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Valued Paramedics


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#1 sr_medic

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Posted 12 March 2013 - 07:03 AM

Hello All,
I'm hoping you can share with me some programs you either work for or have worked with, that value paramedic's as an "equal" member of the interdisciplinary treatment team. As I get further into my career, I am finding there is a broad range of opinions when it comes to paramedics working in the inter facility/critical care transport environment. My hope is to someday work for a CCT program (RW/FW/Ground) that utilizes paramedics as an equal member of the RN/PM team. You are welcome to post, or PM me; either way- your comments are greatly appreciated.

Thanks!
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D.F., BS, NREMT-P, FP-C

"Body and soul cannot be separated for purposes of treatment, for they are one and indivisible. Sick minds must be healed as well as sick bodies." -C. Jeff Miller

#2 BrianACNP

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Posted 12 March 2013 - 04:09 PM

Hello All,
I'm hoping you can share with me some programs you either work for or have worked with, that value paramedic's as an "equal" member of the interdisciplinary treatment team. As I get further into my career, I am finding there is a broad range of opinions when it comes to paramedics working in the inter facility/critical care transport environment. My hope is to someday work for a CCT program (RW/FW/Ground) that utilizes paramedics as an equal member of the RN/PM team. You are welcome to post, or PM me; either way- your comments are greatly appreciated.

Thanks!


Instead of looking at ways to be viewed as equals, why not look at the strengths that paramedics bring to the multiprofessional team? I will quickly concede that generalizations about paramedics are out there...no doubt. The best thing you and other paramedics can do is to learn your job and learn it well. Recognize that the interfacility environment (ICU transfers, etc) is typically more of a domain for nursing and where nursing will excel more just as a prehospital provider will excel in the prehospital environment much more than the nurse. You gain respect by learning and demonstrating what you know. Back in the day when I knew flight paramedics in the different locales where I worked, the paramedics with extended knowledge were highly regarded. Respect is not given to you...it's earned.

Brian
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#3 ForeverLearning

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Posted 12 March 2013 - 07:17 PM

Instead of looking at ways to be viewed as equals, why not look at the strengths that paramedics bring to the multiprofessional team? I will quickly concede that generalizations about paramedics are out there...no doubt. The best thing you and other paramedics can do is to learn your job and learn it well. Recognize that the interfacility environment (ICU transfers, etc) is typically more of a domain for nursing and where nursing will excel more just as a prehospital provider will excel in the prehospital environment much more than the nurse. You gain respect by learning and demonstrating what you know. Back in the day when I knew flight paramedics in the different locales where I worked, the paramedics with extended knowledge were highly regarded. Respect is not given to you...it's earned.

Brian


Would it not make more sense to work on your weaker areas so there is no disparity? If you know that your ICU management is a weak point, why not devote time and effort to getting rotations and education to be if not on par with ICU nurse but narrow the gap so to speak?

If on scene response the medic has to coach the nurse and in ICU setting the nurse has to coach the medic it seems both would benefit on strengthening their weak points?
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#4 old school

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Posted 12 March 2013 - 11:35 PM

Hello All,
I'm hoping you can share with me some programs you either work for or have worked with, that value paramedic's as an "equal" member of the interdisciplinary treatment team. As I get further into my career, I am finding there is a broad range of opinions when it comes to paramedics working in the inter facility/critical care transport environment. My hope is to someday work for a CCT program (RW/FW/Ground) that utilizes paramedics as an equal member of the RN/PM team. You are welcome to post, or PM me; either way- your comments are greatly appreciated.

Thanks!


Every HEMS program I've been familiar that flew with RN's and EMTP's had both disciplines complete the same training, follow the same protocols, perform the same skills, and be accountable to the same standards.

I'm sure there are some that aren't like that, but there's a lot that are.

You are welcome to PM me for specific program names.
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#5 Jwade

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Posted 13 March 2013 - 12:26 AM

Every HEMS program I've been familiar that flew with RN's and EMTP's had both disciplines complete the same training, follow the same protocols, perform the same skills, and be accountable to the same standards.

I'm sure there are some that aren't like that, but there's a lot that are.

You are welcome to PM me for specific program names.



Agree with Old School I do..... Any program not treated as equals stay far away from. Not worth your time, effort or risk to your life. More than likely has a terrible safety culture to go along with their holier than thou attitudes.

