# What does it take to fly as a medic?



## 8jimi8 (Mar 28, 2009)

Hello all

This is my first posting here.

     A little background on myself.  First, I must declare my complete respect for EMS.  I am a student nurse with 6 weeks left in my associate degree program.  I am ACLS and PALS certified and last semester during my OB/Pedi rotations, to further distinguish myself from my class, I did my EMT-B online and finished it up with a 2 week intensive skills bootcamp.  I also have a bachelor's in psychology.  So i'm sure i've already annoyed some of the big dogs around here because A) i'm about to be an RN and B ) I didn't do a traditional class based EMS program; however please hear me out!
     After college i focused on crisis counseling with a major emphasis on domestic violence.  I've worked on scene with law enforcement advocating and educating as well as transporting victims of crime.   This is where i learned that I have a cool head under pressure.  I have to admit, that when I was getting out of crisis counseling I met a firefighter captain who lives in southern Oregon, who convinced me that paramedics were thankedless workers with a high burnout rate, low compensation and no benefits.  He highly encouraged me to go to RN school.  Now that I am at the end of my two year program I SO FREAKING WISH that I had gone to paramedic school...I mean jeeze!  I could be 6 weeks away from being a Paramedic.  The only places I can see myself working as an RN are, ICU, ER, or Prehospital / Transport / Flight.
     Honestly, I am going to take a full time job as a Basic on a box, until I can get into an ICU job, after which- I will drop to part time in the ambulance.  This leaves me with another awesome option!
Get the full time box job and go to paramedic school!  So the original question I have is, what does it take to fly as a paramedic?  From what I have seen for RN's it is at minimum 5 years experience in ICU/ER.  I assume it is something similar for Flight Medics, but I haven't quite seen the standards.   Since there is a huge oversaturation of RN's in my area, i feel that it is likely that I will be able to complete the 10-11 month paramedic program in my area (from the searching that I have seen I would skip EMT-I, since I have my B already.)
     I've been searching around the internet and mostly what I have seen is paramedics crossing over to nursing, not vice versa.  But after going through my basic, I really can't help but think that EVERY RN should take an emt-b course.  The advanced first aid and focus on emergency medicine is invaluable.  I am also quite dismayed with the lack of information we received on dealing with injuries.  
     So i know I have rambled.  The most important piece of this post to me is, what does it take to fly as a medic.  I know i'm getting ahead of myself here, but I am doing some career mapping.  In the air is where I want to be.  I don't care if I get there with a Red Patch or an RN alphabet behind my name.


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## Ridryder911 (Mar 28, 2009)

Wow! All that education and you still don't know the profession yet. Plan on obtaining at the least five years experience. No matter RN or Paramedic. Knowledge is essential so is having the clinical experience. 

Sure you can take an abbreviated course, and among most medics still not be considered qualified enough. Again, experience in both arenas. You need to pay your dues and obtain the crucial part of gaining that experience of clinical practice. 

I disagree with the statement of nurses requiring to take an EMT course. If the student understood basics of medicine most would understand basic emergency care. It is reinforced through each portion of medical surgical, pediatrics, Ob-gyn. 

The same requirements are usually instituted for Paramedics as for the Flight Nurses. I ask why should they be different? 

No nursing shortage in your area? Wow! That is unique. 

R/r 911


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## AJ Hidell (Mar 28, 2009)

Anyone you have annoyed isn't worth taking advice from, so don't worry about them.

What does it take to fly?  That is going to vary a great deal from service to service.  Most places it is like you say, which is a minimum of three to five years in a busy EMS system or Level I trauma center.  Of course, generally the only people who get hired with those minimums are the ones sleeping with someone that does the hiring.  You're looking at twice that usually.  But you're on the right track.

First let me assure you that you absolutely went the correct route by doing the nursing degree first.  Education is a pyramid.  Doing a focused specialization course like paramedic before the broad foundation of nursing is backwards, and not nearly as effective a path of education.  You only get one chance to build a foundation, and by doing nursing first, you did that.  Had you done paramedic school and gone back for nursing, you would not become nearly the practitioner you will now be, so congratulations on getting off to the right start.

Although I do not recommend that an EMT get field experience before paramedic school, I do recommend that a nurse get nursing experience before paramedic school.  Unlike the EMT, you actually have an educational foundation to build upon.  If you do not immediately capitalize on that foundation by putting it to use, you will lose much of it.  Not to mention the horrible distraction that EMS would be on your professional development.  Working as an EMT now or going to paramedic school now would do very little to help you get in the air any sooner, and again, it will stunt your development.

ER is not the way to go for nursing experience if you plan to fly.  The majority of flights are interfacility transfers and medical patients.  Patients that are on drips, pumps, vents, and meds that few medics know anything about.  It's more airborne ICU work than airborne ambulance work.  That's why they want nurses in the first place.  A medic who just happens to have a nursing degree is of no more use than any other medic, so concentrate on the nursing portion of your development.  Get into a Critical Care internship somewhere, where you will get the opportunity to rotate through different ICUs, including medical, cardiac, surgical, and pedi.  From there, you'll get a better idea of where your niche is and can go with that after finishing the internship.  Do at least a couple of years of ICU work and work on your CCRN cert while you're at it.  CCRN and EMT-B are about all a nurse needs to get a flight job, assuming you have the requisite number of years of experience, and assuming there are any jobs available.  Just remember, everyone thinks they want to be a flight medic, just like you do.  Watching too much TV I guess.  It's silly, but I digress.  The point is that there are dozens of applications for every opening.  Just experience and letters after your name aren't enough.  You're going to have to be sharp enough to impress people with a lot more experience and education than you to get hired.

Around the time you get CCRN certified, you're going to want to go to paramedic school.  Screw the 10 month course.  Do the 10 week course.  It is, for the most part, going to be nothing more than a review for you anyhow.  Only at that point do you need to spend any time on an ambulance.  I would NOT do it before then.  Trust me, as a RN/EMT-B working on an ambulance, you're going to go crazy while cocky EMTs and medics attempt to assert their superiority over you because you are on "their turf".  You won't be allowed to practice anything you know as a nurse, which will frustrate you endlessly.  And you'll end up depressed over the helplessness you feel.  Not to mention the fact that they'll be paying you a third of what you make as a nurse.  Just forget about that, concentrate on the nursing, then go to medic school.

