# becoming a flight paramedic



## HNcorpsman (Jul 24, 2009)

alright, so right now i am a FMF corpsman in the US Navy, i am assigned to a marine corps unit and am taking care of marines... my ultimate goal right now is to eventually become a flight paramedic, in the civilian world... i realize that i cant just "become" a flight paramedic, but that i have to take steps... my plan right now is to get my pre reqs out of the way, then once i get back to the states (im in japan right now) i will try to get my AS in para-medicine... once i get there i want to work in a high call area, (chicago, new york, phoenix) for around 5 years... during the 5 years i will get all my certs PALS, PHTLS, ACLS, ILS, PPC... etc. then i will start looking for my flight paramedic job... is this a good plan or are there some more things i can think about NOW that will help me get my job later? what about flight paramedic requirments??? vision, tattoo policy? schooling? anything else?


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## VentMedic (Jul 24, 2009)

Get a solid education to go with the alphabet soup. Applicants with a Paramedic cert and a bunch of weekend certs are a dime a dozen. They also may have the 5 years of field experience but are burnt out and believe Flight is much easier. 

If you haven't already taken college level A&P (at least 2 semesters), Pharmacology, Microbiology and Pathophysiology, I would suggest getting that foundation established. The A.S. in Paramedicine is definitely a great idea. These classes will make the list below a lot easier.

Certs are impressive as long as you got something out of each class for the certification. Being able to pass a test is not good enough and the BS factor will be evident in the interview if you memorized and don't actually understand the material. 

However, the cert you may need is the FP-C. The CCEMTP from UMBC is good also and there is a CCP-C exam in the works.

http://www.emtlife.com/showthread.php?t=13377&highlight=FP-C


If you plan on getting on with a Flight service that does IFT, you may need to know what these (listed below) are all about. However, if you do Flight with a FD that does just scene response HEMS, there may not be much extra you need to know and they may get you on the helicopter sooner since the training may be similar or the same for the ground crews. Essentially some of these helicopters are just a quicker means of transport and do not necessarily offer expanded skills such as RSI. They may also have just one Paramedic in the back.

Ventilators
IABP
LVAD and other VADs
12-lead ECG interpretation
Hemodynamics
Lab values
Various venous access devices
Arterial lines and PA catheters
Chest tubes
Formulas to anything from gas laws to gas exchange and acid-base correction

Suggested references:
References:
CAMTS book (These standards change often)
The Aeromedical Certification Examinations Self-Assessment Test (ACE SAT). 
Dr. Bledsoe's Critical Care EMT-P textbook (Brady)
Certified Flight Paramedic (FP-C) Study Guide.
Air and Surface Patient Transport Principles and Practices 2nd or 3rd edition.



Tattoos are generally frowned upon if they are visible. Luckily for those who have tattoos, the Flight suits are generally long sleeved. However, if they can not be covered or are visible during the interview, you may go to the bottom of the stack of applicants.


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## akflightmedic (Jul 24, 2009)

You have a great plan, stick to it.

1. Get your degree ( do not short cut this goal you have already set)

2. ACLS, BLS, PALS, PHTLS (You will/should get these during your paramedic class)

3. Read some threads on here about quantity versus quality  Yes you want to diversify and not work in a completely rural area, but there are tons of smaller cities that have "high" call volume and a fair mix of both rural/urban...interstates, county roads...dont just shop for the big names as it really isnt all that impressive.

4. Work as a paramedic for 3-5 years and continue to learn and improve. Take the FP-C exam, take a CCEMT P course. Flightweb.com has info on both.

5. Explore flightweb.com now and read the threads on there. Read the topics and look at the education level of the intelligence level of discussions on there. This will give you great insight to things you should know or will be expected to know.

6. When you are ready to start looking for flight jobs, be very picky. But for now you dont have to worry about that.

Stick to the plan you have, do not deviate.

Have fun and good luck!!


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## subliminal1284 (Jul 24, 2009)

Dont know how it is in your area but on the helicopters here there are no Paramedics or EMT's on a flight for life chopper. They are staffed by an ER doctor, an ER Nurse and a Pilot. Id say if you want a chance youre going to to have to go a step above Paramedic and become an RN.


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## VentMedic (Jul 24, 2009)

subliminal1284 said:


> Dont know how it is in your area but on the helicopters here there are no Paramedics or EMT's on a flight for life chopper. They are staffed by an ER doctor, an ER Nurse and a Pilot. Id say if you want a chance youre going to to have to go a step above Paramedic and become an RN.


 
Where are you at that an ER doctor goes on every call? IFT and/or HEMS? Is this a teaching hospital?  I only know of  a handful of teams configured like that.


