# Critical Care Ops



## VentMonkey (Sep 18, 2016)

Flight, ground, both. Let's hear your CCT ops set up be it past, present, or even future. I'll go first.

We're a small set up, 1 ground CCT unit, and one RW (407). We have a total of 3 shifts for each station/ bases which work a 24 hour on/ off rotating Kelly schedule that parallels the local city fire departments. We're a separate division (actually a separate company) of a larger ambulance company on the southern tip of the California's Central Valley. We have separate nurse protocols for our CCT division to allow for some expanded formulary, and RSI; the protocols are the same from ground, and air be it the IFT, or 911 calls that we respond to.

Ground: 
Our unit is a 2009 Freightliner chassis with a double cab for family members to ride in up front on LDT's. We do a mixture of IFT/ LDT's, and 911 calls. The call volume varies and can range from a 24 hour shift with all IFT/ LDT's, to all 911, to a mixture of both, though they do try and keep us dedicated to CCT transfers, as this is our main priority. We hardly run ALS transfers. Our set up is RN/P/B, and all of our ground employees are employeed by our larger, parent company. The EMT's, and paramedics are free to roam to the "911" side, and pick up shifts as they see fit.

Air:
We have a Bell 407 single engine RW that is owned, and operated by the largest air medical provider in the country, to my knowledge. Our staffing is RN/P, and both the paramedic, and nurse are employees of our parent company, and not our vendors; the pilot is an employee of our vendor. We are one of two helicopters in our county who split the geographical areas for 911 scene response. Our call volume is ~60/40 scene to IFT which seems to alternate by rotation, week, month, cosmic alignment, etc., etc., etc. We are a CAMTS accredited program all around, so all of our RN's and paramedics must have the proper certifications within 2 years of hire, be it CFRN, CCRN, CEN, CCP-C, or FP-C.

That's my program in a nutshell, so what's say we hear yours?...


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## IFRMedic (Sep 18, 2016)

Do you work for hall/medevac 1?


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## VentMonkey (Sep 18, 2016)

Yes.


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## IFRMedic (Sep 18, 2016)

ahh cool. besides the 407 it seems like a cool program. we had a ground leg (san juaquin) and hall picked us up right by your base.


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## VentMonkey (Sep 18, 2016)

And where might I ask do you work, sir?


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## TXmed (Sep 18, 2016)

my cct experience has been all air medical. Mixture of 206 and 407's. RN/P crew, CAMTS accredited based in texas. Scene to IFT is 70/30 although some of the IFT's might as well be scene flights especially when we pick if from a hospital by the border of mexico, which we do frequently. Transport times range from 20min to 90min. We do IABP, impellas, invasive monitoring. We can do any transfer except ECMO. 

Ive worked here for a year and a half. Before that i did 4+ years ground 911 in a pretty busy urban service.


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## VentMonkey (Sep 18, 2016)

Nice.


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## IFRMedic (Sep 18, 2016)

@VentMonkey - Sure! .. i work for Mercy Air, down in SD. I pick up shifts at our Mojave base sometimes.


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## VentMonkey (Sep 18, 2016)

IFRMedic said:


> @VentMonkey - Sure! .. i work for Mercy Air, down in SD. I pick up shifts at our Mojave base sometimes.


Very cool. Welcome to the forum, glad you could join us. There are quite a few SoCal people on here who I'm sure would love to pick a Mercy Air paramedics brain, too.

SD, huh? 5, 6, or 19?


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## IFRMedic (Sep 19, 2016)

19? we dont have a 19.  ... i dont really wanna out my base honestly..but, i can PM you if you really want to know. 

sure! ive been lurking this site for a while, will answer any question within reason.


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## VentMonkey (Sep 19, 2016)

IFRMedic said:


> 19? we dont have a 19.  ... i dont really wanna out my base honestly..but, i can PM you if you really want to know.
> 
> sure! ive been lurking this site for a while, will answer any question within reason.


PM sent.


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## TransportJockey (Sep 19, 2016)

I have worked for two programs. Both in western Texas. 
One was a pure fixed wing program, we flew a King Air 200 on regional and longer haul flights w/ anything from stable repatriation flights to critical transfers to specialty centers. Even a few fixed wing 'scene flights' (land at airport and meet a 911 ambulance w/ a patient going to a higher level of care that has yet to go to a hospital). We worked set days, 48 hours one week, 72 the next. Great schedule and good company to work for
The place I worked before that was an odd duck. My base was frontier texas 911 at a CCT level (BIS monitors, iStats, expansive protocols, expanded formulary, vents on every truck, etc), but we also had a fixed wing based in town. The company also ran fixed wing operations at 2 other bases (at the time, now it's more like 4). 7 days on/7 days off was my rotation, which wasn't too bad considering it was 360 miles each way.