Good Luck.

JW
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John Wade MBA, CCEMT-P, FP-C, RN

"Have the courage to follow your heart and intuition, they somehow already know what you truly want to become" Steve Jobs

#6 BrianACNP

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Posted 13 March 2013 - 01:43 AM

Agree with Old School I do..... Any program not treated as equals stay far away from. Not worth your time, effort or risk to your life. More than likely has a terrible safety culture to go along with their holier than thou attitudes.

Good Luck.

JW


Just for clarity from my standpoint, there's a difference between being treated as equal professionals and playing to clinical strengths and strengthening weaknesses. Everyone should be treated equally as a flight crew member. No one member should have more clout than the other. Having clinical respect is another. I have fellow NP/PAs in my practice who I do not treat as clinical equals until they gain some experience under their belt or at least proven they can handle clinical situations, thereby gaining respect. The critical care transport environment should not be any different.

Brian
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#7 Jwade

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Posted 13 March 2013 - 01:48 AM

Just for clarity from my standpoint, there's a difference between being treated as equal professionals and playing to clinical strengths and strengthening weaknesses. Everyone should be treated equally as a flight crew member. No one member should have more clout than the other. Having clinical respect is another. I have fellow NP/PAs in my practice who I do not treat as clinical equals until they gain some experience under their belt or at least proven they can handle clinical situations, thereby gaining respect. The critical care transport environment should not be any different.

Brian



Agreed, and probably the same way you had to earn the respect from your Attending M.D.'s......when you started working as an NP in the SICU.
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John Wade MBA, CCEMT-P, FP-C, RN

"Have the courage to follow your heart and intuition, they somehow already know what you truly want to become" Steve Jobs

#8 BrianACNP

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Posted 13 March 2013 - 02:20 AM

Agreed, and probably the same way you had to earn the respect from your Attending M.D.'s......when you started working as an NP in the SICU.


Yep......we've all been there at some point.
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Brian, MSN, ACNP, CCRN

#9 old school

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Posted 13 March 2013 - 01:09 PM

Agree with Old School I do..... Any program not treated as equals stay far away from. Not worth your time, effort or risk to your life. More than likely has a terrible safety culture to go along with their holier than thou attitudes.

Good Luck.

JW


Not sure how you come to that conclusion.

The last program I worked for flew RN/RRT or RN/RN on both RW and FW. We had paramedics but they only worked ground. And by ground I mean, mostly ALS interfacilities or driving for an RN/RRT or RN/RN crew doing CCT. The paramedics also do CCT's with an RN partner, but I think they spend a little more time in the driver's seat than in the back. Same training and protocols as the RN's.

It's probably not someplace I would be satisfied working as a paramedic - and I don't think it's the kind of place the OP is looking for - but the paramedics aren't poorly treated at all, and many of them have been there quite a while. It's a good place to be if you don't need to fly but you want to transport a lot of sick patients, and also a good job to have while you are going to school or while you are taking your time searching for a really good position as a flight paramedic.

Anyway, this program has by far the best safety culture & safety record of the 3 that I've worked at, and no one has a "holier than thou" attitude towards anyone else.
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#10 Jwade

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Posted 13 March 2013 - 04:34 PM

Not sure how you come to that conclusion.

The last program I worked for flew RN/RRT or RN/RN on both RW and FW. We had paramedics but they only worked ground. And by ground I mean, mostly ALS interfacilities or driving for an RN/RRT or RN/RN crew doing CCT. The paramedics also do CCT's with an RN partner, but I think they spend a little more time in the driver's seat than in the back. Same training and protocols as the RN's.

It's probably not someplace I would be satisfied working as a paramedic - and I don't think it's the kind of place the OP is looking for - but the paramedics aren't poorly treated at all, and many of them have been there quite a while. It's a good place to be if you don't need to fly but you want to transport a lot of sick patients, and also a good job to have while you are going to school or while you are taking your time searching for a really good position as a flight paramedic.

Anyway, this program has by far the best safety culture & safety record of the 3 that I've worked at, and no one has a "holier than thou" attitude towards anyone else.


