# Looking to Add Critical Care Transport



## NREMTPPrjDir (Feb 8, 2013)

As a new member I am looking for some assistance. My company is working to bring Critical Care Transport to the area we serve. We are in a Primarily Rural Setting where the nearest Tertiary Care Centers are approximately one hour away. 

We are planning this as part of an expansion including aeromedical service as well as new service areas. I am looking for some adviice on generator sizes. We have decided on the International Durastar 4300 Quad Cab Chassis. We have contacted a couple of nearby noncompeting services and they are reasonable in their operational costs. 

We are also planning on the Zoll X as the monitor. Any other advice is welcome. Thank you.


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## Veneficus (Feb 8, 2013)

The very highest caliber people is what you need. 

Everything else is just gravy.

"Critical care is not a place, it is a mindset."


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## NREMTPPrjDir (Feb 8, 2013)

Veneficus said:


> The very highest caliber people is what you need.
> 
> Everything else is just gravy.
> 
> "Critical care is not a place, it is a mindset."



That is true, but if you put the best equipment in the best peoples hands and you have something great. Plus I have to get this right as the first Critical Care Provider in the area.


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## socalmedic (Feb 9, 2013)

If you want to know generator size we must know what you will be powering with said generator and how much power they draw (amps or watts will do), as well as how many power outlets you plan on installing for possible use.


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## NREMTPPrjDir (Feb 9, 2013)

Looking at a ZOLL X Monitor with associated charger. We currently have Impact 754 Vents, IVAC Minimed Pumps. Also adding a 19" Flatcreen, PS3 Slim, Refrigerator (undecided on model suggestions welcome), Blanket Warmer (Also undecided), and Panasonic Toughbook CF-19 MDT. Plan is for a total of five outlets.


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## MMiz (Feb 9, 2013)

It seems like you're going about this the wrong way.  I've seen Critical Care transport teams in type II vanbulances and others in medium duty rigs with the latest everything.

I think you'll find that as long as you have a good vent, pumps, and qualified medics you'll be fine.  The fancy monitor, flat screen TVs, PS3, and everything else are impressive, but that's not why someone selects a critical care unit.


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## NREMTPPrjDir (Feb 9, 2013)

MMiz said:


> It seems like you're going about this the wrong way.  I've seen Critical Care transport teams in type II vanbulances and others in medium duty rigs with the latest everything.
> 
> I think you'll find that as long as you have a good vent, pumps, and qualified medics you'll be fine.  The fancy monitor, flat screen TVs, PS3, and everything else are impressive, but that's not why someone selects a critical care unit.



The Zoll X fits what we want. The fluff is just that, but when you are trying to expand fluff often sells. That is also why we are working on CAMTS accredidation. The area we are in has a local service that has horribly damaged EMS, so we are working to improve the image and providing a good experience is part of the solution. So the comfort aspect of this is, while not a neccessity, part of an image improvement effort. Sorry that I didn't point that out.


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## socalmedic (Feb 9, 2013)

your fridge and blanket warmer are going to be the biggest power hogs. you need to choose models first then look at their power usage... are you going to be using 120v or 12v HVAC for the box? all these must be answered prior to selecting a generator. your ambulance manufacturer may only have a few options when it comes to generators anyway. I would suggest one that operates on the same fuel as the engine, this will make plumbing and re-fueling painless.


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## Aidey (Feb 9, 2013)

Honestly, the only time I've seen ambs equipped with entertainment items is when they routinely do 4hr+ transports or are a speciality pediatric CCT amb. The fridge is unnecessary because the majority of your CCT pts will be NPO. A blanket warmer is also rendered unnecessary by investing in a good thermal wrap for the gurney. There is a specific yellow one that all the CCT units I've worked with like to use. 

Being on time, being polite and having the ability to take lots of meds and stuff will go far further towards fixing the reputation of EMS than a PS3 will.


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## Hunter (Feb 9, 2013)

Aidey said:


> Honestly, the only time I've seen ambs equipped with entertainment items is when they routinely do 4hr+ transports or are a speciality pediatric CCT amb.
> 
> *This*
> 
> ...



Is the fridge for food/drinks or for storing medications? We have small electric coolers where we keep temperatutesensitive meds and cold saline for post rosc transports to cath labs.
If it's for snacks then as aidey said most patients will be npo. If it's meds you only need a small cooler.


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## Veneficus (Feb 9, 2013)

MMiz said:


> It seems like you're going about this the wrong way.  I've seen Critical Care transport teams in type II vanbulances and others in medium duty rigs with the latest everything.



On my word, I could set up a critical care golf cart and it would function as well as anything out there.

Once again, before you lose all of your critical care billing profits to smoke and mirrors...

Forget the fancy gadgets, invest in education and training for your people.

That way when a gadget fails, they can still function.


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## Akulahawk (Feb 10, 2013)

I've _done_ CCT in those Type II vanbulances and some larger modular trucks. While you get more "work" room in the larger units, what makes the difference is the crew's ability to care for the patient. That, in a word, is _education_. I have worked with some very good people over the years and it's those _people_ that will truly make or break your CCT service. After you've got the people side figured out, you'll need _reliable_ equipment. It doesn't need to be the hottest, latest stuff on the market. You will need stuff that _works_ so that it isn't going to fail... and even then if it does, you will have people that will _know_ how to deal with that failure effectively. 