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## akflightmedic (Jul 24, 2009)

subliminal1284 said:


> Dont know how it is in your area but on the helicopters here there are no Paramedics or EMT's on a flight for life chopper. They are staffed by an ER doctor, an ER Nurse and a Pilot. Id say if you want a chance youre going to to have to go a step above Paramedic and become an RN.




What?? Where??

The majority of flight programs have paramedic/nurse configurations for scene responses, some are medic/medic, and some are nurse/respiratory therapist.

I personally do not know of any program where an ER doctor goes on EVERY flight, but evidently Vent is aware of some as you are, so I am sure she will share...regardless, this is the exception and not the rule.


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## subliminal1284 (Jul 24, 2009)

This is in the Milwaukee area.


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## akflightmedic (Jul 24, 2009)

subliminal1284 said:


> This is in the Milwaukee area.



Just one service or all of them...names?


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## akflightmedic (Jul 24, 2009)

Flight for Life in Milwaukee

http://www.jsonline.com/news/waukesha/29299784.html

This was snipped from the article...care to cite any other inaccuracies?

"Flight for Life plans to sign a long-term lease with Waukesha County and build a 15,000-square-foot base of operations, at an estimated cost of $2 million. If all goes smoothly, the move could take place by early next summer. The facility will be staffed by 24 pilots, paramedics, dispatchers and other employees."

Flight for Life website...http://www.flightforlife.org/

No mention of doctors, only nurses and paramedics...

To the OP...stay on your goals and no worries.

I stand corrected...Doctors are mentioned at the bottom of page and they are on duty "when scheduled" and at the Waukesha/Milwaukee base only.


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## VentMedic (Jul 24, 2009)

He was probably referring to Med Flight which is one that I did know. 

https://www.emed.wisc.edu/emedicine/medflight/program_description.php

Another one, I believe in Pennsylvania used 3rd year residents.

I also want to say there is a MD/RN team in Chicago but I could be wrong or they may have changed.

Definitely not that many that fly MD/RN as a standard configuration.


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## akflightmedic (Jul 24, 2009)

Yeh, I may get a little snippy from time to time but I do not like misinformation being put forth as fact or as fact for everything under that title. I usually do my best to research an answer to people's questions if I do not already know it and I tend to expect the same out of others.

He was discouraging a prospective medic with an excellent game plan by implying that medics do not fly often. He knows of one program and implies it is true for all the other 500+ programs in the US...bad morning, who knows. I am going fishing...


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## subliminal1284 (Jul 24, 2009)

Guess I stand corrected, I was told they only use RN's and Doctors.


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## spisco85 (Jul 24, 2009)

Lifestar in CT has nurse/rrt on it. The nurse has to be a medic with the alphabet suit and preference with a BSN. Experience requirements in CCUs, ERs and street paramedic. They do a mixture of HEMS and IFT. They also have a max weight of 200lb per crew member.


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## VentMedic (Jul 24, 2009)

spisco85 said:


> Lifestar in CT has nurse/rrt on it. The nurse has to be a medic with the alphabet suit and preference with a BSN. Experience requirements in CCUs, ERs and *street paramedic*. They do a mixture of HEMS and IFT. They also have a max weight of 200lb per crew member.


 
They do not need to be a street medic.  They may do some ride alongs for experience.  

Our RNs in Florida are also required to have a Paramedic cert if they do scene response but that is due to an old statute still on the books.   Most will just challenge the state certification test.    Some states want RNs to have proof of the training but don't require them to maintain a license as a Paramedic.  Other states have a Trauma Nurse Specialist, PHRN or MICN training/credentialing which makes the Paramedic cert unnecessary.  Connecticut also has a couple of RN to Paramedic transition programs which allows them to take what is necessary without going back through 10th grade anatomy or learning to start an IV the "paramedic way".

Also if you notice on LifeStar's requirements, Paramedic license is listed between the "certs".   

Qualification Standards: 

Baccalaureate prepared Registered Nurse.
Must have a minimum of three years of experience in critical care/emergency nursing, one of which must be in an ICU.
Must hold current certification as a Certified Emergency Nurse or Certified Critical Care Nurse.
Licensed as a Paramedic.
Certified in Advanced Cardiac Life Support, Pediatric Advanced Life Support, and Neonatal Advanced Life Support.


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## timmy84 (Jul 24, 2009)

VentMedic said:


> He was probably referring to Med Flight which is one that I did know.
> 
> https://www.emed.wisc.edu/emedicine/medflight/program_description.php
> 
> ...



University of Chicago Aeromedical Network (UCAN) usually has a RN/MD/pilot configuration.  They can also accommodate a third crew member if needed (RT, another RN/MD, or paramedic).