There's only half a dozen or less flight nurses or medics on this site.  The place you ought to be hanging out is www.flightweb.com.  That's where most of the aeromedical professionals hang out.  We're not above helping n00bs out with advice, although I highly recommend that you spend a lot of time just reading there before you jump in.  Trust me, you aren't the first one to ask these questions there.  We get the same old questions from other eager n00bs several times a week, so grab a Red Bull, sit down, and start reading there.  But again, I would forget all about any involvement in EMS for the next two or three years.  We simply have nothing to offer you that will serve your goals well at this point, unless you're just looking for an opportunity to play with the siren.

Good luck!


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## 8jimi8 (Mar 28, 2009)

What kind of advanced first aid training were you given as an RN?

I was given more information about bandaging wounds and techniques for stopping bleeding in my basic training than my RN education.

We didn't cover pressure points, we covered things like wet to dry, dry to dry and dressings with drains etc.  First aid was really glossed over.  We didn't cover anything about splinting / traction splinting, spinal immobilization, backboarding or patient transfers (except sliding someone up in bed, or helping them to the ground if they fell on you)

I am not expecting less or trying to minimize experience for a Paramedic trying to fly, what I asked was what is the experience requirement.

Maybe i should rephrase my comment about the oversaturation of nursing in my area.  

The ICU where i want to work is the only level 2 trauma center in my region. (they will shortly become a level 1 because the university is going to back them)

It is highly competitive and my primary drive is to get patient contacts in an acute / emergent setting.

Damn right i don't know the profession. I'm not a professional, i'm a student.  I haven't applied for any ambulance jobs yet.  I'm haven't worked professionally as an RN. 

That is why I am asking questions. 

Honestly I don't think it matters where my education comes from, there is always going to be someone with more experience than me who bags on me for being a greenhorn.  I am humble enough to learn from people no matter what their style of dissemination of information.  It's not like I am going to be getting into this with no experience in pharmacology, anatomy, or patient assessment and care.  I'll have 2 years of experience floor nursing and supplement that with otj experience as a basic.  

Who knows I may not have time to start paramedic school before I get hired into a department where I want to work.  Like i said, I'm career mapping  and trying to decide what is going to get me where I want to be.

Either way I go, I'm at the beginning of my career and extremely interested and excited.  I don't take my education lightly and I've got great clinical experiences to build on.  The school that I am in right now puts emphasis on clinical experience, our program actually got knocked by our accreditation agency for having almost as many clinical hours as a 4 year degree program.  

I think what has me so excited about paramedic school is that I enjoyed my EMS clinical rotations so much more than my nursing clinicals.

There is something about walking into the unknown with only your senses to lead you to the correct course of action that draws me to EMS.  Sure you walk into a patients room not quite knowing everything that is going on, but these patients are usually stable.

I'm not hoping for people to have a bad day, I'm just hoping that I get lucky enough to go and get them and help out as much as i can.


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## 8jimi8 (Mar 28, 2009)

*Thanks*

Aj thanks for the thoughtful response!

Honestly I have been looking at those accelerated paramedic programs as well; however i noticed that they are for experienced acute care RNs.  I greatly appreciate your advice to hold off on medic school.  At first I thought that I wanted to be an ER nurse, then move to flight, but I was also advised by a flight nurse to go the ICU route.  ER is such a mixed bag of backaches, earaches and upset stomachs with an occasional real emergency, that is what I learned in my ED portion of my EMS rotations.  I have been lurking on flightweb as well.  I have also imagined the frustration of working on a BLS box and having to call ALS to start an IV or advanced airway (in Texas basics are not allowed to use the combi-tube or lma).  I still think that I can gain useful experience with assessments and BLS while I am looking for my ICU job.  Your post really hit the nail on the head for me, thanks for your time and expertise.


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## medic417 (Mar 28, 2009)

http://allnurses.com/flight-nursing-surface/rn-paramedic-bridge-17852-page7.html


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## MSDeltaFlt (Mar 28, 2009)

As far as medics go, you'll need all of your certs: CPR, ACLS, PALS, NRP, PHTLS/ITLS.  Not to mention your 3-5 years of *busy* 911 experience.  Depending on the flight service, you'll either be required or preferred to have CCEMT-P or FP-C.  Let's face it.  A medical aircraft is an *ambulance* that is a flying *ER/ICU*, not just a flying ER only.  There are those that tend to overlook that aspect.


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## AJ Hidell (Mar 28, 2009)

8jimi8 said:


> in Texas basics are not allowed to use the combi-tube or lma


That is not entirely correct.  There is no statewide Scope Of Practice in Texas.  A basic can do whatever his medical director authorizes him to do.  There are EMT-B schools that even teach the Combi-Tube in the basic curriculum.  Of course, nothing above the bare minimum to pass the test is taught in an accelerated school, so you missed out on that.  And, of course, you won't see that expanded scope happening in an urban area like Austin, where there is no shortage of paramedics.



> I still think that I can gain useful experience with assessments and BLS while I am looking for my ICU job.


Seriously, it will not be particularly useful to you.  It is extremely likely to simply interfere with getting established in your nursing practice.  And the frustration of operating as a basic will almost certainly affect your attitude, alienating all your partners, who will already resent you for being more educated than them.  I've seen many a good nurse get burned out and run out of EMS because of that.  Word to the wise.  Let it go for awhile.



> Your post really hit the nail on the head for me, thanks for your time and expertise.


My pleasure!  My first BS minored in Psychology.  The best partner I ever had in thirty-five years of practice had a BS in Psychology.  I know how significantly that contributes to EMS practice.  You're going to be great for the profession.  Just PLEASE don't get in a hurry to get there.  Take one profession at a time.  For you, Paramedicine should be a specialty focus built upon your nursing foundation.  And you've got a couple of years ahead of you before having the best possible foundation.  If you start trying to juggle too many balls, both are going to suffer to an extent.  Slow down, focus, and concentrate.

Of the four replies you have gotten here so far, three of us are or were flight nurses and/or medics, so don't discount anything you've heard.  MSDF is right on.  There are going to be plenty of EMTs, medics, and firemen on the scenes you make as a flight nurse.  They are calling you to provide the services that they can NOT provide, not the ones that they can provide.  Again, that's why it is most important to focus on critical care nursing, and not on EMS.