There is always an outlier in the group. Through my consulting travels, unfortunately, i have run across more than a few of these programs. I also live very close to one of those programs now.........The last interaction i had with them on a recent PR was less than desirable to say the least when i asked them some very direct questions.

Being a CCT " DRIVER" sounds like a great job......Sign me up......Who cares how sick the patients are in the back if you are always driving......

JW
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John Wade MBA, CCEMT-P, FP-C, RN

"Have the courage to follow your heart and intuition, they somehow already know what you truly want to become" Steve Jobs

#11 old school

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Posted 13 March 2013 - 05:28 PM

There is always an outlier in the group. Through my consulting travels, unfortunately, i have run across more than a few of these programs. I also live very close to one of those programs now.........The last interaction i had with them on a recent PR was less than desirable to say the least when i asked them some very direct questions.

Being a CCT " DRIVER" sounds like a great job......Sign me up......Who cares how sick the patients are in the back if you are always driving......

JW


Well, they aren't just "drivers", they get a lot of exposure to critical patients at one of the busiest transport programs in the country.

But the point wasn't whether it was a job that JW or any other individual wanted; the point was that because a program may choose to have paramedics and nurses fill different roles does not in any way indicate a deficient safety culture.

And my former program is not an outlier. HEMS programs that don't fly with paramedics are a minority, and I'm familiar with a handful of them that utilize paramedics differently than RN's or RRT's. And none of them are known to have a deficient safety culture. In fact some of these are among the best-respected programs in the country.


The bottom line is that accusing a significant swath of the airmedical industry of having a "terrible safety culture" and a "holier than thou attitude" is probably not something that should be claimed without facts to back it up.
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#12 Jwade

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Posted 13 March 2013 - 05:58 PM

Well, they aren't just "drivers", they get a lot of exposure to critical patients at one of the busiest transport programs in the country.

But the point wasn't whether it was a job that JW or any other individual wanted; the point was that because a program may choose to have paramedics and nurses fill different roles does not in any way indicate a deficient safety culture.

And my former program is not an outlier. HEMS programs that don't fly with paramedics are a minority, and I'm familiar with a handful of them that utilize paramedics differently than RN's or RRT's. And none of them are known to have a deficient safety culture. In fact some of these are among the best-respected programs in the country.


The bottom line is that accusing a significant swath of the airmedical industry of having a "terrible safety culture" and a "holier than thou attitude" is probably not something that should be claimed without facts to back it up.



No offense, But, until you have experienced the interactions with as many programs as I have over the last couple of years, I think it would be hard for you to make such a statement. I have plenty of facts to back up, however, some of the non-disclosures i have signed for my contracts prevent me from posting names. The safety cultures i have seen in the last couple of years would put you in disbelief......

Let's just say, it has not surprised me to see some of the headlines in the last 6 months......

Furthermore, Here is a direct quote from a Flight Crew in the last 6 months from one of the " Best-Respected Programs " in the country.

Question: Why does your program refuse to hire Paramedics and only fly RN/RN.

Answer: "We believe RN's are better educated and experienced to provide emergency and critical care to our patient population"

Now, this crew had no idea who i was, as I was just another person at the PR event, nor did I tell them my name and background. Nevermind, the fact the local patient population is no different from anywhere else in the country.....LOL.....

How do you quantify one of the busiest transport programs in the country? What statistics are you using to arrive at this conclusion?

JW
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John Wade MBA, CCEMT-P, FP-C, RN

"Have the courage to follow your heart and intuition, they somehow already know what you truly want to become" Steve Jobs

#13 old school

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Posted 13 March 2013 - 07:54 PM

No offense, But, until you have experienced the interactions with as many programs as I have over the last couple of years, I think it would be hard for you to make such a statement. I have plenty of facts to back up, however, some of the non-disclosures i have signed for my contracts prevent me from posting names. The safety cultures i have seen in the last couple of years would put you in disbelief......


Ahh, the good old evidence by proclamation....."just trust me, I know more than you".

You stated that programs who don't use paramedics (or use them differently than nurses) are "holier than thou" and probably less safe. That is just a ridiculous claim that you can't possibly back up.

If I'm wrong and you do in fact have data that proves that programs that don't utilize paramedics are less safe, share it. You don't have to post any program identifying information at all.


Furthermore, Here is a direct quote from a Flight Crew in the last 6 months from one of the " Best-Respected Programs " in the country.