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## VentMedic (Jul 24, 2009)

Thank you for the Chicago info. It's hard to keep track of all of them. 

There are a few things one should know about Flight services now is some do change owners frequently as well as starting up and disappearing quickly. That is not to discourage anyone but to make them more aware of the importance of finding a reputable service. 

If the only question they ask you in an interview is your uniform size, that may not be the best run service.


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## timmy84 (Jul 24, 2009)

VentMedic said:


> If the only question they ask you in an interview is your uniform size, that may not be the best run service.



LOL... that is exactly what they asked me when I had my interview at McDonald's in high school.  Even at 15 I thought that was peculiar.


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## HNcorpsman (Jul 24, 2009)

yeah, i realize that some organizations have paramedics on the bird and some dont, but it wont discourage me...


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## usafmedic45 (Jul 24, 2009)

Perhaps the risk (comparable to, if not arguably higher than military MEDEVAC and CASEVAC operations because of lax regulations and more or less non-existent enforcement) associated with minimal to no benefit to the patient (unlike in combat settings) will give you pause.  Is your life really worth putting at great risk simply for the rush of helicopter operations and the profit of your employer?  

That's a question you really need to ask yourself.  Ask your wife/girlfriend and/or mother if she thinks that's a fair trade.  Ask whether they will think the chance for them to find themselves standing over a grave containing your battered, broken and quite likely charred body is a fair trade so that some ground provider didn't miss the last 10 minutes of _Daisy of Love_ or so that some kid from a car accident can be discharged shortly after arrival from a trauma center instead of the local hospital?  

We laud our dead and speak of them in dulcent tones and the few of us who bring up the pointless and tragic waste of lives of good colleagues in these helicopter crashes on senseless and indefensible flights are told that we should remain silent so as not to disparage the memory of the fallen. I take exactly the opposite view- after losing multiple friends- saying that we should not use their loss as an impetus to change and improvement is as disrespectful to their memory as saying a soldier was a hero because he did not know fear.  Of course they know fear- anyone who does not is crazy so to say otherwise is about the highest insult you can pay a soldier or Marine- and of course we should not simply continue on blindly in endeavours that have killed in the past and continue to decimate our ranks if for nothing other than to prevent another wife, child or mother from having to mourn needlessly.


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## HNcorpsman (Jul 25, 2009)

maybe im stupid but your response didn't make a whole lot of sense, because i have no idea what you are talking about... really im lost... are you saying that there is a higher risk associated with civilian air evac operations than military ones? i hope not, because if you are you are severely mistaken... were/are you in the air force? PJ? anyways im sorry for your losses, i recently lost a good friend of mine, who died in Afghanistan... but i would not say that his death was "pointless" that is an insult upon him and all of those who serve this great country... he died for what he believed in and he died defending me and you and everyone else. but what does this have to do with the topic anyways? and whoo said that i was in it for the rush of the helicopter, and for profit from the employer? im in it because i care for people, and i love medicine.


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## usafmedic45 (Jul 25, 2009)

> are you saying that there is a higher risk associated with civilian air evac operations than military ones?



I am saying the crash rates are comparable, especially if you exlude military crashes due to enemy action.  That statement is based upon conversations I have had with US Army and US Air Force safety researchers with whom I have dealt in the course of my work (I work in aviation safety research as my primary occupation, although I practice clinically as a respiratory therapist on the side to make extra money).  

If you any reputable evidence to show that the fatal crash rate for military operations (on a crashes per X missions or crashes per X hours flown basis) is higher, then I would be happy to look at it, but I do have a nearly complete tally of military helicopter crashes (in combat zones) since the start of the Afghanistan campaign and the numbers have been very similar when one takes into account the far greater number of missions flown by military helicopter units.  The loss of life is also higher, but that is to be expected when you are dealing with CH-46s and MH-53s compared to the Dauphins, Sikorsky S-76s and other smaller helicopters commonly used by HEMS operations.  It's like comparing the crashes of airliners to the crashes of Cessnas in terms of lives lost. 



> but i would not say that his death was "pointless" that is an insult upon him and all of those who serve this great country... he died for what he believed in and he died defending me and you and everyone else. but what does this have to do with the topic anyways?



Sorry to hear about your friend.  I've lost several friends in Iraq and Afghanistan as well.  If you ever need an empathetic ear, I'm more than happy to provide one.

I was not speaking of military operations.  I was speaking of civilian HEMS crashes.  Most flights are of little to no benefit to the patient.  That is the definition of a pointless risk. 



> were/are you in the air force? PJ?



