turnover statistic, but some of the things I have seen will probably cause me to be one.


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