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## VentMonkey (Oct 11, 2016)

Thread bump...for the sake of keeping this section of our forum alive.

I would still love to hear from others. Past, present, or future. Any CCT/ HEMS ops. Whether you are, were, or will be an EMT, paramedic, RN, M.D., what-ev-er!

I would be interested in hearing others experiences with whatever service interests you, you have worked for, or anything in between.

I know there's a group of guys on here who recently got hired with some Air Methods outfits throughout the country; no need to out your ops, or base directly if you don't want to, but feel free to update our community!


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## VFlutter (Oct 11, 2016)

Just got back from cooperate orientation and start will start orientation at my program this week. My main base has a 407 and the other base I will be training at has a BK117. Both do IABP/VAD and specialty team flights, BK117 can fly ECMO. RN/P team.


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## VentMonkey (Oct 11, 2016)

Chase said:


> Just got back from cooperate orientation and start will start orientation at my program this week. My main base has a 407 and the other base I will be training at has a BK117. Both do IABP/VAD and specialty team flights, BK117 can fly ECMO. RN/P team.


How long is corporate orientation, and is it the same amount of time for all new hire med crew members?


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## VFlutter (Oct 11, 2016)

VentMonkey said:


> How long is corporate orientation, and is it the same amount of time for all new hire med crew members?



6 days. All new hire med crew members attend. 8 weeks local orientation.


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## usalsfyre (Oct 11, 2016)

Fixed wing Paramedic/Paramedic crew in a King Air C90.


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## Carlos Danger (Oct 11, 2016)

I worked for 3 HEMS/CCT programs. The last one was a large health-system based program. We had 3 helicopter bases (Bell 430's when I started with the program, but we had switched to EC-135's by the time I left) that were always staffed RN/RRT or RN/RN. We also had 3 FW's (two Citation jets and a King Air 200) that were staffed the same as the helicopters, and a busy ground division. Ground staffing could be anything from EMT only to paramedic, to the same as the aircraft. I worked full time at one of the helicopter bases and also rotated through FW and ground shifts. We did some IABP transports but mostly a lot of trauma and general critical care (sepsis, etc.) transports. A lot of burns too.

Also had a dedicated NICU team that responded by whichever mode was appropriate considering distance and time sensitivity.


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## VentMonkey (Oct 11, 2016)

usalsfyre said:


> Fixed wing Paramedic/Paramedic crew in a King Air C90.


@usalsfyre, nice! I haven't heard of too many PM/PM HEMS configurations. How did you find it worked in terms of efficiency? I'd imagine you'd have to be a pretty solid CCP to work double PM, on a FW nonetheless.



Chase said:


> 6 days. All new hire med crew members attend. 8 weeks local orientation.


@Chase , just for my personal knowledge, how long is each new hires training once they're placed at their base of hire? Is it dependent on them personally? Is there a bare minimum?

 "





Remi said:


> I worked for 3 HEMS/CCT programs. The last one was a large health-system based program. We had 3 helicopter bases (Bell 430's when I started with the program, but we had switched to EC-135's by the time I left) that were always staffed RN/RRT or RN/RN. We also had 3 FW's (two Citation jets and a King Air 200) that were staffed the same as the helicopters, and a busy ground division. Ground staffing could be anything from EMT only to paramedic, to the same as the aircraft. I worked full time at one of the helicopter bases and also rotated through FW and ground shifts. We did some IABP transports but mostly a lot of trauma and general critical care (sepsis, etc.) transports. A lot of burns too.
> 
> Also had a dedicated NICU team that responded by whichever mode was appropriate considering distance and time sensitivity.


@Remi, very cool. Were the ground paramedics utilized in a critical care fashion, or did they mainly drive?

What was your scene to IFT ratio at the RRT/RN/RN program?

We have one (large) program up and down the California coast that is an entire RN/RN configuration. They fly all 135's if I am not mistaken, with one or two FW in their fleet.
They were recently acquired by one of the larger competitors as well.

Thanks guys for contributing, good stuff!


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## VFlutter (Oct 11, 2016)

I believe it is standardized for everyone. 8 weeks doing simulations, OR time, and 3rd rider and then 3 months "probationary" period. I am sure it would be extended if needed.


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## VentMonkey (Oct 11, 2016)

Chase said:


> I believe it is standardized for everyone. 8 weeks doing simulations, OR time, and 3rd rider and then 3 months "probationary" period. I am sure it would be extended if needed.


Very cool. Congrats, and welcome to HEMS. 
Your program is well respected.


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## Carlos Danger (Oct 11, 2016)

> @Remi, very cool. Were the ground paramedics utilized in a critical care fashion, or did they mainly drive?
> 
> What was your scene to IFT ratio at the RRT/RN/RN program?
> 
> ...



