# Mercy Air Protocols



## CTMD (May 23, 2018)

I'm curious as to how Mercy Air's protocols work throughout the US, specifically in Southern California/Southern Arizona. Are there corporate wide protocols that are followed or is it like ground EMS where each region has a unique set of protocols established by their individual medical directors? 
I've heard that the scope is extremely restrictive in CA for flight medics but opens up dramatically once you cross the state line and head to AZ, OR, Etc. Is anyone able to shed some light on this and eleborate on what the protocols are like for Mercy Air? (For medics) 
Also, is there a difference in protocols between companies like REACH or Mercy? Or is it all pretty uniform for the region?


----------



## DesertMedic66 (May 23, 2018)

In CA the scope is all determined based on state and county protocols. So medics are not able to do surgical crics, chest tubes, pediatric ET, or admin a huge list of medications. The flight nurse is however able to preform all those skills. 

If you jump over to AZ from what I have heard the RN and medic can operate as equals.


----------



## VentMonkey (May 24, 2018)

It really is state-dependent. And before another nauseating Texas hijack occurs here, the CC environment is completely not about skills performed. It is about the education behind the skills performed.

You may end up as equals in another state yet find yourself doing the same amount of hands-on skills as the state you’d left. *It is thee educational standards* that sets the CC provider and world apart from the base-level knowledge. 

IMO, Air Methods does a phenomenal job with educating their med crews, and EBM. I quite literally learned how to do all of those “cool skills” in an 8-hour cadaver lab (e.g., chest tubes, pericardiocentisis, surgical cric, etc.). 

Am I an expert in all of them? Absolutely not, but the hands on practice coupled more so with the insight as to why they’re performed, and any proper techniques/ considerations vs. deleterious effects seems so much more applicable to the HEMS/ CC environment.

Also, FWIW, Mercy Air is merely a California/ Nevada Air Methods CBS faction. They have several “Mercy Air-type” CBS’ in AZ alone. Tri-State CareFlite and Native Air being the two prominent programs in AZ, respectively.

Incidentally, in talking to a former Tri-State nurse a few years ago she absolutely had nothing but good things to say about the volume and experience out of their Bullhead City base.


----------



## CANMAN (May 24, 2018)

DesertMedic66 said:


> In CA the scope is all determined based on state and county protocols. So medics are not able to do surgical crics, chest tubes, pediatric ET, or admin a huge list of medications. The flight nurse is however able to preform all those skills.
> 
> If you jump over to AZ from what I have heard the RN and medic can operate as equals.



That sounds just absolutely awful. Makes me wonder why anyone would want to work in HEMS as a medic there.


----------



## CTMD (May 25, 2018)

VentMonkey said:


> It really is state-dependent. And before another nauseating Texas hijack occurs here, the CC environment is completely not about skills performed. It is about the education behind the skills performed.
> 
> You may end up as equals in another state yet find yourself doing the same amount of hands-on skills as the state you’d left. *It is thee educational standards* that sets the CC provider and world apart from the base-level knowledge.
> 
> ...


I know that after being hired at Mercy they send you to Colorado for training and orientation; is this similar to getting hired at their other subsidiaries? I know at the orientation they would cover company operations and the what not but do they also cover the advanced medical topics/procedures? 

So are there not a set of written protocols that flight crews operate off of? I'm curious as to how calls actually run while in the air as all I know is the 5-10 minutes of what happens while on the ground. 

Are there frequent skills labs to keep up proficiency in the more advanced skills? 

Also, how is the transition going from ground to flight in terms of the IFT aspect? That is in terms of learning all the new medications and procedures that are commonplace in CC/HEMS. Are these also taught in orientation or are you expected to already have sufficient knowledge of them prior to hire? 

Anyone have any other info on Tri-State, CareFlite or Native Air? I'm particularly interested in the Yuma region and am trying to find out more about the HEMS down there.


----------



## RocketMedic (May 27, 2018)

For the ground CCT team (Kangaroo Crew) here in Houston, the difference looks to be focus. All they train for, do and prep for is sick/injured kids. And they're really good at it.


----------



## VentMonkey (Aug 8, 2018)

I finally got my hands on Air Methods’ PCG’s. They’re not to be taken lightly (pun intended).

My old partner did a work over at my base and brought them with her. Along with all of the material required to be completed before her “third rider” time is completed.

Let’s just say none of it is to be taken lightly. And that is no joke. I am sure @VFlutter can attest.


----------



## VFlutter (Aug 9, 2018)

VentMonkey said:


> Let’s just say none of it is to be taken lightly. And that is no joke. I am sure @VFlutter can attest.




Ya orientation can be brutal. Ton of stuff to get done and learn. The new PCGs are pretty legit. Push dose pressors, ARDS.net vent settings, more liberal Ketamine usage, etc.


----------



## NPO (Aug 19, 2018)

DesertMedic66 said:


> So medics are not able to do ... pediatric ET...



Just to clarify, that's not true. 
CA passed a stop gap measure to allow Paramedics employed by CAMTS accredited agencies to do pediatric ETI until the formal Critical Care license scope is put into place.