Get the right people and build the service around _them_, not the equipment first and attempt to fit the people to that.


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## NREMTPPrjDir (Feb 14, 2013)

Akulahawk said:


> I've _done_ CCT in those Type II vanbulances and some larger modular trucks. While you get more "work" room in the larger units, what makes the difference is the crew's ability to care for the patient. That, in a word, is _education_. I have worked with some very good people over the years and it's those _people_ that will truly make or break your CCT service. After you've got the people side figured out, you'll need _reliable_ equipment. It doesn't need to be the hottest, latest stuff on the market. You will need stuff that _works_ so that it isn't going to fail... and even then if it does, you will have people that will _know_ how to deal with that failure effectively.
> 
> Get the right people and build the service around _them_, not the equipment first and attempt to fit the people to that.



We are sponsering the UMB CCEMT-P Course along with our current program for continuing education. We are adding regular CC education.


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## Veneficus (Feb 14, 2013)

NREMTPPrjDir said:


> We are sponsering the UMB CCEMT-P Course along with our current program for continuing education. We are adding regular CC education.



Did you recruit any experienced CC people from outside of your agency?


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## NREMTPPrjDir (Feb 14, 2013)

Veneficus said:


> Did you recruit any experienced CC people from outside of your agency?



Yes. We are also evaluating our people for protocol compliance, job performance, and history of obtaining additional education. 

I appreciate everyones advice and welcome more of it. This is new to our area and we want to ensure that it is successful as it is a needed service.


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## truetiger (Feb 14, 2013)

Aidey said:


> Honestly, the only time I've seen ambs equipped with entertainment items is when they routinely do 4hr+ transports or are a speciality pediatric CCT amb. The fridge is unnecessary because the majority of your CCT pts will be NPO. A blanket warmer is also rendered unnecessary by investing in a good thermal wrap for the gurney. There is a specific yellow one that all the CCT units I've worked with like to use.
> 
> Being on time, being polite and having the ability to take lots of meds and stuff will go far further towards fixing the reputation of EMS than a PS3 will.



Umm the fridge is for the Anectine, saline (therapeutic hypothermia), and other temp sensitive meds. We have them at one of my services and god help  you if they catch you putting food or drink items in them. Without refrigeration, Anectine gets outdated every 30 days.


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## NomadicMedic (Feb 14, 2013)

I also worked at a service that kept the sux, Ativan and cardizem in a small fridge in the ambulance. 

We don't keep our meds in the fridge here and have to toss the sux every 15 days, on the order of a PharmD that got the ear of a medical director.


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## truetiger (Feb 14, 2013)

With the cost of meds and the drug shortages, wouldn't it be more advantageous to keep the meds in the fridge instead of tossing em every 30 days? I've begged the other service I work for to get the fridges but they just aren't interested. They tell us succs is back ordered now and the supply is gone. It kills me to think of all the succs that was wasted because we couldn't put a refrigerator in the ambulance.


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## Flight-LP (Feb 15, 2013)

OP- what is your target population that you see needs this level of care? Peds, OB, Neo, CV, Neuro?

Can you give us some more geographical info, State, region?

I agree with others when it is suggested to ditch the entertainment items. If they truly need a level of care that is considered CCT or SCT for billing, then they probably don't need to be playing on a PS3. 

When you say aeromedical, are you referencing fixed wing? Rotor wing? What kind of aircraft? Single or dual pilot? VFR or IFR program? 

What about your medical staffing? RN / Medic, RT?

What level of practice is your medical director prepared to authorize for you? What about your State agency?

Do you have a strong enough relationship and trust level established by your local facilities? Are they going to feel secure in allowing you to take the multi drip ICU patient, or post CABG IABP patient?

These are just a few of the questions that must be answered before pursuing this endeavormm


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## CANMAN (Feb 19, 2013)

Flight-LP said:


> OP- what is your target population that you see needs this level of care? Peds, OB, Neo, CV, Neuro?
> 
> Can you give us some more geographical info, State, region?
> 
> ...



Answers to all of this as well please. And why on earth do you need Quadcab Internationals? Such a waste of money. I work for a Critical Care Ground and Flight program that had to have Internationals and let me tell you I will take a F450 or E chassis over them any day. You can put a more then sufficent size box for critical care on either of those two chassis and save yourself a boatload of money. 

I agree with everyone here on education, top notch providers, etc. Have new and fancy toys is great if you have the money but just remember new and expensive doesn't equal competence.  There was a time when I worked at the number one hospital in the nation, and we had Propac monitors for vitals and invasive lines, and also brought a Zoll E-series monitor in for defib/pacing. Hated life and we were certainly working with outdated equipment but we got the job done and I worked with some absolutely brilliant clinicians.

To answer your original question though, a 6 KW Diesel Generator would power anything you want from IABP's, VAD's, Isolette's, Vapotherm heaters etc.


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## Rick Tresnak (Sep 9, 2014)

A good vent, a great monitor, a few IV pumps, meds for RSI and longer term sedation, some educated people and a great Con ed program to keep them up on what they learned in the CCP course.


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