Unfortunately, paramedics weren't really utilized much in this program. The only CCT that the medics did was sometimes they'd go on transport with one of the flight nurses and an EMT driver. Most often though, they'd be doing ALS transports with an EMT driver, or they'd be driving for an RN/RN or RN/RRT team.

The other 2 programs I flew with were paramedic/RN. Both were small, 2-base HEMS programs.


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## gonefishing (Oct 11, 2016)

Several ground cct units dual RN/RT and 2 emts in the past experience.  Air was private call in or county based.

Sent from my SM-G920P using Tapatalk


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## VentMonkey (Oct 11, 2016)

gonefishing said:


> Several ground cct units dual RN/RT and 2 emts in the past experience.  Air was private call in or county based.
> 
> Sent from my SM-G920P using Tapatalk


Were your guys RT's on call or did you have separate RT units?

In my old AMR BLS CCT days we had both RN/EMT/EMT, and RRT/EMT/EMT units, respectively.


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## gonefishing (Oct 11, 2016)

VentMonkey said:


> Were your guys RT's on call or did you have separate RT units?
> 
> In my old AMR BLS CCT days we had both RN/EMT/EMT, and RRT/EMT/EMT units, respectively.


It eventually became dual role rn so they would play the role of both rt and rn.  
I now work at an awesome company with incredible flight medics! Truly angels in the sky and incredibly knowledgeable!

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## VentMonkey (Oct 11, 2016)

gonefishing said:


> It eventually became dual role rn so they would play the role of both rt and rn.
> I now work at an awesome company with incredible flight medics! Truly angels in the sky and incredibly knowledgeable!
> 
> Sent from my SM-G920P using Tapatalk


Where's this at?? Surely not Kern County!?


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## gonefishing (Oct 11, 2016)

VentMonkey said:


> Where's this at?? Surely not Kern County!?


No comment lol

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## CALEMT (Oct 11, 2016)

VentMonkey said:


> In my old AMR BLS CCT days we had both RN/EMT/EMT, and RRT/EMT/EMT units, respectively.



It's still this way in Riverside Co. to the extent of my knowledge.


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## VentMonkey (Oct 11, 2016)

CALEMT said:


> It's still this way in Riverside Co. to the extent of my knowledge.


I had a blast doing CCT work at AMR. They had some very knowledgeable RN's and RT's, too.


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## EpiEMS (Oct 11, 2016)

VentMonkey said:


> In my old AMR BLS CCT days we had both RN/EMT/EMT, and RRT/EMT/EMT units, respectively.


Are these RNs with medic scope of practice and formulary?


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## VentMonkey (Oct 11, 2016)

EpiEMS said:


> Are these RNs with medic scope of practice and formulary?


No, they had an "ALS bag", a monitor, and IV pumps. There was no RSI, anything they wanted done needed to be done prior to leaving the sending facility, or with a doctors order to be done en route. They did not participate in, nor usually cared to, in the "911" system.

Still, most had been RN's, and RT's long enough to remember candy stripes, and the "iron lung", and again, were a wealth of knowledge if you were smart enough to take advantage.


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## EpiEMS (Oct 11, 2016)

VentMonkey said:


> No, they had an "ALS bag", a monitor, and IV pumps. There was no RSI, anything they wanted done needed to be done prior to leaving the sending facility, or with a doctors order to be done en route. They did not participate in, nor usually cared to, in the "911" system.
> 
> Still, most had been RN's, and RT's long enough to remember candy stripes, and the "iron lung", and again, were a wealth of knowledge if you were smart enough to take advantage.


Interesting. So generally few new en route interventions?


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## VentMonkey (Oct 11, 2016)

EpiEMS said:


> Interesting. So generally few new en route interventions?


Generally, yes; they functioned soley as mobile ICU's. They didn't have their own separate set of protocols to work under on their own.


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## TXpeds16 (Oct 12, 2016)

I'm currently working for a pediatric transport team that does RW/FW/ground.  CAMTS certified in all modes of transportation. Primary configurations are RN/RT/Medic.  There are Medic/Medic teams, however they basically just do BLS calls.  Prior to this I did 4 1/2 years in a fairly busy 911 system with dual medic configuration.  There we had transitioned to E-450 chassis with gas engines and varying boxes.

At my current employer...

For ground transportation our frontline trucks are F-550 chassis with Horton boxes.

For RW we contract with PHI who supplies a Sikorski S-76C++.  It is a dual pilot IFR program.  The S-76 is the only RW i've been in, and I feel it has ruined me for future flight jobs.  We have no weight limit, and it comfortably seats four persons in the back and can fit two patients.  It's a Cadillac.