I was in the Air Force but I was not special operations. 



> and whoo said that i was in it for the rush of the helicopter, and for profit from the employer?



I was not implying that and I apologize if it came across that way.  I just know a lot of people- myself included really enjoy the excitement of helicopter operations.  

As for the profit of HEMS operators, remember they are by and large for profit operations and most of them act exactly as such where safety is a secondary priority.  This has been documented time and again in crashes where pressure was put on pilots to take missions by the company when they had no business flying. 



> im in it because i care for people, and i love medicine.



Then I recommend you look at how much impact you will actually have on people's lives as a flight paramedic.  It is not the same impact you have in a combat setting where helicopters save lives.  In the civilian world, they are expense flashy flying billboards that in very few settings may make a difference.  I can count these settings on one hand. Most (>90% by some estimates) of flights have no valid medical impact on patient outcomes.  

As I was trying to point out in my first post, those who fly for most services are taking their lives in their hands out of concern for their fellow man or whatever other reasons that lead them to work in the field, but the actual effect they have on their patients is minimal at best.    At some point, the question has to be asked: When is the return (the benefit to the patient) not worth the risk (the very real chance of dying in a crash)?   One research project put the chance of being involved in a fatal civilian HEMS crash during a 20 year career at higher than one in three.

There are ways to care for people that actually save far more lives and are much less likely to result in your death.


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## HNcorpsman (Jul 25, 2009)

i can understand that probably some of the calls that these flight paramedics, RNs, and pilots go on are probably not needed, but what about those calls where a helicopter is truly needed??? you cant just drop the fact that having a helicopter can be one of the best solutions to a dyeing PT... what if the hospital is more than 4 hours away, and that PT has a tension pnuemo thorax, or a abdominal evisceration??? how can you just tell your self that helicopters are not essential and that they cause pointless deaths... how? ambulances transfer PTs that DONT need medical aid, all the time, probably a good 70% of the time. working in an ambulance as a paramedic/EMT might even be more dangerous than working a bird.... but just like the bird they are completely and utterly essential in the treatment of those other 30% of people. 

dangers of flying civilian medevac
1. helicopter malfunctions
2. pilot error
3. weather

dangers of flying military CASEVAC/MEDEVAC
1. helicopter malfunctions (alot higher because in the marine corps we get to use good ol CH-46 from the Mesozoic era) (also our mechanics are 20 years old) (not sayin much, im 20)
2. pilot error ( its hard to fly a plane when your shot in the head) 
3. weather (the weather is bad, guess what your still goin out)
4. enemy fire (shall i say no more?)

so your telling me im safer or just as safe flying on a 1972 CH-46 in afghanistan where 1000 upon 1000s of insurgents would love to chop my head off than flying on a 2006 S-76 in arizona? you might as well say that going to afghanistan to fight for your country is actually safer than driving to work everyday, after all there is a traffic collision every 6 seconds in the united states....


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## akflightmedic (Jul 25, 2009)

HNcorpsman said:


> you might as well say that going to afghanistan to fight for your country is actually safer than driving to work everyday, after all there is a traffic collision every 6 seconds in the united states....



Statistically it is....


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## usafmedic45 (Jul 25, 2009)

> (also our mechanics are 20 years old)



They are also arguably better trained and have better oversight than their civilian counterparts. 



> alot higher because in the marine corps we get to use good ol CH-46 from the Mesozoic era



Care to provide some reputable evidence to this fact?  



> PT has a tension pnuemo thorax



Arguably, flying them with an unrelieved tension pneumo is going to make things worse.  Also, you have to remember that a tension pneumo is something that is an immediate life threat and can not wait for a transfer. 



> what if the hospital is more than 4 hours away



This would be one of those handful of settings that I mentioned where helicopters have some value in the civilian world.



> but just like the bird they are completely and utterly essential in the treatment of those other 30% of people.



No, they are not.  There is no reliable evidence to indicate it is even 1% of cases in which helicopters are "utterly essential" in, let alone thirty percent.  You can not cross-apply between military aeromedical transport and civilian HEMS in this situation which is what you seem to be doing.  



> working in an ambulance as a paramedic/EMT might even be more dangerous than working a bird....



Actually it's not.  The CDC did a study on ground ambulance crash fatality rates and fewer people die in ambulance crashes annually on average than die in HEMS crashes. 


> so your telling me im safer or just as safe flying on a 1972 CH-46 in afghanistan where 1000 upon 1000s of insurgents would love to chop my head off than flying on a 2006 S-76 in arizona?



As AKFlightMedic said, statistically yes.  This is for several reasons partly because of the better maintenance oversight in the military, dual pilot operations, and better redundancy in systems (there is something to be said for designing an aircraft to withstand being shot up).  