Question: Why does your program refuse to hire Paramedics and only fly RN/RN.

Answer: "We believe RN's are better educated and experienced to provide emergency and critical care to our patient population"


So what? Whats your point? They have a different opinion than you. How does that prove anything at all?

You think a crew with paramedics is better. They think a crew with RN's is better. What makes them wrong and you right? Why should we assume that someone who thinks RN's are better is arrogant, but someone who thinks paramedics are better is not?

I think a really good argument can be made that RN's are "better educated and more experienced" than paramedics. You and I may not agree with that, but so what if we agree or not? I can't prove that argument wrong and neither can you. What evidence is there either way? It's simply a matter of opinion.
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#14 sr_medic

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Posted 14 March 2013 - 12:20 AM

Just for clarity from my standpoint, there's a difference between being treated as equal professionals and playing to clinical strengths and strengthening weaknesses. Everyone should be treated equally as a flight crew member. No one member should have more clout than the other. Having clinical respect is another. I have fellow NP/PAs in my practice who I do not treat as clinical equals until they gain some experience under their belt or at least proven they can handle clinical situations, thereby gaining respect. The critical care transport environment should not be any different.

Brian


This is exactly what I was talking about. I fully embrace the idea that PM's bring different things to the table than RN's. That, in my opinion, is the beauty of these crew configurations. I love working with someone who looks at situations differently than me. It's very important for that person to also be willing to share those viewpoints with me, in a constructive and helpful manner. I like to be valued for my intelligence and ability as a critical care provider in a TEAM dynamic.



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D.F., BS, NREMT-P, FP-C

"Body and soul cannot be separated for purposes of treatment, for they are one and indivisible. Sick minds must be healed as well as sick bodies." -C. Jeff Miller

#15 USDalum97

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Posted 14 March 2013 - 06:44 AM

Agree with Old School I do..... Any program not treated as equals stay far away from. Not worth your time, effort or risk to your life. More than likely has a terrible safety culture to go along with their holier than thou attitudes.

Good Luck.

JW


There has to be a distinction made between "treating them equally" and having "equal scope". We train everyone the same, and treat them the same. However, the nurses have an expanded scope. This isn't an issue with the program, rather, it is a a state issue. The state EMS Dept says paramedics can do XYZ. Currently, that doesn't include RSI and paralytics (and other protocols we have). It doesn't matter what our Medical Director writes, he can't overrule the state scope. Also, the state EMS Dept allows for "optional scope" items. If our local EMS Dept doesn't include these optional scope items in the County Protocols for medics, then our medics can't do those either.

The State Board of Nursing regulates nursing licenses. They specifically state in statute that no other state agency, unless given specific permission, can regulate a nursing license. Therefore, nurses are not bound by the state or local EMS protocols. For anyone to say, in this scenario, that the nurses shouldn't be given the extra protocols, medications and procedures, just so that both crew members feel like they are "equal", is misguided.

Our Program Manager (a medic), our medical Director, and myself (an RN and the Clinical Supervisor), would love to be able to add to the medic scope. Unfortunately, our hands are tied, and our great state is not about to loosen its grip any time soon. In fact I just heard pediatric intubation is going to be removed from the paramedic scope statewide in the near future.

To get around this issue, the nurse's protocols are expanded and become "nurse only" meds or procedures. The medics are responsible for knowing them, understanding them, etc, they just can't perform the procedure themselves.


I think where people may take offense to your comment is that your statement seems to infer that if paramedics and nurses aren't given the same protocols then there is some inherent safety culture deficit. That is an absurd assumption and cannot be applied with such a wide brush. However, if any company treats an employee as lesser valued, the company does have a culture issue and needs to reevaluate its priorities. Note, lesser valued does not mean "lesser paid", "less responsibilities", etc. The housekeeping staff and the director of nursing in a hospital can be valued equally, but paid differently. There is a difference.
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#16 medic4cqb

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Posted 14 March 2013 - 03:10 PM

This is exactly what I was talking about. I fully embrace the idea that PM's bring different things to the table than RN's. That, in my opinion, is the beauty of these crew configurations. I love working with someone who looks at situations differently than me. It's very important for that person to also be willing to share those viewpoints with me, in a constructive and helpful manner. I like to be valued for my intelligence and ability as a critical care provider in a TEAM dynamic.