FW is contracted with Sevenbar Aviation.  They supply a Cessna Citation as our primary, and backup is currently a King Air.  Again a dual pilot program.


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## usalsfyre (Oct 12, 2016)

TXpeds16 said:


> I'm currently working for a pediatric transport team that does RW/FW/ground.  CAMTS certified in all modes of transportation. Primary configurations are RN/RT/Medic.  There are Medic/Medic teams, however they basically just do BLS calls.  Prior to this I did 4 1/2 years in a fairly busy 911 system with dual medic configuration.  There we had transitioned to E-450 chassis with gas engines and varying boxes.
> 
> At my current employer...
> 
> ...



It's funny how the world is small enough you know what programs everyone works for.


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## Akulahawk (Oct 12, 2016)

VentMonkey said:


> @usalsfyre, nice! I haven't heard of too many PM/PM HEMS configurations. How did you find it worked in terms of efficiency? I'd imagine you'd have to be a pretty solid CCP to work double PM, on a FW nonetheless.
> 
> 
> @Chase , just for my personal knowledge, how long is each new hires training once they're placed at their base of hire? Is it dependent on them personally? Is there a bare minimum?
> ...


The program that was acquired by a "larger competitor" was probably actually acquired by the parent company. IIRC, they do fly EC135's and a couple of FW, but I recall when the competitor and the company you're referring to both had just 4 bases. The company you're likely referring to used to fly exclusively BO-105's. I've spent many nights unloading patients from one of their 105's to transport them about 2 blocks from pad to ED.


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## VentMonkey (Oct 12, 2016)

Akulahawk said:


> The program that was acquired by a "larger competitor" was probably actually acquired by the parent company. IIRC, they do fly EC135's and a couple of FW, but I recall when the competitor and the company you're referring to both had just 4 bases. The company you're likely referring to used to fly exclusively BO-105's. I've spent many nights unloading patients from one of their 105's to transport them about 2 blocks from pad to ED.


Yes, indeed you are correct. I forgot you're from NorCal. The epicenter of their ops.


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## Flight-LP (Oct 13, 2016)

Akulahawk said:


> The program that was acquired by a "larger competitor" was probably actually acquired by the parent company. IIRC, they do fly EC135's and a couple of FW, but I recall when the competitor and the company you're referring to both had just 4 bases. The company you're likely referring to used to fly exclusively BO-105's. I've spent many nights unloading patients from one of their 105's to transport them about 2 blocks from pad to ED.


Interestingly enough, the acquisition was through the California based LLC company, not the parent company. They are now owned by the same folks, but are going to remain (for now) separate brands and companies. So far it has worked smoothly..........


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## VentMonkey (Oct 13, 2016)

Flight-LP said:


> Interestingly enough, the acquisition was through the California based LLC company, not the parent company. They are now owned by the same folks, but are going to remain (for now) separate brands and companies. So far it has worked smoothly..........


Do you see their current configuration being replaced with the more "cost-effective" paramedic/ RN staffing? 

I personally like their current set up as it's unique to California, and seems to work well for them.


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## Handsome Robb (Oct 13, 2016)

Are you talking about CALSTAR? 


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## VentMonkey (Oct 13, 2016)

Handsome Robb said:


> Are you talking about CALSTAR?
> 
> 
> Sent from my iPhone using Tapatalk


Lol, yes, CALSTAR. 

The cat's out of the bag!


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## Handsome Robb (Oct 13, 2016)

VentMonkey said:


> Lol, yes, CALSTAR.
> 
> The cat's out of the bag!


Whoops! My bad! 


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## VentMonkey (Oct 13, 2016)

Handsome Robb said:


> Whoops! My bad!
> 
> 
> Sent from my iPhone using Tapatalk


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## VFlutter (Nov 23, 2016)

Anyone doing Impella transports in a 407? How is the setup? Do you have an actual mount for the console? We have not done one since getting the 407 and a few local facilities are starting to put more in.


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## VentMonkey (Nov 23, 2016)

Chase said:


> Anyone doing Impella transports in a 407? How is the setup? Do you have an actual mount for the console? We have not done one since getting the 407 and a few local facilities are starting to put more in.


I have yet to even see an Impella make its way out here, but if it does, I'll be sure to PM you.


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## gonefishing (Nov 23, 2016)

I've toured one but I am in no way shape or form a flight medic.  Very interesting set up.

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## VentMonkey (Nov 23, 2016)

gonefishing said:


> I've toured one but I am in no way shape or form a *flight medic*.  Very interesting set up.


Being a *"flight medic"* isn't all that relevant to understanding advanced hemodynamics, maybe being a critical care paramedic is. I feel flight paramedicine is an _extension _of critical care. 

I guarantee there are ground CCP's who would run circles around me on this particular device; that's all I mean.


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