RT's in EMS

I have seen one local HEMS agency having RT's on their helicopters. I was just wondering what the point is having an RT on the helicopter. What purpose do they serve? I mean can't a medic and an RN do everything a RT can do in the prehospital setting?

LanceCorpsman said:

I have seen one local HEMS agency having RT's on their helicopters. I was just wondering what the point is having an RT on the helicopter. What purpose do they serve? I mean can't a medic and an RN do everything a RT can do in the prehospital setting?

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Yes, and no. While a RN/ paramedic is the most common HEMS configuration there are many reasons a particular service, base, or program may staff RT's.

Their overall knowledge of ventilators, and ventilator management far exceeds that of most paramedics and nurses.

For instance, if said program has a large bulk of high acuity NICU transports, they'll typically look for RT's/ RCP's well versed in NICU ventilator management.

Most HEMS programs who do employ RT's typically want them to at least have their EMT, if not their paramedic, or RN license along with a degree, and several years of in hospital ICU/CCU/ER/specialty time.

Proper ventilator management is not something to be taken lightly.

LanceCorpsman said:

I have seen one local HEMS agency having RT's on their helicopters. I was just wondering what the point is having an RT on the helicopter. What purpose do they serve? I mean can't a medic and an RN do everything a RT can do in the prehospital setting?

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Yes, but there is a big difference between being able to do something, and being really, really good at doing something because you have focused training and years of experience doing it.

The last HEMS program that I flew with was one of only a few in the country that regularly utilizes RRT's in non-specialty transports, and may be the only one in the nation that uses them to the full scope of their training, with the RRT's using the same protocols as the flight nurses.

I remember being skeptical about working with RRT's when I started the job. I had been flying for about 7 years already, mostly in a RN - EMTP crew configuration. But I had also flown dual paramedic, dual nurse, solo paramedic, even with EM residents. I was convinced that it was impossible to improve on the EMTP/RN crew configuration. Part of my skepticism came from the fact that that at the large hospital where I'd gotten my few years of ICU experience, the RRT's did almost nothing but turn knobs on the vents and run gases. They usually didn't even draw the gases or give neb treatments - the RN's did most of that. So that was pretty much all I knew about RRT's.

Anyway.....it turned out that most of the RRT's that I worked with here were very strong critical care clinicians. Turns out you learn a lot about general critical care management running vents in SICU's and MICU's and rounding with the CC attendings and fellows in a large, tertiary hospital. These guys had solid airway skills and knew their way around a vent like you wouldn't believe. The came to the program not having done much general patient care and needing a good orientation to medications and protocols, and maybe they weren't the best at starting IV's, but because of their background, they picked that stuff up quick. Compared to the flight nurses, these guys were also hands down more motivated to go out and get some EMS experience and go to EMT and paramedic school on their own, as well. Many of them did that on their own time and dime.

The truth is, you don't need their level of expertise on the vast majority of transports, but I can remember a few flights we did during the H5N1 outbreak that I honestly don't think we could have completed successfully without the the knowledge of my RRT partner.

I started my career as a paramedic for several years and flew as a paramedic before becoming an RN. My full time partner had become a paramedic after he started flying (and did way more than the minimum time on the truck, just because he wanted the experience), so when we were on duty you had an RN/RRT crew, with both guys also being paramedics and having a lot of EMS experience between them. There were other crews like that, too. It was pretty much the best of all worlds.

LanceCorpsman said:

I have seen one local HEMS agency having RT's on their helicopters. I was just wondering what the point is having an RT on the helicopter. What purpose do they serve? I mean can't a medic and an RN do everything a RT can do in the prehospital setting?

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RTs have critical care and respiratory care knowledge that could really be quite beneficial...not to mention, their scope can be quite broad.

Remi said:

Yes, but there is a big difference between being able to do something, and being really, really good at doing something because you have focused training and years of experience doing it.

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This, a thousand times, this.

Some excellent programs, such as DHART, use RTs.

Hartford Hospital's Lifestar flies with an RN and an RT/medic.

Thanks for all of the info, definitely learned a lot. I guess I don't think about the critical care transport side of HEMS too much because I only interact with them in the field for traumas.
When I work shifts in the ICU, I only see those RTs check blood gas and give nebulizer treatments and don't really see them do a lot.

LanceCorpsman said:

When I work shifts in the ICU, I only see those RTs check blood gas and give nebulizer treatments and don't really see them do a lot.

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It really depends where they work. Many just do stuff like that, but some get really great experience.

LanceCorpsman said:

I guess I don't think about the critical care transport side of HEMS too much because I only interact with them in the field for traumas.

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Well that's too bad, sorry to hear that, truly.