Idaho,

I agree with you and your view that both nurses and paramedics bring their stregnths to a transport team. One thing that should be pointed out here, is that whether the crew configuration is RN/PM, RN/RN, RN/RRT, the mission of the program should be to provide the highest level of care to the patient population. Many FNs have had some experience as paramedics (those that weren't paper medics) prior to getting a HEMS job, and they were successful as paramedics before transitioning to RNs. Those RNs still posses the skills and experience they've obtained from their field work. Many on here can attest to that, myself being one of those, whose made that transition.
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Steve A., RN, CCRN, EMT-P

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#17 Macgyver

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Posted 15 March 2013 - 10:38 PM

Both bring different things to the table. I flew with a dual RN program that is well respected - but given their turnover (just under 2 years) I'd rather be picked up by the competitors for a trauma scene call.

It is more than likely you could have an 14 month RN and a 2 month RN (flying experience, not total) from an ICU background with a few OR tubes and only training ETT under their belts show up to do an RSI. At least with the Medic/RN team, even with a part time medic who is usually on a ground service with little RSI experience (but many field intubations without the state restricted RSI drugs) you get a team with lots of actual intubation experience.

Now for interfacilities, the ER RN/ Medic combo is likely to not be as proficient than the dual ICU RN team - for obvious reasons.

The thing is - it all evens out after about 3 years of flight experience. And as mentioned previously, it is more about how you operate in the aircraft and are treated by the company than what the state BON and EMS board allow. Unfortunately, unequal (legal) scope almost always translates into uneven pay rates despite equal expectations by programs.

Having said that, there are also dual medic programs out there (CC level and CAMTS accredited)... and my first program (as a medic) treated all staff interchangeably with equal pay - you were an Aeromedical Specialist. So you could fly dual medic, dual RN or a mixed team - totally at random and per the schedule for the day.
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#18 Kevin87

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Posted 16 March 2013 - 01:31 PM

Hello All,
I'm hoping you can share with me some programs you either work for or have worked with, that value paramedic's as an "equal" member of the interdisciplinary treatment team. As I get further into my career, I am finding there is a broad range of opinions when it comes to paramedics working in the inter facility/critical care transport environment. My hope is to someday work for a CCT program (RW/FW/Ground) that utilizes paramedics as an equal member of the RN/PM team. You are welcome to post, or PM me; either way- your comments are greatly appreciated.

Thanks!


Hey idahomedic,

I'm pretty green to the HEMS and this whole flight PM thing (literally started < 6 months ago). However, in response to the topic I have found that the program I am with very much so treats paramedics as an equal member of the team. The RNs/PMs here are cross trained on each skill set and may interchange them as needed or desired. My opinion is taken into account and all decisions made regarding any treatment or transport options are a team effort. It has been a really great experience so far! I realize from looking back at the forums and older posts that this is actually a pretty touchy subject but just wanted to add my two cents that as a PM there are places with equal treatment, even for PMs that are newer to flight / CCT like me, good luck with your search!
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#19 onearmwonder

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Posted 16 March 2013 - 07:35 PM

Airlife Denver treats their paramedics just like their nurses. Expectations are equal across the board. Because of this their MD has applied for every medical waiver there is for their paramedics so that they can practice completely equal with their RN partner. Brief history... Airlife was an RN/RN team for all of their existence until roughly 2 years ago. They were having a difficult time finding enough qualified RNs that would work well with their team. That;s when their MD asked "What about paramedics? The RNs have embrassed this change with open arms. The rest is history and it is working quite well. My friend who was one of the first paramedics hired there says it is the best career decision he has ever made.

Good Luck,

Matt
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#20 MSDeltaFlt

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Posted 24 March 2013 - 03:51 AM

Agree with the above statements... mostly. Because depending on the state in which you fly, the nurse might be the higher level of care according to said state's rules and regulations. And yet in other states the paramedic might be the higher level of care... according to the state. Now as far as how one's company views its medical crew members depends on onething and one thing only: choice. Choice from corporate all the way down to the line.
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Mike Hester, RRT/NRP/FP-C
Courage is resistance to fear, mastery of fear - not absence of fear -- Mark Twain