# Flight question



## Flightorbust (Sep 13, 2011)

So if you get a job as a flight medic or nurse are you required to hold certs in every state that you fly over? For instance if I'm based out of Colorado and I have to fly some one to Texas. Will my Colorado cert cover me or do I need one for Colorado, Oklahoma and Texas as well as any other states I fly above?


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## usafmedic45 (Sep 13, 2011)

At least for our operation, we are covered under the licenses we have for our base of operations.  Given that so far we've been to roughly 30 states, it would be impossible for us to maintain licenses everywhere especially for the nurses, PA-Cs and RTs due to the costs involved.


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## Flight-LP (Sep 13, 2011)

Typically it is the state your base is located in. Never had an issue crossing state lines in the air.


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## Flightorbust (Sep 13, 2011)

ok thanks guys. I knew it would be expensive thats why I wondered.


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## usafmedic45 (Sep 13, 2011)

Flightorbust said:


> ok thanks guys. I knew it would be expensive thats why I wondered.



LOL EMS credentials are cheap.  You should see what we get gouged for in some of the other professions.


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## Flightorbust (Sep 13, 2011)

usafmedic45 said:


> LOL EMS credentials are cheap.  You should see what we get gouged for in some of the other professions.



Ultimately I want to do flight nursing so I would have to pay for my R.N. As well as my Paramedic. Having to pay for both in multiple states would kill me.


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## usafmedic45 (Sep 13, 2011)

> Ultimately I want to do flight nursing so I would have to pay for my R.N. As well as my Paramedic.



....or you could just work fixed wing and maintain just the credential you are actually working under.


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## Flightorbust (Sep 13, 2011)

True, but some of the places Ive looked at want duel certs.


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## usafmedic45 (Sep 13, 2011)

Eh....a paramedic credential isn't all that expensive to maintain.  Heck the only expense I have for my RT license here is paying the fee to the state every two years (it's under $100) because I have a rule that I don't pay for CEUs.


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## Flightorbust (Sep 13, 2011)

Thats not too bad. I can handle one state. I was more referring to it getting really expensive if I had to carry for multiple states.


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## Bluestar (Sep 17, 2011)

around where im at is close to kentucky and tennessee line...i know at least air evac requires duel certs in tn and ky...aint for sure about the other two air services but i assume they do to


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## usafmedic45 (Sep 17, 2011)

Bluestar said:


> around where im at is close to kentucky and tennessee line...i know at least air evac requires duel certs in tn and ky...aint for sure about the other two air services but i assume they do to



That is simple enough: Don't work for Air Evac.  Not only would it be cheaper, you'll live longer.

Most likely the dual cert requirement is so that they can shuffle people between bases in both states.


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## Flightorbust (Sep 19, 2011)

Im living on bonus time right now anyways so I'm ok with the risk. If I can ask, Do you work fixed wing?


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## usafmedic45 (Sep 19, 2011)

Yeah, I work fixed wing although I was offered a part-time ground job yesterday.  For my primary jobs I manage a clinic located within a physician office and run my own company to conduct research, respectively.

As both an EMS provider and an aviation safety researcher, there's no way you could get me to work for an HEMS outfit.  I value my life too much and don't want my girlfriend to have to dust off her dress uniform for a funeral any time soon.


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## usafmedic45 (Sep 19, 2011)

> Im living on bonus time right now anyways so I'm ok with the risk



The risk is for no benefit to the patients.  According to a massive multicenter study put out at the AAST conference this month, there was _no_ difference among any class of trauma patient going by ground versus by helicopter in terms of any measure of outcome at 1 day, 28 days and 6 months.  Are you really willing to die simply to perpetuate a myth and line some company's pockets?


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## Flightorbust (Sep 19, 2011)

No, It has nothing to do with the risk for a company's profit margin. I want to do for me. It's a desire that I have had for some time. What I'm saying is that I should have been dead when I was 20. Every day I have is a bonus but I understand that it can end at anytime. That's why I say what I do.


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## usalsfyre (Sep 19, 2011)

Flightorbust said:


> No, It has nothing to do with the risk for a company's profit margin. I want to do for me. It's a desire that I have had for some time. What I'm saying is that I should have been dead when I was 20. Every day I have is a bonus but I understand that it can end at anytime. That's why I say what I do.



Honestly, if that's the attitude you display I'm not sure I'd want you on an aircraft with me. The whole basis behind "safety culture" is that you start with a bunch of people who are risk adverse.


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## usafmedic45 (Sep 19, 2011)

Flightorbust said:


> No, It has nothing to do with the risk for a company's profit margin. I want to do for me. It's a desire that I have had for some time. What I'm saying is that I should have been dead when I was 20. Every day I have is a bonus but I understand that it can end at anytime. That's why I say what I do.



Welcome to how not to get hired in the aeromedical industry or at least get fired very quickly.  As both a medical provider and a safety researcher, I would refuse to fly with you.  No one wants to fly with a person who has what is tantamount to a death wish.  As USALFYRE said, we don't need more cowboys in the field and will do everything to weed them out that is within our power.  You want to approach aeromedical operations looking for reasons why not to take a mission, not reasons why you can probably make it and if not, oh well, it might just kill us all but what does it matter since today is a gift anyhow.  Risk averse is the best approach. 

Do some reading about safety culture and see if you'd fit into that.  If not, give up on your "desire".