And speaking of MSDF, if you really want to be the best of the best, go to Respiratory Therapy school before paramedic school too.  With all three of those licenses, you'll be unstoppable.


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## VentMedic (Mar 28, 2009)

Since you are very close to finishing your nursing degree, finish and get your foot into the door of a good hospital that offers many internships into the units. You can even get hired now at some places as an ER tech or student intern doing limited duties similiar to a PCT.

Get great at nursing assessments. There is little you will learn as an EMT-B doing BLS assessments for the goals you have in mind. You will see more patients in the hospital in a day than some EMTs will see in a week or a month. 

Once you get your RN license, work med-surg or anywhere to get your confidence with the routine nursing skills and time management which is probably the most essential of all skills. Too many enter the ICUs without getting a rhythm for multitasking and sink miserably. Your RN preceptors will also be very upset if you spent more time riding around an ambulance doing BLS assessments than mastering very simple RN skills and assessments.

You will need at least 5 years of nursing experience in the ICUs with a little in the ED before you apply for a Flight NURSE position. Don't worry about the Paramedic if you want to be a Flight NURSE. Just as it is for some RRTs, the Paramedic cert is just another patch with a little different training. Often if you are part of a good flight program and have the necessary broad ICU base knowledge, you will be trained/educated for whatever you need to know. Several RNs and RRTs take the Paramedic training and get the cert but don't always license with their state as to not having any duo license conflicts. 

Your ICU experience should definitely have a heavy medical and CV component. If you place to go with a service that does Peds, you will need no less than 1 year with 18 months to 2 years preferred. The same goes if the service also doesn Neonatal although that is usually a Specialty team which usually wants their RNs to have no less than 5 years of NICU experience. Working on a Specialty Transport team for either PICU or NICU would be extremely rewarding and give you much experience. The RNs on these teams are quite often trained in intubation and many more invasive skills than a Paramedic may be allowed to perform on that age group. 

ED experience is good but for Flight, especially for a program that does interfacility, it will be the ICU experience they are looking at. If you work for a straight HEMS, the ED experience and a quick Paramedic program might be worthwhile. Strictly HEMS programs are often with a FD or County EMS agency and may use Paramedics, but you won't get the experience or type of patients you would see as a Flight Nurse on a combiation service of both HEMS and Interfacility. Often the strictly HEMS agencies will use ground paramedics with no extra training except for safety. 

Don't waste a great opportunity to explore the world of nursing. While 5 years may sound like a lot, it will go by quickly especially if you are constantly learning things and thinking about the next challenge. Even at 5 years you may feel you have not seen or learned enough which is why many RNs don't enter a Flight program until after 10 years. Paramedics on the other hand may think they are ready after 2 years, which is the requirement in some places but they are looking at it from a field perspective without seeing life in a Critical Care unit.

We get approximately 200 Paramedic applications for each opening that get weeded down to maybe 10 who are qualified or see willing enough to learn new tricks. For the Flight RN position, we may get 10 applications with 9 of those being very qualified. It is competitive for RNs and a BSN may be required or preferred at some agencies. The alphabet soup (PALS, ACLS etc) you can get in a handful of weekends but most of it you will already have as the same courses may be required for nursing.

After 5 years of working the critical care units of a good hospital, you can re-evaluate if you want or even need the Paramedic cert.

Now if you go for Paramedic and just keep your RN as letters to add on your name tag, you will not be able to hold a Flight Nurse position and whatever knowledge you have as an RN will make you a better Paramedic but working as a Paramedic may not make you a better RN if you have no experience as a nurse.

Nursing is a challenge. Give it a try. It may be rough but if you can get through the first few months, you may be able to see your goals clearer. If not, just get a quick cert as a Paramedic. But, don't use the Paramedic cert as a quick fix for a rough time as a nurse.  Times will be rough for a reason.


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## AJ Hidell (Mar 28, 2009)

VentMedic said:


> Strictly HEMS programs are often with a FD or County EMS agency and may use Paramedics, but you won't get the experience or type of patients you would see as a Flight Nurse on a combiation service of both HEMS and Interfacility. Often the strictly HEMS agencies will use ground paramedics with no extra training except for safety.


Glad you mentioned that, Vent.  That applies to Austin-Travis County EMS, who operates the HEMS in her area.  They only hire medics.  And with that agency being populated by some of the best and most experienced medics in the state, competition is overwhelming for the few flight medic spots.  Having critical care nurse experience on top of several years with them would give you an edge in that application process, but it is certainly not a shortcut.  You're looking at probably ten years from today to even be considered, so be prepared to relocate if you remain dead set on flying.


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## medic417 (Mar 28, 2009)

AJ Hidell said:


> Of the four replies you have gotten here so far, three of us are or were flight nurses and/or medics, so don't discount anything you've heard.



Now 4 of 5 responses are from people with flight experience.  I am the one w/o.  I figure if God wanted me to fly he would have given me wings.


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## TransportJockey (Mar 28, 2009)

AJ Hidell said:


> And speaking of MSDF, if you really want to be the best of the best, go to Respiratory Therapy school before paramedic school too.  With all three of those licenses, you'll be unstoppable.



Since you brought it up... I've been toying with going to school after I get my AAS in paramedicine for a BSN and my RRT. I know I want at least one or the other, but are you serious that all three would be a good combo? I thought so, but I'm still a youngster (both in the field and literally) 

EDIT: I might wanna add that flight (mainly fixed wing IFT) is one of my goals


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## Veneficus (Mar 28, 2009)

8jimi8 said:


> What kind of advanced first aid training were you given as an RN?
> 
> I was given more information about bandaging wounds and techniques for stopping bleeding in my basic training than my RN education.
> 
> We didn't cover pressure points, we covered things like wet to dry, dry to dry and dressings with drains etc.  First aid was really glossed over..



Not being a nurse, I cannot answer this directly, but I did want to show you how much more your education is worth than the average paramedics I have met. (above average people pay no attention, below average, well, you'll need more than my reply here)

first off, you took some kind of anatomy class. During that class you may have noticed there are certain places where blood flow can be decreased if there were an occlusion. Using a pressure point is no more than applying that knowledge and manually causing an occlusion. Forget about it anyway. It is rarely used and not very effective on the practical side. You planning on holding the pressure point the whole time untill something else is done to stop the bleeding? Direct pressure stops close to 90% of bleeding acording to 7th ed ATLS. There is some advances in tq. use but it is so new it is not in curriculum yet.