----------



## NPO (Aug 19, 2018)

If you listen to any of Eric Bauer's stuff, he talks about it. He used to be part of the clinical team at Air Methods. He stresses how Air Methods does NOT use protocols, but rather guidelines because they stress clinical judgement rather than algorithmic practice.


----------



## DesertMedic66 (Aug 19, 2018)

NPO said:


> Just to clarify, that's not true.
> CA passed a stop gap measure to allow Paramedics employed by CAMTS accredited agencies to do pediatric ETI until the formal Critical Care license scope is put into place.


Yep, I am aware of that. That post was prior to the state putting that stipulation in place.


----------



## VentMonkey (Aug 19, 2018)

NPO said:


> Paramedics employed by CAMTS accredited agencies to do pediatric ETI...


It’s certainly a current gray area. The smaller HBS programs such as ours are still caught in the middle of this bureaucratic band aid.


NPO said:


> Just to clarify, that's not true.
> CA passed a stop gap measure until...Critical Care license scope is put into place.


I’m curious to see, or know how this will play out. 

When I talked to our medical director last about this potentiality, we shared a similar thought process about upholding a curriculum so it does not water down the added licensure, or its renewal process.

That said, the current clinical requirements, on paper, looks like a logistical nightmare. I’d also be curious to see where this would leave many of the “CCT” nurses when it’s all said and done.


NPO said:


> If you listen to any of Eric Bauer's stuff, he talks about it. He used to be part of the clinical team at Air Methods. He stresses how Air Methods does NOT use protocols, but rather guidelines because they stress clinical judgement rather than algorithmic practice.


Correct, they’re referred to as Patient Care Guidelines, or “PCG’s”. IIRC, he was at one point head of the company’s clinical department. However, people such as Allen Wolfe, and Dave Olvera have certainly picked up where he left off.

The company itself, clinically, is arguably at the epicenter of much of the out-of-hospital cutting edge practices. My guess is much of it has to do with the amount of educated, clinically-driven providers (imagine that). I’m sure the company’s buy-in itself doesn’t hurt.


----------



## SandpitMedic (Aug 26, 2018)

Am I the only guy here who worked for Mercy Air?

Mercy Air is on the level when it comes to CC training and call volume to maintain skills and knowledge base. For why it’s worth, and it has been said already, it is important to note that Mercy Air is part of Air Methods Corporation (AMC).  So yes, anyone hired by any AMC goes to Denver for a week  long indoc and CCT training course. Quarterly labs are the standard with hours and hours of continuing education to help you stay sharp. Cadaver labs are an annual thing where I was at, and the labs are mandatory. I gained more knowledge from those labs and the physicians teaching them then I ever did on an online CE module. 

The protocols are called PCGs, and as someone alluded to earlier, it’s right there in the name: Patient Care Guidelines. 

They are big time on you using your critical thinking skills and performing at the top of your training. At the top of your training. At the top of your training... repeated for importance. They are indeed guidelines. You are expected to follow some more than others and in general they are all good guidelines based on the latest EBM. They update about once or twice a year, so they stay on it. They are written by a collaboration of all of the medical directors that AMC has throughout the country. For our area, our medical director was awesome, and had personal relationships and was on a first name basis with most of our local crews. Real good dude and exceptional practicing Emergency Medicine Physician. If you go outside the guidelines, you can usually call your medical director and explain yourself and get the blessing. You write it up as such in your after action report/debrief. 

I miss the good old days at Mercy Air, and the crews. A great gang and great clinicians.


----------



## DesertMedic66 (Aug 26, 2018)

SandpitMedic said:


> Am I the only guy here who worked for Mercy Air?


From the sounds of it yes you are haha. 

I’ll have more to add to this thread next month since I will be going through their indoctrination class then.


----------



## SandpitMedic (Aug 26, 2018)

DesertMedic66 said:


> From the sounds of it yes you are haha.
> 
> I’ll have more to add to this thread next month since I will be going through their indoctrination class then.


Congratulations! Do you know which base you’ll be yet? The desert bases stay busy. 

I was in Vegas. 

And for what it’s worth... we were warned about crossing that imaginary enemy line into CA and that we should be aware of what to do/not to do... more so, who was watching.


----------



## DesertMedic66 (Aug 26, 2018)

SandpitMedic said:


> Congratulations! Do you know which base you’ll be yet? The desert bases stay busy.
> 
> I was in Vegas.
> 
> And for what it’s worth... we were warned about crossing that imaginary enemy line into CA and that we should be aware of what to do/not to do... more so, who was watching.


PM sent


----------



## VFlutter (Aug 26, 2018)

SandpitMedic said:


> And for what it’s worth... we were warned about crossing that imaginary enemy line into CA and that we should be aware of what to do/not to do... more so, who was watching.



I found it sadly numerous in the book Trauma Junkie when they talked about trying to figure out which CA county they were in to know if they were allowed to do a certain procedure or not.


----------



## VentMonkey (Aug 27, 2018)

VFlutter said:


> I found it sadly numerous in the book Trauma Junkie when they talked about trying to figure out which CA county they were in to know if they were allowed to do a certain procedure or not.


