Jump to content


Photo

Paramedic Added To Cct-Rn Crew


  • Please log in to reply
11 replies to this topic

#1 Ron Webb

Ron Webb

    Newbie

  • Members
  • Pip
  • 1 posts

Posted 12 March 2014 - 04:41 AM

I have been working as a CCT nurse now for 9 years full-time. Our company has a standard staffing of two EMTs with a nurse on a dedicated 12-hour shift. The reason for this current thread is a change in condition that I personally find silly. We have recently started a new 911 contract in a county that provides us EXCLUSIVE service in the county, including CCT, but with one ridiculous caveat; they require that EVERY CCT rig has a paramedic on-board. At this time, that means that we have to rendezvous with one of our 911 rigs (staffed with a paramedic and an EMT) and have a paramedic join us for transports that originate in that particular county (taking them out of circulation for 911 calls). As a company, we cover numerous counties and rotate crews around based on needs, so we maintain our standard two EMTs with a nurse on our units. That means we are using 5 people for CCT calls in that county... granted, the EMT partner of the paramedic could possibly do something else while his/her paramedic is tied up on our call.

While we have annual competencies in skills including intubation, we are told that is what the paramedic is there to do; this is ironic because the paramedic protocols for this county has removed ETT intubation from most situations, relying on the King tube instead. I have never needed to intubate in the back of a rig, as the evaluation as to whether it is possibly needed is addressed prior to departure of sending facility. During my 9 years of full-time CCT, I have yet to have a situation where having a paramedic, as opposed to an EMT, would have made a positive difference. I do not intend to belittle a paramedic, I just do not see a point in wasting such a resource.

When we asked WHY they have added the new requirement of having a paramedic on board, we are told it is to comply with a national standard. As we are told "national standard", I'm just curious as to the validity of that. I understand that other places do use paramedics with a nurse on CCT, but a standard? I am curious as to how others are using a paramedic in their CCT-RN programs. If it makes any difference, we do NOT do scene calls, we only do inter-facility transports.

I really do not want to call attention to our company nor the county this is taking place in, just curious as to if anyone has run into similar issues.
  • 0

#2 medic4cqb

medic4cqb

    Advanced Member

  • Members
  • PipPipPip
  • 308 posts

Posted 30 March 2014 - 06:51 PM

I have been working as a CCT nurse now for 9 years full-time. Our company has a standard staffing of two EMTs with a nurse on a dedicated 12-hour shift. The reason for this current thread is a change in condition that I personally find silly. We have recently started a new 911 contract in a county that provides us EXCLUSIVE service in the county, including CCT, but with one ridiculous caveat; they require that EVERY CCT rig has a paramedic on-board. At this time, that means that we have to rendezvous with one of our 911 rigs (staffed with a paramedic and an EMT) and have a paramedic join us for transports that originate in that particular county (taking them out of circulation for 911 calls). As a company, we cover numerous counties and rotate crews around based on needs, so we maintain our standard two EMTs with a nurse on our units. That means we are using 5 people for CCT calls in that county... granted, the EMT partner of the paramedic could possibly do something else while his/her paramedic is tied up on our call.

While we have annual competencies in skills including intubation, we are told that is what the paramedic is there to do; this is ironic because the paramedic protocols for this county has removed ETT intubation from most situations, relying on the King tube instead. I have never needed to intubate in the back of a rig, as the evaluation as to whether it is possibly needed is addressed prior to departure of sending facility. During my 9 years of full-time CCT, I have yet to have a situation where having a paramedic, as opposed to an EMT, would have made a positive difference. I do not intend to belittle a paramedic, I just do not see a point in wasting such a resource.

When we asked WHY they have added the new requirement of having a paramedic on board, we are told it is to comply with a national standard. As we are told "national standard", I'm just curious as to the validity of that. I understand that other places do use paramedics with a nurse on CCT, but a standard? I am curious as to how others are using a paramedic in their CCT-RN programs. If it makes any difference, we do NOT do scene calls, we only do inter-facility transports.

I really do not want to call attention to our company nor the county this is taking place in, just curious as to if anyone has run into similar issues.


Ron,

I'm curious as to why your company uses 2 EMTs and 1 RN for ground CCT instead of RN/PM/EMT crew configuration? What is the need for 2 EMTs? Technically, the paramedic's base training, is as a EMT-Basic and simply adding a paramedic to the crew configuration and removing the second EMT, would solve that problem. I work as a CCT-RN for a hospital-based program which has an RN/PM crew configuration with an EMT-B driver, the flight team uses RN/RRT configuration. This meets state and national standards and we transport SICK patients just fine with these configurations.