8jimi8 said:


> We didn't cover anything about splinting / traction splinting, spinal immobilization, backboarding or patient transfers (except sliding someone up in bed, or helping them to the ground if they fell on you)..



If you took EMT-B you should have covered a large part of splinting. (all types except maybe plaster) The reason you probably didn't talk about backboarding is because there isn't any evidence it does what it is supposed to so no loss.



8jimi8 said:


> The ICU where i want to work is the only level 2 trauma center in my region. (they will shortly become a level 1 because the university is going to back them)
> 
> It is highly competitive and my primary drive is to get patient contacts in an acute / emergent setting.)



So move. Also be aware that Trauma is surgical in nature, Emergency and trauma are not synonomous. Nurses in the trauma service are usually in the SICU, Theatre, and wards in my experience. ED nurses are in the ED and do help with trauma. The only time I have seen a trauma nurse in the ED she was there for QA/QC of the surgical residents on the trauma team at the behest of the Chief of trauma. (a surgeon)



8jimi8 said:


> Damn right i don't know the profession. I'm not a professional, i'm a student.  I haven't applied for any ambulance jobs yet.  I'm haven't worked professionally as an RN.



Forget the ambulance. Work in nursing. It has been my experience that providers who learn how to handle simple medical problems are often (not always) better than providers who never learned it. Many in EMS do not agree with my opinion on this, but I think you will find as many that do.



8jimi8 said:


> That is why I am asking questions.



and never stop asking questions in your life. It is a virtue to know what one does not know.



8jimi8 said:


> Honestly I don't think it matters where my education comes from, there is always going to be someone with more experience than me who bags on me for being a greenhorn.  I am humble enough to learn from people no matter what their style of dissemination of information.  It's not like I am going to be getting into this with no experience in pharmacology, anatomy, or patient assessment and care.  I'll have 2 years of experience floor nursing and supplement that with otj experience as a basic.



"if you didn't come to win, you shouldn't have come at all." Many places equate experience with chronology. Find yourself a place with high volume, high accuity, and write your own ticket. When it comes to education, where matter less than what you do with it, but when it comes to experience, more is better than longer.  (a provider who works in a facility that sees 100,000 patients a year in the ED is worth far more in 2 years than a provider who sees 5000 patients in the ed for 10 years) 

what you stand to gain as a basic is so minimal compared to what you stand to gain in a nursing position, you would set yourself back by focusing any attention as a basic.  



8jimi8 said:


> Who knows I may not have time to start paramedic school before I get hired into a department where I want to work.  Like i said, I'm career mapping  and trying to decide what is going to get me where I want to be..



A focus on your nursing career will get you anywhere you want to go faster than focusing on an EMT career. Even if you want to be a prehospital RN.



8jimi8 said:


> Either way I go, I'm at the beginning of my career and extremely interested and excited.  I don't take my education lightly and I've got great clinical experiences to build on.  The school that I am in right now puts emphasis on clinical experience, our program actually got knocked by our accreditation agency for having almost as many clinical hours as a 4 year degree program. ..



make sure you find a way to make that known at any interview you ever go to. 



8jimi8 said:


> I think what has me so excited about paramedic school is that I enjoyed my EMS clinical rotations so much more than my nursing clinicals..



Could it be you didn't get a large enough sample of your EMS clinical experience? Just a thought. 



8jimi8 said:


> There is something about walking into the unknown with only your senses to lead you to the correct course of action that draws me to EMS.  Sure you walk into a patients room not quite knowing everything that is going on, but these patients are usually stable...



Not in the ED. You will also see more patients in a day in an ED than on any one ambulance. You will also learn how to handle multiple patients at once a lot sooner than you will in EMS.



8jimi8 said:


> I'm not hoping for people to have a bad day, I'm just hoping that I get lucky enough to go and get them and help out as much as i can.



The one thing you never want to be is the patient that critical care providers find "interesting."


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## AJ Hidell (Mar 28, 2009)

Beware, RT school is significantly harder than medic or nursing school.  Hardest schooling I have ever had.  Probably contributed more to my paramedic practice than nursing school too.  Although, it is not quite as utilitarian overall as nursing school was.

But just the simple math says it's a great choice.  There are a LOT more nurses out there applying for flight jobs than RRTs.  And there are more flight medic jobs than there are flight nurse jobs.  Then you see flights where the flight medic gets pulled off the bird to make room for an RT because so many flown patients are on vents.  The medic is the one crewmember that is disposable.  A medic/RRT is an excellent combination for someone looking to eventually go to flight duty because you are much more qualified for critical care.  Just be warned that once you go to RT school, you'll suddenly be appalled that we let paramedics practice with the dismally insufficient education they currently get.


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## TransportJockey (Mar 28, 2009)

AJ Hidell said:


> Beware, RT school is significantly harder than medic or nursing school.  Hardest schooling I have ever had.  Probably contributed more to my paramedic practice than nursing school too.  Although, it is not quite as utilitarian overall as nursing school was.
> 
> But just the simple math says it's a great choice.  There are a LOT more nurses out there applying for flight jobs than RRTs.  And there are more flight medic jobs than there are flight nurse jobs.  Then you see flights where the flight medic gets pulled off the bird to make room for an RT because so many flown patients are on vents.  The medic is the one crewmember that is disposable.  A medic/RRT is an excellent combination for someone looking to eventually go to flight duty because you are much more qualified for critical care.  Just be warned that once you go to RT school, you'll suddenly be appalled that we let paramedics practice with the dismally insufficient education they currently get.



Thank you for the advice. I still can't decide if I really want to go to nursing school or just go straight to RRT school... Part of my problem is I love learning and being in school.


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## AJ Hidell (Mar 28, 2009)

jtpaintball70 said:


> Thank you for the advice. I still can't decide if I really want to go to nursing school or just go straight to RRT school... Part of my problem is I love learning and being in school.


Wow... well if you are up to doing both, I would never discourage anyone from doing so.  Just don't rush it.  You'll need a couple years of RN experience before devoting time to RT school.  Otherwise, you'll stunt your professional development.