A large part of what my program does, and many HEMS programs for that matter do, is in fact critical care medicine.

This is a big part of what drove me to critical care, wanting to learn more about ventilator management. I find it ironic that paramedics are always taught airway, and it's importance in the order of things in the field setting. Why not learn a bit more about this part of airway management?

While I by no means possess the knowledge of a respiratory therapist, it would seem to be in the best interest in both the patient, and myself to learn a bit more than what was simply taught in paramedic school.

I would like to think most HEMS programs pride themselves on much more than rapid transport to the nearest trauma center for trauma patients only.

This is only a mere fraction of what we do, and with due respect, knowing a bit more about what it is your, or any HEMS program does, or doesn't do may just surprise you (general statement).

@Remi you mentioned you had EM Residents on board. Did they do anything? Is it helpful to have a person who is new to medicine?

LanceCorpsman said:

@Remi you mentioned you had EM Residents on board. Did they do anything? Is it helpful to have a person who is new to medicine?

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Unless if I'm misunderstanding here, EM residents definitely don't strike me as being "new to medicine". Surely you mean something else?

Flying said:

Unless if I'm misunderstanding here, EM residents definitely don't strike me as being "new to medicine". Surely you mean something else?

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Well arent EM Residents straight out of med school? I would way rather trust a RN or Medic who has had several years of experience (which is what is required to my understanding). I mean you cant really replace the years of actual field experience, so compared to the experienced RNs, residents are "new" since they technically cant practice on their own.

LanceCorpsman said:

Well arent EM Residents straight out of med school? I would way rather trust a RN or Medic who has had several years of experience (which is what is required to my understanding). I mean you cant really replace the years of actual field experience, so compared to the experienced RNs, residents are "new" since they technically cant practice on their own.

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I'm sure @Remi will, or can elaborate as to what exactly he was referring to.

To my knowledge, many of the more prestigious Level 1 hospital-based HEMS programs have EM residents do flight time as part of their residency, and/ or fellowship.

Think of it this way, the U.K. utilizes soley EM physicans, with a paramedic as their assistant in the HEMS environment.

I don't know, nor can speak first hand for the programs here in the states that allow EM residents to function as providers on a helicopter, but can only imagine by the time they are given this opportunity they are not first year resident wide-eyed, and lacking the clinical knowledge required in this environment.

These folks are all very squared away, and more than likely bring to the table experience, skills, and a scope of practice that far exceeds that of the average flight paramedic.

We used to have RT ground units. RTs are much more familiar with ventilators and patients ventilation needs compared to RNs and Medics. We often had RTs jump on CCT-RN units for an RN/RT combo if the patient was on several drips and ventilated.

Bonus points: we even sometimes took an MD.

LanceCorpsman said:

Well arent EM Residents straight out of med school? I would way rather trust a RN or Medic who has had several years of experience (which is what is required to my understanding). I mean you cant really replace the years of actual field experience, so compared to the experienced RNs, residents are "new" since they technically cant practice on their own.

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These were third year EM residents and EMS fellows, not scut monkeys. It was an optional rotation for them. They were good. I remember learning a lot from them.

VentMonkey said:

I'm sure @Remi

Think of it this way, the U.K. utilizes soley EM physicans, with a paramedic as their assistant in the HEMS environment.

I

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Similar in Scandinavia. In Denmark HEMS has an anesthesiologist and a paramedic partner.

LanceCorpsman said:

Well arent EM Residents straight out of med school? I would way rather trust a RN or Medic who has had several years of experience (which is what is required to my understanding). I mean you cant really replace the years of actual field experience, so compared to the experienced RNs, residents are "new" since they technically cant practice on their own.

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I don't think you can really replace a third year resident's education either...

Tigger said:

I don't think you can really replace a third year resident's education either...

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Well of course there is a difference between am intern year resident and 3rd year resident. But pre-hospital and the ED is a lot different as well.

LanceCorpsman said:

.When I work shifts in the ICU, I only see those RTs check blood gas and give nebulizer treatments and don't really see them do a lot.

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Does doing little mean the knowledge is little?

LanceCorpsman said:

Well of course there is a difference between am intern year resident and 3rd year resident. But pre-hospital and the ED is a lot different as well.

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There's not really as much of a difference as you'd think, other than availability of extra manpower and medications/treatments/imaging.

LanceCorpsman said:

Well of course there is a difference between am intern year resident and 3rd year resident. But pre-hospital and the ED is a lot different as well.

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Less resources, sure, but don't forget - the advantage that the physician has is knowledge. He or she is as capable - or more - at triaging to the appropriate resource, determining the needs post-ED, etc.