Another company I am very familiar with, used RN/EMT configuration and would add the PM for complex transports requiring additional man-power. Today, they are RN/PM with EMT driver and these numbers still work great for them.
  • 0

Steve A., RN, CCRN, EMT-P

"The usefulness of a cup is in its emptiness..."
- Bruce Lee


#3 ForeverLearning

ForeverLearning

    Advanced Member

  • Members
  • PipPipPip
  • 382 posts

Posted 30 March 2014 - 11:48 PM

I don't believe there is national "standard" for who should staff CCT. There are CATMS recommendations, recommendations by AAOS in ATLS class, perhaps sending physicians request to have "X" present during transport sometimes they note "ACLS" or "PALS", "NRP" provider.

Truth of the matter CCT can have various providers. I work on a ground truck that utilized 1 EMT-B and 1 Paramedic (does not have to have any Critical Care certs, not even National registry) and I'd wager over time I transport the same call types that "Flight Team RN/Medic/ or RN/RT with all the alphabet soup" are dispatched to.

This battle of providers honestly is idiotic. If you perform transport work, I don't care if you are RN, RT, or Medic you will see the same cases and you will have to render appropriate care regardless of the letters that follow your name. Persons pathophysiology does not alter based on your alphabet soup.

All of you can get your panties in a bunch and proclaim the benefits of RT's on hard ARDS case, or the skills of RN when you need to transition 8 drips etc. however when asked to state specifics when presented with a case it's crickets all of a sudden. So this high horse name tag thing is pure nonsense. If I now had RN degree do you honestly think my care would alter on how I would approach a STEMI transport?


Seems from your post you are just upset that you no longer the "top dog" in your rig and now have to have a medic come along for the ride. I agree this is a silly waste of resources to take out a unit and perform 1 transport with 5 providers. Welcome to EMS. Posted Image
  • 0

#4 Jwade

Jwade

    Advanced Member

  • Members
  • PipPipPip
  • 1405 posts

Posted 31 March 2014 - 12:32 AM

I don't believe there is national "standard" for who should staff CCT. There are CATMS recommendations, recommendations by AAOS in ATLS class, perhaps sending physicians request to have "X" present during transport sometimes they note "ACLS" or "PALS", "NRP" provider.

Truth of the matter CCT can have various providers. I work on a ground truck that utilized 1 EMT-B and 1 Paramedic (does not have to have any Critical Care certs, not even National registry) and I'd wager over time I transport the same call types that "Flight Team RN/Medic/ or RN/RT with all the alphabet soup" are dispatched to.

This battle of providers honestly is idiotic. If you perform transport work, I don't care if you are RN, RT, or Medic you will see the same cases and you will have to render appropriate care regardless of the letters that follow your name. Persons pathophysiology does not alter based on your alphabet soup.

All of you can get your panties in a bunch and proclaim the benefits of RT's on hard ARDS case, or the skills of RN when you need to transition 8 drips etc. however when asked to state specifics when presented with a case it's crickets all of a sudden. So this high horse name tag thing is pure nonsense. If I now had RN degree do you honestly think my care would alter on how I would approach a STEMI transport?


Seems from your post you are just upset that you no longer the "top dog" in your rig and now have to have a medic come along for the ride. I agree this is a silly waste of resources to take out a unit and perform 1 transport with 5 providers. Welcome to EMS. Posted Image



Transport any ECMO or Bi-Vad Patients lately?
  • 0
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

#5 BrianACNP

BrianACNP

    Advanced Member

  • Moderators
  • PipPipPip
  • 591 posts

Posted 31 March 2014 - 12:45 AM

I don't believe there is national "standard" for who should staff CCT. There are CATMS recommendations, recommendations by AAOS in ATLS class, perhaps sending physicians request to have "X" present during transport sometimes they note "ACLS" or "PALS", "NRP" provider.

Truth of the matter CCT can have various providers. I work on a ground truck that utilized 1 EMT-B and 1 Paramedic (does not have to have any Critical Care certs, not even National registry) and I'd wager over time I transport the same call types that "Flight Team RN/Medic/ or RN/RT with all the alphabet soup" are dispatched to.