Ideally, one would attend nursing school, then RT school, and then paramedic school at the end.  It's about an ever narrowing focus of education, starting with the broadest possible base, and then culminating with the EMS focus.  Unfortunately, you've already gone off track for the optimum plan, and are now working backwards.  But either or both goals would be definite career enhancers, making you many times the paramedic that you would otherwise be.  Nursing school contributes the most overall to your knowledge base and your competence.  RT, of course, is focused primarily on the most important part of your interventions, which is Airway and breathing, so it probably contributes most to your "skills", and also makes you stand out more as a specialist.  But if you're weak or marginal in the heavy sciences like math, chemistry, and physics, you're going to have trouble finishing RT school.  Again, it is significantly harder than nursing school.


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## VentMedic (Mar 28, 2009)

AJ Hidell said:


> Wow... well if you are up to doing both, I would never discourage anyone from doing so. Just don't rush it. You'll need a couple years of RN experience before devoting time to RT school. Otherwise, you'll stunt your professional development.
> 
> Ideally, one would attend nursing school, then RT school, and then paramedic school at the end. It's about an ever narrowing focus of education, starting with the broadest possible base, and then culminating with the EMS focus. Unfortunately, you've already gone off track for the optimum plan, and are now working backwards. But either or both goals would be definite career enhancers, making you many times the paramedic that you would otherwise be. Nursing school contributes the most overall to your knowledge base and your competence. RT, of course, is focused primarily on the most important part of your interventions, which is Airway and breathing, so it probably contributes most to your "skills", and also makes you stand out more as a specialist. But if you're weak or marginal in the heavy sciences like math, chemistry, and physics, you're going to have trouble finishing RT school. Again, it is significantly harder than nursing school.


 
However, if you go to RT school first, the hardest sciences will be behind you. As an RT, you can be a social butterfly and visit every unit or floor to see if anything fascinates you about Nursing. Nursing school will be much easier since you will be at home almost any place in the hospital because you will have worked a code in almost every place in the hospital.

But, get into nursing school before you have to retake any of the sciences or maths. In some states that is 5 years and 7 in others.


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## VentMedic (Mar 28, 2009)

> Originally Posted by *8jimi8*
> 
> 
> _What kind of advanced first aid training were you given as an RN?_
> ...


 
As an RN, it will depend on where you work. Med-surg gives you a wide variety. You will learn about moving and log rolling a patient with a spinal injury and definitely see some amazing C-Spine devices. Ortho and surgical floors will have their own unique equipment and challenges. Microsurgery is also a fascinating world of reattaching limbs and leeches. Bandaging and blood flow monitoring will be taken to the _nth_ degree.

Bandaging will vary but you will get your share of bandages that few EMT(s) will every see. If you want to do serious bandages, try the burn unit. But, you will be bandaging stumps, hands, arms, or whatever for a variety of reasons. And, you will have a wide variety of bandages and medications to apply. 

Pressure points and applying pressure? Hang post out in a dialysis unit. Not only will you learn how to apply pressure to the shunt but you will learn how not to. You may also learn how to use sandbags for applying pressure to the groin post procedure. Where ever you work in the hospital will come with its own P&P manual for you to review. 

You will be amazed at how many "skills" you will accumulate as an RN and you will have the educational foundation along with additional education with each step to understand the hows and whys of each skill or procedure.


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## firecoins (Mar 28, 2009)

As a medic I don't lift or lift off.  I like the ground just fine.


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## AJ Hidell (Mar 28, 2009)

Definitely do not get caught up in an obsession with "skills".  That is not what medicine is about.  I literally taught my sister to intubate and start an IV at age 10, and she caught on to both in only a couple of hours.  Big deal.  Bandaging and splinting?  Despite all the time spent on them in EMT school, they're among the least used "skills" in EMS.  Any monkey can quickly be trained for that stuff.  What separates the professionals from the skills monkeys is the knowledge necessary to make intelligent advanced assessments and treatment decisions without having to cook by the book.  That's why it is so important for you to focus on your educational development and not get in a hurry to go play ambulance driver.


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## Veneficus (Mar 28, 2009)

AJ Hidell said:


> Definitely do not get caught up in an obsession with "skills".  That is not what medicine is about.  I literally taught my sister to intubate and start an IV at age 10, and she caught on to both in only a couple of hours.  Big deal.  Bandaging and splinting?  Despite all the time spent on them in EMT school, they're among the least used "skills" in EMS.  Any monkey can quickly be trained for that stuff.  What separates the professionals from the skills monkeys is the knowledge necessary to make intelligent advanced assessments and treatment decisions without having to cook by the book.  That's why it is so important for you to focus on your educational development and not get in a hurry to go play ambulance driver.



could we make this very quote the coverpage of all EMS texts?


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## Sasha (Mar 28, 2009)

> First aid was really glossed over..



Perhaps because nurses are not so much first aid providers, but a participant of definitive care?


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## 8jimi8 (Mar 28, 2009)

AJ Hidell said:


> Definitely do not get caught up in an obsession with "skills".  That is not what medicine is about.  I literally taught my sister to intubate and start an IV at age 10, and she caught on to both in only a couple of hours.  Big deal.  Bandaging and splinting?  Despite all the time spent on them in EMT school, they're among the least used "skills" in EMS.  Any monkey can quickly be trained for that stuff.  What separates the professionals from the skills monkeys is the knowledge necessary to make intelligent advanced assessments and treatment decisions without having to cook by the book.  That's why it is so important for you to focus on your educational development and not get in a hurry to go play ambulance driver.



I definitely appreciate the importance of this statement.  I think the confidence derived from "skills," is having a platform from which to operate in the face of crisis.  My first two semesters I was on a telemetry med / surg floor and I was very scared that someone would code on me.  Why?  Because I didn't have a basis from which to react, other than my knowledge of "hit the button, call the code, and start cpr."  It wasn't until I took an ACLS class that I understood what would happen in a code.  What did I do on my first code?  Chest compressions.  But having the knowledge of what was about to be going on around me and then the understanding of what _was_ going on around me, while i did my compressions, gave me a sense of relief.  A sense of knowing which direction things were going, and ultimately that I was doing everything I should be.

***edited for punctuation***


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## Ridryder911 (Mar 28, 2009)

One has to recognize, the drama and glamorous life of a flight nurse/medic is really over exaggerated. If you do not like the ground areas of ER, Field, ICU then you will hate the air. The only difference between the ground units and air is speed. 