> weather (the weather is bad, guess what your still goin out)



That's the attitude of a lot of HEMS operators as well.  The difference is that the military is a lot safer in their approach to helicopter IFR operations.


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## HNcorpsman (Jul 25, 2009)

ahhh statistics, statistics, statistics, every argument is solved with a statistic. fine so be it... statistically i am wrong. 

C'mon you know im just kidding about the ch-46s but the last time they were made was 1972 sooo they are still pretty old...

well of course tension pneumo is an immediate life threat, and of course you would do your needle decompression, but they  need that chest tube. 

anyways, i really dont care... unless they do away with HEMS, which they wont anytime soon... i am still going to go for it and get to that position.


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## VentMedic (Jul 25, 2009)

HNcorpsman said:


> well of course tension pneumo is an immediate life threat, and of course you would do your needle decompression, but they need that chest tube.


 
On some teams you may be doing the chest tube insertion.


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## HNcorpsman (Jul 25, 2009)

another reason why i wanna be flight paramedic... i definitely would never do a chest tube on a PT in an ambulance... but i would get the opportunity to do it on the bird, and alot of other procedures.


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## VentMedic (Jul 25, 2009)

HNcorpsman said:


> another reason why i wanna be flight paramedic... i definitely would never do a chest tube on a PT in an ambulance... but i would get the opportunity to do it on the bird, and alot of other procedures.


 
Just get a solid education foundation so the agencies that have a broad scope of practice will know you are in it for more than the cool "skills". Without the education, you could end up at a company that just wants to know your uniform size and you  "fly real fast" to the hospital.


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## usafmedic45 (Jul 25, 2009)

> ahhh statistics, statistics, statistics, every argument is solved with a statistic. fine so be it... statistically i am wrong.



How else are we supposed to judge what we should or should not be doing?  If you have a better approach, there's likely several major awards coming your way that would look good on your application to any job your heart desires in health care. 



> unless they do away with HEMS, which they wont anytime soon



The number of services is likely to drop considerably once the FAA gets their teeth into them with the new safety regulations coming down the pike.  That and increasing awareness among physicians and EMS providers about the lack of benefit and -more directly- a suggested decrease in the reimbursement practices regarding aeromedical transport (especially scene transport) will decrease the number of flights which will in turn decrease the number of helicopters kept ready to go 24/7 and thus decrease the number of positions available.  The end result is making all the education that VentMedic and others so wisely suggested all the more vital in competing against other extremely competent providers. 



> Without the education, you could end up at a company that just wants to know your uniform size and you "fly real fast" to the hospital.


*cough* AirEvac Lifeteam *cough* *cough* Maryland State Police Aviation *cough*



> i am still going to go for it and get to that position.



Right, and I'm not trying to stop you.  I just want you to go in with your eyes open and your head clear.  Beyond that, my colleagues conducting aviation safety research and I will do anything and everything in our powers to improve the chances of you and your colleagues coming home to your families safely at the end of each and every shift.  Best of luck, be safe and thank you for your service to our country.


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## Ridryder911 (Jul 26, 2009)

HNcorpsman said:


> another reason why i wanna be flight paramedic... i definitely would never do a chest tube on a PT in an ambulance... but i would get the opportunity to do it on the bird, and alot of other procedures.



Actually, most will not perform many procedures such as this in the air either. Really do you think you can hear lung sounds with a jet engine behind you? Again, another mythical illusion that many of these so called special procedures are performed while in transit when in fact one should perform it before lifting off. 

As the old saying goes if you think that it should be done, you should have already done it. 

True there are some that allow chest tube insertions but in recent years that has dropped remarkably as better chest decompression sets have been developed. Again, many flight services have no more advancement than aggressive EMS in fact maybe less. 

Nothing against HEMS by far but let's be truthful. 

R/r 911


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## HNcorpsman (Jul 26, 2009)

i did a chest tube on a live pig, with gunshots going off around me... wasn't too bad. its not saying much, im sure its ALOT different with a human.


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## VentMedic (Jul 26, 2009)

HNcorpsman said:


> i did a chest tube on a live pig, with gunshots going off around me... wasn't too bad. its not saying much, im sure its ALOT different with a human.


 
Just like putting plastic down someone's throat, it is a skill but both have serious complications. It is little more than just poking holes. The teams that do chest tubes which are primarily IFTs and often they are Specialty teams. You won't find any FD HEMS doing many advanced skills in this country that I know of. Again, it is the education that sets them apart for them to know when it is also not appropriate to do the skill.   The actual "skill" will only be a small part of what they do.


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