This battle of providers honestly is idiotic. If you perform transport work, I don't care if you are RN, RT, or Medic you will see the same cases and you will have to render appropriate care regardless of the letters that follow your name. Persons pathophysiology does not alter based on your alphabet soup.

All of you can get your panties in a bunch and proclaim the benefits of RT's on hard ARDS case, or the skills of RN when you need to transition 8 drips etc. however when asked to state specifics when presented with a case it's crickets all of a sudden. So this high horse name tag thing is pure nonsense. If I now had RN degree do you honestly think my care would alter on how I would approach a STEMI transport?


Seems from your post you are just upset that you no longer the "top dog" in your rig and now have to have a medic come along for the ride. I agree this is a silly waste of resources to take out a unit and perform 1 transport with 5 providers. Welcome to EMS. Posted Image


Why don't you let sleeping dogs lie on this one!

Brian
  • 0
Brian, MSN, ACNP, CCRN

#6 ForeverLearning

ForeverLearning

    Advanced Member

  • Members
  • PipPipPip
  • 382 posts

Posted 31 March 2014 - 02:10 AM

Transport any ECMO or Bi-Vad Patients lately?


All the time man Posted Image


Do you guys rock these patches on your scrubs?

Posted Image

  • 0

#7 medic4cqb

medic4cqb

    Advanced Member

  • Members
  • PipPipPip
  • 308 posts

Posted 31 March 2014 - 02:45 AM

This battle of providers honestly is idiotic. If you perform transport work, I don't care if you are RN, RT, or Medic you will see the same cases and you will have to render appropriate care regardless of the letters that follow your name. Persons pathophysiology does not alter based on your alphabet soup.
Posted Image


When it comes down to it, it's really much bigger than a battle of providers...it's about the Benjamins baby!! Reimbursement, don't you know.
  • 0

Steve A., RN, CCRN, EMT-P

"The usefulness of a cup is in its emptiness..."
- Bruce Lee


#8 ForeverLearning

ForeverLearning

    Advanced Member

  • Members
  • PipPipPip
  • 382 posts

Posted 31 March 2014 - 03:17 AM

When it comes down to it, it's really much bigger than a battle of providers...it's about the Benjamins baby!! Reimbursement, don't you know.


Yep, time to join the dark side.
  • 0

#9 old school

old school

    Advanced Member

  • Members
  • PipPipPip
  • 1121 posts

Posted 31 March 2014 - 11:35 PM

If I now had RN degree do you honestly think my care would alter on how I would approach a STEMI?


You are 100% correct that it isn't about the letters after your name.

Once you have several years of ICU experience however, I assure you that you will see things quite differently than you do now.
  • 0
bring it in for the real thing

#10 USDalum97

USDalum97

    Advanced Member

  • Members
  • PipPipPip
  • 259 posts

Posted 02 April 2014 - 03:44 AM

I have been working as a CCT nurse now for 9 years full-time. Our company has a standard staffing of two EMTs with a nurse on a dedicated 12-hour shift. The reason for this current thread is a change in condition that I personally find silly. We have recently started a new 911 contract in a county that provides us EXCLUSIVE service in the county, including CCT, but with one ridiculous caveat; they require that EVERY CCT rig has a paramedic on-board. At this time, that means that we have to rendezvous with one of our 911 rigs (staffed with a paramedic and an EMT) and have a paramedic join us for transports that originate in that particular county (taking them out of circulation for 911 calls). As a company, we cover numerous counties and rotate crews around based on needs, so we maintain our standard two EMTs with a nurse on our units. That means we are using 5 people for CCT calls in that county... granted, the EMT partner of the paramedic could possibly do something else while his/her paramedic is tied up on our call.

While we have annual competencies in skills including intubation, we are told that is what the paramedic is there to do; this is ironic because the paramedic protocols for this county has removed ETT intubation from most situations, relying on the King tube instead. I have never needed to intubate in the back of a rig, as the evaluation as to whether it is possibly needed is addressed prior to departure of sending facility. During my 9 years of full-time CCT, I have yet to have a situation where having a paramedic, as opposed to an EMT, would have made a positive difference. I do not intend to belittle a paramedic, I just do not see a point in wasting such a resource.