Having RT's must be a regional thing. I have not seen an RT on a neonate or flight team in over a decade. Most of our Neonate team is Neonate Nurse Practitioner with a RN/Paramedic or CCP speciality trained in neonate. The Paramedic being more of an assistant. As well, very few flights are now with neonate as it is hard to justify a helicopter with a scene time >1hr and then rapid transport? Most around here have also included a ground transport unit. 

I believe we see will a major reduction of HEMS within as little as 2-3 years. Economics will determine that it is foolish in the majority of cases of calling a helicopter and awaiting then to transport when if the patient was properly diverted or immediately transported the patient would had been at the appropriate facility to begin with. 

Our HEMS is only making it because of trauma funding associated with tag tax at this time. Even now, this week there is meetings to cut that pie open and share with more with others. Interfacility transfers per HEMS is beginning to decline, justifying a $10,000+ trip is hard to do and insurance companies are exploring these justifications even more. I am seeing more and more abuse of HEMS services as well. Barely justification and definitely not "time" warranted. The reason it is one of the most competitive medical areas known. Also with the safety record being as it is, it will be under more of a microscope. 

In reality many of the HEMS have lost their appeal in my area. The truthfulness that there is not or any difference in treatment regime and also many flight services have lost their "attraction" as the pay is many times no different nor the personal on them any better than ground units have. Many have returned back to the streets or units for better working conditions and schedules. 

If one is really serious about aviation medicine, then one has to be very comfortable on the ground in the unit, field. Obtain as much experience for autonomy and being to perform needed clinical skills in adverse conditions. Hence the reason for the required experience. 

R/r 911


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## 8jimi8 (Mar 28, 2009)

While Air transport is my stated goal, I think I would be equally happy doing ground ICU.  The flight nurses that I have talked to, also have other jobs "so they can afford to fly."  There is a rumor that, Acadian, a private company that operates in the surrounding areas of Austin has a mobile ICU that rolls with an RN.  Like i said in my first post... I WISH I WENT TO PARAMEDIC SCHOOL INSTEAD!  I don't know why my brain is so drawn to pre-hospital.  Believe me, i'm not going to waste the two years I've spent to get where I am.  I'm going to take my education and alot of advice from those who came before and do what I know is right, advocate for the patients.  There is no telling where my final destination will be, the least that I know is that I'll be studying hard to get there.


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## VentMedic (Mar 29, 2009)

Ridryder911 said:


> Having RT's must be a regional thing. I have not seen an RT on a neonate or flight team in over a decade. Most of our Neonate team is Neonate Nurse Practitioner with a RN/Paramedic or CCP speciality trained in neonate. The Paramedic being more of an assistant. As well, very few flights are now with neonate as it is hard to justify a helicopter with a scene time >1hr and then rapid transport? Most around here have also included a ground transport unit.
> 
> 
> R/r 911


 
This seriously must be limited to Oklahoma.  Read the American Academy of Pediatrics for recommendations for Pedi teams.  

The majority of Neo specialty teams do include an RRT.  The other teams are RN/RN or RN/NP.  

Honestly, would you want a Paramedic who does not have the ability to work inside of an NICU caring for your newborn on transport or an RRT or RN with a minimum of 5 years of experience exclusively in neonates with several hundred intubations, line placement and education of the latest technology and meds?

There are now 5 established HEMS services with RRTs. 

How did Oklahoma not get the memo that RRTs have moved on?  Maybe that is why they are so poorly represented at the nationals.  No interest but they still must meet the national level of education to take the boards whether they like it or not in that state.


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## VentMedic (Mar 29, 2009)

8jimi8 said:


> While Air transport is my stated goal, I think I would be equally happy doing ground ICU. The flight nurses that I have talked to, also have other jobs "so they can afford to fly." There is a rumor that, Acadian, a private company that operates in the surrounding areas of Austin has a mobile ICU that rolls with an RN. Like i said in my first post... I WISH I WENT TO PARAMEDIC SCHOOL INSTEAD! I don't know why my brain is so drawn to pre-hospital. Believe me, i'm not going to waste the two years I've spent to get where I am. I'm going to take my education and alot of advice from those who came before and do what I know is right, advocate for the patients. There is no telling where my final destination will be, the least that I know is that I'll be studying hard to get there.


 
Flight nurses can not afford not to work somewhere else because they must maintain their expertise in critical care.  They must continuously stay on top of the latest technology and protocols in the ICUs.  If they rely only on the experience from flight, they will eventually become ineffective as a Flight Nurse with critical interfacility transports.

If you are not up to the challenges of being a nurse, then by all means go on to be a Paramedic.    Which ever one you choose, stick with it and don't be constantly saying I wish I had done the other.  That will not gain any points with your co-workers and your supervisors will not be impressed with your lack of dedication or enthusiasm for the job.


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## Ridryder911 (Mar 29, 2009)

Vent I believe you will see more and more working somewhere else.  I know of five flight services in neighboring states that requires flight teams to work in the ED, clinics, and even the two neonate teams works in either the clinics or NICU in between flights. There are more flight nurses in many parts of this area that work in between flights than just performing flights alone. Even our state teaching facility has contracted out the NICU flight team and has been controversial as they are only PRN assigned. 

Many do not work in the ICU areas as being assigned a patient and leaving, many are assigned in the ED's as the Paramedics are as well. Twenty four hour shifts are becoming less and less popular, and when that occurs many feel the downtime one should be productive. 

In fact interfacility transports per flights have decreased remarkably being able to justify a $10-25K bill over a $800 is difficult to do. Insurance companies are becoming more savvy and know many of these teams are more for PR for hospitals than any real change in outcome as studies showing any difference between ground teams and having a flight team is minimal to none. 

That is why many of our HEMS are no longer speciality teams but are primarily scene flights. Trauma funds are now the support as they recieve a guarenteed payment but alas even this will be changing. Along with the obvious safety issue, I believe with economic issues many HEMS will be soon a thing of the past. Having a 3-10 million dollar helo sitting in front of the hospital one will still have to justify and I don't believe many will be able to do it. Speciality teams yes.. but; not always per helicopters. 

R/r 911


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## 8jimi8 (Mar 29, 2009)

VentMedic said:


> Flight nurses can not afford not to work somewhere else because they must maintain their expertise in critical care.  They must continuously stay on top of the latest technology and protocols in the ICUs.  If they rely only on the experience from flight, they will eventually become ineffective as a Flight Nurse with critical interfacility transports.
> 
> If you are not up to the challenges of being a nurse, then by all means go on to be a Paramedic.    Which ever one you choose, stick with it and don't be constantly saying I wish I had done the other.  That will not gain any points with your co-workers and your supervisors will not be impressed with your lack of dedication or enthusiasm for the job.



