# Flight Medic process?



## emtCourt31 (Jan 25, 2010)

Hey so I'm new here.

I just got a job with a local Orange County ambulance company. I'm working on my paramedic school requirements (minimum of 6months-1year in the field). Anyways my ultimate goal is to be a flight medic. Any flight medics out there with advice? Whats the process?

I only know of Mercy Air in California.

Thanks!
Courtney


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## TransportJockey (Jan 25, 2010)

I can say that around here in NM the flight medics need to have 3 years minimum, 5 years preffered, of high volume 911 experience. Along with CCT and FP-C.


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## ExpatMedic0 (Jan 25, 2010)

All I know about it is that most agency's require you have at least 3-5 years experience in a busy ALS system as a Paramedic first. I am sure some of the other guys can provide more info, goodluck!


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## emtCourt31 (Jan 25, 2010)

I was expecting the 5 year experience. I heard you can enter the military and they will train you. But I'm super unfamiliar with that whole thing.


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## medicdan (Jan 25, 2010)

There are a few members here with current or past flight experience, so I will leave the specifics to them. Essentially, in order to be considered for a flight position, you need several years in a busy 911 system, as a medic, and often significant ER/ICU clinical time.

Because many CCT flight systems dont just do scene (911) responses, but also CCT IFT (ICU to ICU), the staff are more likely to be an RN and RRT, with one of them being an medic as an aside. 
A military/civilian flight nurse has an excellent blog describing her training and experiences (but unfortunately hasn't posted in some time). She still has some good How Tos, 
http://crzegrl.net/index.php/becoming-a-flight-nurse-2/
check out the flight program in your area for details. The program in my area, Boston MedFlight. To see their pre-employment requirements, see 
http://www.bostonmedflight.org/employ.html

Good Luck!


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## Akulahawk (Jan 25, 2010)

I'm not a flight medic... but one flight provider up here in the Sacramento area has this as their standard: Follow the link for other descriptions as well... http://www.reachair.com/careers/clinical.html

*Candidates for Flight Paramedic should be prepared for the position by meeting the following criteria:* 
• Eligibility for or current licensure as a paramedic in State where employed.
• Minimum three years pre-hospital EMS experience (in a busy 911 system).
• Pediatric/Neonatal experience desirable.
• Basic computer skills (word processing, database).
• Current BCLS, ACLS, PALS, and NRP Provider.
• Must maintain a duty weight of less than 205 lbs. (body weight plus uniform and equipment).

When these positions do open up, expect that there's going to be more than a little competition... and they'd probably only start seriously looking at you once you reach about twice that experience.


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## TransportJockey (Jan 25, 2010)

I'm still waiting to see more services switch to RN/RN crew configs


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## emtCourt31 (Jan 25, 2010)

Thanks guys!


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## fire_911medic (Jan 25, 2010)

There is also Calstar - but they fly RN/RN config.  You are likely going to be a more competitive candidate as an RN/medic than as a medic alone.  Also getting your degree pushes you forward as well as excellent skills and clinical decision making ability.  Most have a written and skills test process in addition to a panel interview.  Get all the experience you can on the ground with high quality progressive services.  Cali unfortunately is not known for it's ground CCT and it is much behind what CCT ground programs are in other areas.  

If you choose to go the RN route - go for the ICU experience as that will give you a better rounded experience to compliment your EMS time.  About 5 years in each will make you a strong candidate as you can fill either slot they are looking for.  But more than anything - look for a program with a good safety record - it's not just about flying, and trust me the job isn't what you think it is.  It's very little scene flights and mostly IFT's.  You won't be doing tubes left and right and you'll be excited to find an IV in place and scared to death of what to do with the multiple drips that you know very little about.  That's where the RN side comes in rather handy.  All in this area fly medic/RN with the exception of the two neonate teams that fly RN/RT.  Yeah it's a cool job, but your safety comes first.  Do your homework first, get the ground experience, get the degree, and look at getting your alphabet soup along with instructor in some (as education's a big thing with alot of the services).  Then as your time gets closer, several programs do fly alongs - talk to them about that, get a feel for the service, what they're about, see how things roll in the air.  Plus a good experience will be beneficial to both sides.  Take care and stay safe.


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## Akulahawk (Jan 25, 2010)

CALSTAR does fly RN/RN crews. The last time I spoke with a flight crew, they (and actually Stanford's Life Flight too) prefer someone who has both RN and EMT-P experience. Since they both do scene calls, already having field experience makes it MUCH easier to train a new Flight RN to be a field provider... 

California Paramedic CCT programs are pretty much in their infancy, and compared to a "normal" RN staffed CCT program... well, there's a long way for them to go...