When we asked WHY they have added the new requirement of having a paramedic on board, we are told it is to comply with a national standard. As we are told "national standard", I'm just curious as to the validity of that. I understand that other places do use paramedics with a nurse on CCT, but a standard? I am curious as to how others are using a paramedic in their CCT-RN programs. If it makes any difference, we do NOT do scene calls, we only do inter-facility transports.

I really do not want to call attention to our company nor the county this is taking place in, just curious as to if anyone has run into similar issues.


We use EMT/PM/RN, however, we also run scene calls.

I see your point that taking a medic out of the 911 system, just to hop on board to meet a county requirement that cannot be fully explained, seems silly. I don't think your OP was meant as a medic vs nurse debate. It's a shame that the thread turned to that so quickly.

There are two things I can see that you can do.

1) Fight it. Do response times change in that county now that the paramedic unit is OOS? If so, what affect does that have on the rest of the system?

2) Embrace it. Recognize that as a field provider, your job is to run the calls that you are dispatched to. Now you have a paramedic in the back? Great. Sounds like an extra set of hands when things go bad. Ever have a patient code during transport? Now you have a second ALS provider that can help push meds, analyze rhythm, change compressors when you get fatigued because the other person can do the ACLS stuff, etc. Collaborate with the medic on scene. Many hands make light work.

I think it is a great configuration that can be beneficial to both crew members and the patient.
  • 0

#11 ForeverLearning

ForeverLearning

    Advanced Member

  • Members
  • PipPipPip
  • 382 posts

Posted 02 April 2014 - 04:19 AM

What's funny is that this is like a polar opposite of an ad hoc team by grabbing any nurse on the floor (regardless of transport experience) and putting them on a transport unit as per hospital "policy". Seat belts go on like this brand new novel invention, please ask me every 15 minutes for all the vitals and I will certainly dial in the perfect temp for your scrubs and crocks regardless of what the patient needs. Let me assist you entering and exiting the ambulance so you don't fall. Welcome to Babysitting 101.
  • 0

#12 MSDeltaFlt

MSDeltaFlt

    Advanced Member

  • Members
  • PipPipPip
  • 559 posts

Posted 09 April 2014 - 02:49 PM

I have been working as a CCT nurse now for 9 years full-time. Our company has a standard staffing of two EMTs with a nurse on a dedicated 12-hour shift. The reason for this current thread is a change in condition that I personally find silly. We have recently started a new 911 contract in a county that provides us EXCLUSIVE service in the county, including CCT, but with one ridiculous caveat; they require that EVERY CCT rig has a paramedic on-board. At this time, that means that we have to rendezvous with one of our 911 rigs (staffed with a paramedic and an EMT) and have a paramedic join us for transports that originate in that particular county (taking them out of circulation for 911 calls). As a company, we cover numerous counties and rotate crews around based on needs, so we maintain our standard two EMTs with a nurse on our units. That means we are using 5 people for CCT calls in that county... granted, the EMT partner of the paramedic could possibly do something else while his/her paramedic is tied up on our call.

While we have annual competencies in skills including intubation, we are told that is what the paramedic is there to do; this is ironic because the paramedic protocols for this county has removed ETT intubation from most situations, relying on the King tube instead. I have never needed to intubate in the back of a rig, as the evaluation as to whether it is possibly needed is addressed prior to departure of sending facility. During my 9 years of full-time CCT, I have yet to have a situation where having a paramedic, as opposed to an EMT, would have made a positive difference. I do not intend to belittle a paramedic, I just do not see a point in wasting such a resource.

When we asked WHY they have added the new requirement of having a paramedic on board, we are told it is to comply with a national standard. As we are told "national standard", I'm just curious as to the validity of that. I understand that other places do use paramedics with a nurse on CCT, but a standard? I am curious as to how others are using a paramedic in their CCT-RN programs. If it makes any difference, we do NOT do scene calls, we only do inter-facility transports.

I really do not want to call attention to our company nor the county this is taking place in, just curious as to if anyone has run into similar issues.


Staying on target. I have not seen, nor heard of, any other service working their crew line up like this. Though I can see why. It appears to me that it might written in your county's contract that there will be a paramedic on each and every rig period regardless of type of transport. And/or the bureaucrats are nkt aware of the level of training with proof and documentation of your nurses. Get a study going on the strain this set up puts kn the 911 response of depleting your county of a paramedic.
  • 0
Mike Hester, RRT/NRP/FP-C
Courage is resistance to fear, mastery of fear - not absence of fear -- Mark Twain