I was always under the impression that the programs protocols, or PCG's, superseded something as silly as county lines, or boundaries. Not quite maritime law, but you get the gist.


----------



## SandpitMedic (Aug 27, 2018)

They do not.


----------



## NPO (Aug 27, 2018)

Theoretically, they should be allowed to practice under the protocols for the county they are from, regardless of where they are physically located.


----------



## VFlutter (Aug 27, 2018)

It's been a while since I read the book to remember the exact details but it took place in the 90s i believe so I am sure different now. I know our protocols supersede some of the weird regional protocols in our area.


----------



## CTMD (Aug 31, 2018)

Any insight into applying for one of the Air Methods subsidiaries in AZ? Is it a universal type hiring/application process or is there something unique to applying in that region? I've heard that there is a pretty high turnover rate in Arizona. Can anyone confirm this or speak to the reasons why?


----------



## SandpitMedic (Sep 1, 2018)

AZ has had its share of management issues. I wasn’t down there, but they did have a high turnover. 

As for hiring, it’s all through airmethods.com.
It is a universal process and indoc.


----------



## SandpitMedic (Sep 1, 2018)

The nurses did not have any issues as they are licensed by the state(s). 
The problem is medics in CA are licensed by counties that all have their hands in the cookie jar, and a bunch of hostilities among agencies for whatever reason. For a while there it was that bordering medics had to have ICEMA, then we didn’t, then we did, now we didn’t again... Then they didn’t want you going outside of their ICEMA scope despite being trained at a higher standard. That brought a lot of BS with fire department personnel and other EMS or law enforcement personnel “snitching.” They’d literally call the EMS agency and taddle that they saw the medic touching the pump/doing a chest tube/et cetera. 

It caused a lot of headaches, but as of the last few years I didn’t notice much of that BS. I ran a lot of calls in Baker, Death Valley, Dumont Dunes, etc and I never had an issue except for once. Generally, the medical director will have your back, as I mentioned before. The EMS agencies and ICEMA office have their own medical directors. That said, most of the physicians know each other and usually can squash whatever issues arise.


----------



## CTMD (Sep 1, 2018)

SandpitMedic said:


> AZ has had its share of management issues. I wasn’t down there, but they did have a high turnover.
> 
> As for hiring, it’s all through airmethods.com.
> It is a universal process and indoc.


Interesting. So is it relatively easy to transfer from one base to another? Like going from AZ to California or Vegas? For overtime as well as moving to a new home base.


----------



## DesertMedic66 (Sep 1, 2018)

CTMD said:


> Interesting. So is it relatively easy to transfer from one base to another? Like going from AZ to California or Vegas? For overtime as well as moving to a new home base.


From my understanding it is. For moving bases you normally have to have an interview with the area manager for that base to make sure they like you. Also Air Methods is starting to put in year long contracts at bases that are hard to staff. The base I am going to is a hard to staff one so I had to sign the year contract.


----------



## SandpitMedic (Sep 3, 2018)

Transferring can be easy or it can be impossible based on staffing needs...

Where I was, we had about a 90% staffing turnover in a year. Made it nearly impossible to transfer even within the same region.


----------



## CTMD (Sep 4, 2018)

DesertMedic66 said:


> From my understanding it is. For moving bases you normally have to have an interview with the area manager for that base to make sure they like you. Also Air Methods is starting to put in year long contracts at bases that are hard to staff. The base I am going to is a hard to staff one so I had to sign the year contract.


Does this go for overtime as well? Or just a permanent transfer?


----------



## VFlutter (Sep 4, 2018)

CTMD said:


> Does this go for overtime as well? Or just a permanent transfer?



You can pick up overtime pretty easily almost anywhere in the company. I had the option to work a week of OT with bonus in Arizona when they were short staffed and I am in the Midwest. I am not sure I would pick up overtime outside of your local area / region until after a year anyway tho.


----------



## DesertMedic66 (Sep 4, 2018)

CTMD said:


> Does this go for overtime as well? Or just a permanent transfer?


OT is very easy to pick up. As long as you have a medic license in the state/area where you are wanting to pick up OT at. 

As VFlutter said for at least the nurses they will offer OT in different states that are short staffed and will pay you very well. We have been having a nurse from OR down here in SoCal to cover shifts.


----------



## IFRMedic (Sep 4, 2018)

DesertMedic66 said:


> From my understanding it is. For moving bases you normally have to have an interview with the area manager for that base to make sure they like you. Also Air Methods is starting to put in year long contracts at bases that are hard to staff. The base I am going to is a hard to staff one so I had to sign the year contract.



what base are you staffing?


----------



## CTMD (Sep 5, 2018)

VFlutter said:


> You can pick up overtime pretty easily almost anywhere in the company. I had the option to work a week of OT with bonus in Arizona when they were short staffed and I am in the Midwest. I am not sure I would pick up overtime outside of your local area / region until after a year anyway tho.


That's not too bad then. Do you suggest waiting a year because of coming off probation or just like getting used to the change in scope, operations, etc.?


----------