The flight nurse that taught my advanced EKG class told me that she was working 3 jobs.  The flight team, in ICU and in the ER.  She is the one that told me that she held these other positions so that she could afford to fly.  But she also remarked that she was going to stop working in the ICU because being there PRN, she was losing touch with the floor and she had "had enough of wiping butts."  Please don't misunderstand my exclamations about paramedic school.  I am VERY excited about working as a nurse, I just know in my bones that I cannot take a regular "floor nursing" job.  I know that many people feel that one should take a med/surg position to get their feet under them, but this is not the type of job that I could handle doing.  I would definitely be willing to take a stepdown IMC floor, but I've got an ER job lined up.  The issue is that I don't even want to be in the ER.  Now that I have found that the ICU is where i need to get my experience my mind is set on that.  I'm not an 18 year old out of high school. I am confident in my skills, organization and assessments and I'm ready.  Now then, I'm not ready to jump into a bird, but that is the destination.


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## AJ Hidell (Mar 29, 2009)

8jimi8 said:


> Like i said in my first post... I WISH I WENT TO PARAMEDIC SCHOOL INSTEAD! I don't know why my brain is so drawn to pre-hospital.


I'm sure it's for the same reason it is drawn to the air.  You have some craving for a sense of sexy excitement that you think exists in both fields that you don't think is in the hospital.  Well trust me; that all wears out very quickly, in less much than a year in the field.  Then you're just stuck with all the mundane, boring, low paid nonsense that everyone else doing the job hates.  Yeah, I know you have to get it out of your system for yourself, but it wil happen quickly.

You absolutely made the intelligent choice by going to nursing school first.  To do otherwise is contrary to every intelligent concept of education.  Education is just like building a house.  You do not specialize in something before establishing a foundation.  And if you try to pour a foundation on top of an already established specialization, it collapses.  I know that you feel ripped off right now, missing out on the sound of the siren and the rotor blades, but get over it.  It's done.  Recognize the fact that you made the right choice and focus on capitalizing on that, rather than trying to think of ways to undo it.


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## VentMedic (Mar 29, 2009)

Ridryder911 said:


> Vent I believe you will see more and more working somewhere else. I know of five flight services in neighboring states that requires flight teams to work in the ED, clinics, and even the two neonate teams works in either the clinics or NICU in between flights. There are more flight nurses in many parts of this area that work in between flights than just performing flights alone. Even our state teaching facility has contracted out the NICU flight team and has been controversial as they are only PRN assigned.
> 
> Many do not work in the ICU areas as being assigned a patient and leaving, many are assigned in the ED's as the Paramedics are as well. Twenty four hour shifts are becoming less and less popular, and when that occurs many feel the downtime one should be productive.
> 
> ...


 
Rid,
Specialty teams such as NICU or PICU are usually dedicated and from the ICUs. Sometimes they can be on call and sometimes they can be floaters in the units. 

I believe that are at least 2 or 3 dedicated NICU teams in Oklahoma that use RN/RRT. One I know is in Tulsa, St. Francis. You can check the AAP database to see which hospitals have dedicated teams.

That being said, not all babies need a level 3 NICU or a pedi ICU. A state level 1 baby will probably be fine with a Paramedic even with limited knowledge or training. A low acuity child will also be okay most of the time. However, if you are running HFV, nitric oxide, nitrogen, CO2 or ECMO, it would probably be wise to how those actually work with this equipment everyday and not a "once in a blue moon saw that" type flight team or CCT. I do not see where it is PR to dispatch a Level 3 NICU team to a child that requires any of that equipment. These teams are usually busy enough with just 2 or 3 transports in 24 hours since each transport may take 8 hours. They do not go out for room air baby from a hospital that doesn't admit children. Nor will they go out for a baby until it is determined to be viable. So no, I do not see Level 3 NICU Specialty teams as being just a PR stunt.

Specialty teams don't always own their own helicopter. Sometimes they share with other Specialty teams within a hospital or contract a helicopter service with a pilot on call. Sometimes they drive and sometimes it is fixed wing. Occasionally we'll even go commercial with a medical fixed wing for the return. It all depends on where we are going since we travel to several states and countries.  Flight is only on part of Specialty Team's transit system.


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## Ridryder911 (Mar 29, 2009)

I'll even ask this; have you ever been in helicopter before? Seriously, I had a lot of wanna bee's but when I placed them in the back with vibration, noise, see & sawing, majority washed out. Yes, they had all the qualifications but was the understanding that it would be alike inside a hospital and medics were no different. 

Nothing like trying to re-establish an IV in a cramped moving quarters. Unlike what most presume.. it is just a job. Yes, I like flying but I know many that washed out after a few missions because it was nothing alike they presumed. 

I usually describe flight teams either get two types of patients. Those that are B.S. that can walk out to the aircraft (yes, I have seen some) and those that have one foot in the grave and the ER/Unit is pushing you out the door before they die on them. 

Realistically, there is nothing more you can do in the air than in a unit or ground; in fact usually less. 

Let me assure you the "glamorous" side leaves when you soon discover that safety is your first priorty and patient care is second. Also those sexy flight suits get pretty dang hot in the summer and we won't go into altitude and mexican food in a small aircraft. 

Other than the flying part, I really do not know what the "attraction" is to it? Personally more medics are drawn to it than nurses. Nurses appear to be more patient advocates than upon their own egos and adrenaline rushes. I know of many places that have considered flight nursing similar to those that work in a clinic or nursing home (not really nursing). 

The prestige usually comes with the self acknowledgement that you are working with other qualified, experienced peers. Hoping that your combination of education and experience will deliver the best care within that period of time to the patient. ........

Other than that.. it's just an ambulance with rotors...

R/r911


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## AJ Hidell (Mar 29, 2009)

Ridryder911 said:


> Realistically, there is nothing more you can do in the air than in a unit or ground; in fact usually less.


Much less.  Heck, the one thing that medics are always sitting around and wishing for is a full arrest, and we don't even do those in the air, so that eliminates most of the "excitement" that even ground crews get.