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## Flightorbust (Sep 21, 2011)

Please don't misread what I said. Like I said, Every day is a bonus. Im not a "cowboy" as you put it. I just understand that it can end. If there is someone's life at risk I'm even more careful then normal. Just because I understand life can end at anytime doesn't mean I go looking for it. Yes I did to an extent when I got out of the hospital, but now i try to look at the whole picture and don't just go running in head first.


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## usafmedic45 (Sep 21, 2011)

Flightorbust said:


> Please don't misread what I said. Like I said, Every day is a bonus. Im not a "cowboy" as you put it. I just understand that it can end. If there is someone's life at risk I'm even more careful then normal. Just because I understand life can end at anytime doesn't mean I go looking for it. Yes I did to an extent when I got out of the hospital, but now i try to look at the whole picture and don't just go running in head first.



OK.  I just think there is no point in flying as glorified cargo if there's not a benefit to the patient.


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## usalsfyre (Sep 21, 2011)

usafmedic45 said:


> OK.  I just think there is no point in flying as glorified cargo if there's not a benefit to the patient.


I actually truly believe there is benefit when you consider the way the US EMS system is structured. I'm not sold on the transportation method so much as bringing high level providers to bedside. Unfortunately there is no mechanism to do that without an aircraft currently reimbursement wise.


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## usafmedic45 (Sep 21, 2011)

> I'm not sold on the transportation method so much as bringing high level providers to bedside. Unfortunately there is no mechanism to do that without an aircraft currently reimbursement wise.



Then why are we not seeing impacts on outcomes either way?  I think that idea is simply what the HEMS companies throw out there when you start demanding proof they are doing something other than profit mongering.


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## usalsfyre (Sep 21, 2011)

usafmedic45 said:


> Then why are we not seeing impacts on outcomes either way?  I think that idea is simply what the HEMS companies throw out there when you start demanding proof they are doing something other than profit mongering.



My guess? The places doing the research tend to put high level providers at bedside anyway. Plus your not getting a high enough volume out of Joe-Bubbas towing, auto repair and EMS to really skew the results.


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## usafmedic45 (Sep 21, 2011)

> My guess? The places doing the research tend to put high level providers at bedside anyway. Plus your not getting a high enough volume out of Joe-Bubbas towing, auto repair and EMS to really skew the results.



Well, even when they do look at rural environments there is no significant impact.  You don't need high volume of subjects to have statistical significance.


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## usalsfyre (Sep 21, 2011)

usafmedic45 said:


> Well, even when they do look at rural environments there is no significant impact.  You don't need high volume of subjects to have statistical significance.



Refresh my memory, trauma outcomes or overall outcomes? It's been close to six months since I've really looked at air medical outcome data.


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## Flightorbust (Sep 21, 2011)

that surprises me that in a rural environment there's no gain considering the level of care is increased while the transport time is decreased.


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## usalsfyre (Sep 21, 2011)

The reason I ask is...I only see putting those providers at bedside being helpful in a relatively small subset of patients. Even a badly injured, but otherwise simple to manage trauma patient won't benefit. The categories I see it helping are

1)Patients requiring pharmacologically-facilitated airway management.

2)Patients who require complex hemodynamic management (ROSC, cardiogenic shock) 

3)Patients with respiratory failure from disease states that create difficulties in ventilation. (poorly compliant lungs, ect)

Outside of those and maybe a few other situations, I don't see advanced providers making a huge difference. Of course the is 100% opinion, and obviously we're massively over saturated if that's the case.


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## usafmedic45 (Sep 21, 2011)

> the level of care is increased



Have you ever tried to work in the back of a helicopter?  You're not doing a whole heck of a lot while in transit which.....



> while the transport time is decreased.



...explains why you are mistaken until you get into _really_ long distance transports (>100 miles).  Most of the time going by ground is quicker because you don't have all the lag time associated with flight operations and you can do most things en route rather than having to do them prior to loading the patient.


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## usafmedic45 (Sep 21, 2011)

> 1)Patients requiring pharmacologically-facilitated airway management.



Most of those are dead or already Schiavo-esque by the time the bird arrives.



> 3)Patients with respiratory failure from disease states that create difficulties in ventilation. (poorly compliant lungs, ect)



Then you're better off using a fixed-wing where you can carry a more complex ventilator than the Para-Pac, LTV or T-Bird you find on most HEMS operators.  None of those are very good in non-compliant lungs. 



> Patients who require complex hemodynamic management (ROSC, cardiogenic shock)



As opposed to having the ability to carry more pumps on a ground ambulance?  For the purposes of determining what to use, telemedicine is a much more time and cost-effective measure.  You don't need a crew of three (well, two and a pilot) to handle a patient who is ROSC or in cardiogenic shock.  A competent ICU nurse, a ground ambulance crew and a driver with a lead foot is sufficient.  Not to mention if you want to take along an ECMO or IABP, it's a lot simpler to do so during a ground transport.


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## Flightorbust (Sep 21, 2011)

usafmedic45 said:


> ...explains why you are mistaken until you get into _really_ long distance transports (>100 miles).  Most of the time going by ground is quicker because you don't have all the lag time associated with flight operations and you can do most things en route rather than having to do them prior to loading the patient.



Here we have alot of national forest and some areas that would require 100+ mile transport


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## usalsfyre (Sep 21, 2011)

usafmedic45 said:


> Most of those are dead or already Schiavo-esque by the time the bird arrives.
> 
> 
> 
> ...



I agree with every point you make actually. Like I said though, right now it's a reimbursement issue. Ideally you could take the money spent on HEMS and use it redistribute it towards better ground programs.


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