Of course, if you want to work full arrests in the air, you can always go to Iraq or Afghanistan.  We still worked them there, although the helicopters were a LOT bigger than anything flying outside of LA or SBD counties.


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## Veneficus (Mar 29, 2009)

AJ Hidell said:


> Of course, if you want to work full arrests in the air, you can always go to Iraq or Afghanistan.  We still worked them there, although the helicopters were a LOT bigger than anything flying outside of LA or SBD counties.



If there were HEMS flying around in Blackhawks after school I'd definately try to find a p/t gig there. No way would I get on some of the smaller ones I have seen recently. Even as a patient, I'll go by truck thanks.


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## Foxbat (Mar 29, 2009)

Ridryder911 said:


> Other than the flying part, I really do not know what the "attraction" is to it?


My impression was that helicopter crews transport the most challenging patients, so to say.
I did ride-along (or should I say fly-along?) 3 times. No calls. Well, there was one, but we were cancelled before we lift off. I am the whitest white cloud. I will try another time, if that won't work, maybe it's hint for me to stay on the ground


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## MSDeltaFlt (Mar 30, 2009)

Ridryder911 said:


> I'll even ask this; have you ever been in helicopter before? Seriously, I had a lot of wanna bee's but when I placed them in the back with vibration, noise, see & sawing, majority washed out. Yes, they had all the qualifications but was the understanding that it would be alike inside a hospital and medics were no different.
> 
> Nothing like trying to re-establish an IV in a cramped moving quarters. Unlike what most presume.. it is just a job. Yes, I like flying but I know many that washed out after a few missions because it was nothing alike they presumed.
> 
> ...


 
That's where I beg to differ, my friend. Depending on your state and local protocols, you will *not* be able to do the same job in the back of the truck. 

You may not have the equipment. You may not have the protocols. You may not have the QA/QI. You may not have the quality of on/off line Med Control. Hell, you may not even have local protocols to even allow you to touch that stuff on the ground.

The only place where I *can* do this job is as a flight medic. That being said, it's *what* I do, not where I do it that's important - meaning as a flight medic doing a ground transfer for weather.


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## medic417 (Mar 30, 2009)

Actually there is no real difference anymore between air and ground.  I am aware of some air services now flying with Paramedic/Basic crew.  In fact my ground protocols are as aggressive as many air providers.  The day and age of I'm a flight medic meaning you are more educated and better than most ground providers is gone.  Perhaps this will change as they make it harder to fly patients which will lead to many of the get rich flight services that have sprung up on every street corner the past few years shutting their doors.


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## AJ Hidell (Mar 30, 2009)

Foxbat said:


> My impression was that helicopter crews transport the most challenging patients, so to say.


Not so much.  Well over half of the scene responses are not justified by anything more than MOI.  No truly serious injuries.  Even those with truly serious injuries generally do not have any condition that the flight crew can address with anything more than IV and airway, which was usually started by the ground crew before you arrived.  In some areas, half of your flights are for IFTs, where again, your patient had all the stabilizing treatment done before your arrival.  If you're lucky, you're in some area like PA, MD, or VA, where everyone on the ground is an EMT vollywhacker, so no real patient care is done before your arrival, and you get to shoot your wad occasionally.  That is not usually the case though, especial in metropolitan urban and suburban areas.  Again, there is this popular perception of the sexy thrill aspect of flight medicine that is not at all accurate.


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## VentMedic (Mar 30, 2009)

medic417 said:


> Actually there is no real difference anymore between air and ground. I am aware of some air services now flying with Paramedic/Basic crew. In fact my ground protocols are as aggressive as many air providers. The day and age of I'm a flight medic meaning you are more educated and better than most ground providers is gone. Perhaps this will change as they make it harder to fly patients which will lead to many of the get rich flight services that have sprung up on every street corner the past few years shutting their doors.


 
If you are talking about the programs that are strictly HEMS, you may be right.  Although, there are several that do allow for the use of ventilators, RSI, chest tubes and central lines where the ground crew may not have the capability.  Some still hire for more than a warm body for their helicopters. 

If you are talking about a service that also does interfacility, you can be trained to transport IABP, VADs, ventilators other than the ATV, manage (not just stare at) several medicated drips as well as initiating them and monitor a variety of hemodynamics by pressure lines.

The helicopter services that can provide more than a speedy taxi ride will do be than the others.


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## MSDeltaFlt (Mar 30, 2009)

medic417 said:


> *Actually there is no real difference anymore between air and ground*. I am aware of some air services now flying with Paramedic/Basic crew. In fact my ground protocols are as aggressive as many air providers. The day and age of I'm a flight medic meaning you are more educated and better than most ground providers is gone. Perhaps this will change as they make it harder to fly patients which will lead to many of the get rich flight services that have sprung up on every street corner the past few years shutting their doors.


 


VentMedic said:


> If you are talking about the programs that are strictly HEMS, you may be right. Although, there are several that do allow for the use of ventilators, RSI, chest tubes and central lines where the ground crew may not have the capability. Some still hire for more than a warm body for their helicopters.
> 
> *If you are talking about a service that also does interfacility, you can be trained to transport IABP, VADs, ventilators other than the ATV, manage (not just stare at) several medicated drips as well as initiating them and monitor a variety of hemodynamics by pressure lines*.
> 
> The helicopter services that can provide more than a speedy taxi ride will do be than the others.


 
Maybe you should reread my post, medic417.  I told Rid *"depending on your state and local protocols"*.  Also, Vent is dead-on accurate with what she said.  There's a lot more to it than just skills.  Helicopters are not flying ER's.  They are *ambulances* that are flying *ER/ICU's*.  That's not really taught much in paramedic school.


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## paramedicmike (Mar 31, 2009)

medic417 said:


> Actually there is no real difference anymore between air and ground.



I, too, disagree with this statement.  MS and Vent have both accurately described some of the differences between air and ground based services.



> I am aware of some air services now flying with Paramedic/Basic crew.  In fact my ground protocols are as aggressive as many air providers.



Really?  Who?  The only service I'm aware of that does this is the Maryland State Police.  They are famous for picking the smallest provider on scene as "an extra set of hands".  They also had a "flight EMT" program at one point.  This, however, only reinforced their position as being a substandard service providing questionable care to those they flew.

Who else is staffing their aircraft in this manner?

-be safe


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