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## VentMedic (Jan 26, 2010)

jtpaintball70 said:


> I'm still waiting to see more services switch to RN/RN crew configs


 
Many already are. The primary reason some haven't gone with RN/RN is cost of the 2nd RN. The same for the RRT.  

Due to lower education requirements and a limited focus for experience, the Paramedic is relatively cheap. There are also at least 200 Paramedics applying for some Flight positions.

Here's some previous threads:

http://www.emtlife.com/showthread.php?t=13898&highlight=Flight+Paramedic

http://www.emtlife.com/showthread.php?t=11990&highlight=Flight+Paramedic


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## VentMedic (Jan 26, 2010)

Akulahawk said:


> California Paramedic CCT programs are pretty much in their infancy, and compared to a "normal" RN staffed CCT program... well, there's a long way for them to go...


 
What exactly are you referring to as a "normal" RN?  Most of the teams I am familar with in CA do require the RNs to have ICU and ED experience as well as their MICN cert.   Many are also CCRNs and CENs.  

The Paramedic in California has a much longer journey to even acheive adequate care for patients on IFT ALS transports with their very limited scope of practice.


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## Akulahawk (Jan 26, 2010)

VentMedic said:


> What exactly are you referring to as a "normal" RN?  Most of the teams I am familar with in CA do require the RNs to have ICU and ED experience as well as their MICN cert.   Many are also CCRNs and CENs.
> 
> The Paramedic in California has a much longer journey to even acheive adequate care for patients on IFT ALS transports with their very limited scope of practice.


What I mean are the RN's that have zero field experience. The ones that have ONLY ED and/or ICU experience. A 10 hour ride on an ambulance every couple of years does not make an MICN good at being a prehospital provider. Most of the protocol manuals I've read limit RN's (including MICN's) to BLS care only, in the field. One allows MICN's to assist, but not direct care. I also find it interesting that CCT-RNs generally have to have an EMT with them in the back unless the RN is also trained as an EMT...

All the teams I'm familiar with require 3 years ED/ICU experience, with CEN/CCRN/MICN preferred... I've heard statements to the effect that RN's that were not also experienced Paramedics take much longer to train to an adequate level of competency for field work than those that are... and not just from one flight program.

As to the "much longer journey" for California Paramedics to provide what you consider "adequate care" during ALS IFT's, I covered when I stated that the field is in it's infancy. In many ways, it's stuck there. That should very much imply that I mean there's a long way to go before California catches up with most of the rest of the country.


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## JPINFV (Jan 26, 2010)

RNs working on CCTs work under protocols signed by the transfering physician, not the local EMSA medical director. The EMTs are on board to satisfy state requirements on ambulance staffing. Similarly, I can't believe that anyone is comparing CCTs to scene calls, and hence the need for "prehospital experience." Since patients on critical care runs might very well be going to or coming from an ICU, should paramedics running CCTs be required to have ICU experience (and not just paramedic school clinicals)?


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## Akulahawk (Jan 26, 2010)

JPINFV said:


> RNs working on CCTs work under protocols signed by the transfering physician, not the local EMSA medical director. The EMTs are on board to satisfy state requirements on ambulance staffing. Similarly, I can't believe that anyone is comparing CCTs to scene calls, and hence the need for "prehospital experience." Since patients on critical care runs might very well be going to or coming from an ICU, should paramedics running CCTs be required to have ICU experience (and not just paramedic school clinicals)?


I'm quite aware of that. That doesn't explain why the EMSA requires that a CCT Ambulance requires either a crew of TWO EMT's and the RN _or_ the crew be made up of an EMT and an RN/EMT... 

Most of the CCT programs I'm aware of have their own protocols which must be signed off by the EMS Agency's Medical Director... If the transferring Physician has their own orders for that particular patient, the CCT-RN follows those orders, unless the care needed exceeds their capability. In that case... the transferring facility would need to provide personnel that can provide for care or find another appropriate mode of transport.

About the stuff you added after your initial post... I absolutely think that a Paramedic who is doing CCT _should _have ICU experience and education to allow that Paramedic to provide the higher level of care necessary. I do not think that an 80 hour course is even _close_ to adequate. A full-time 6 week course would probably come closer to the mark... if the Paramedic is experienced. Somehow I do not believe that an RN can graduate from school, with license in hand, and provide ICU level care without additional training and education either... and the hospitals provide that education before the new ICU RN begins work in the ICU....


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## JPINFV (Jan 26, 2010)

Sure it does. It's an ambulance. It's the same reason why non-emergent interfacility transports using ambulances have to be stocked just like emergency ambulances even though most non-emergent ambulance providers won't use 3/4s of the supplies in an ambulance in a 6 month period. What happens if someone flags down a CCT ambulance on the way back to base? That patient doesn't fall under the pervue of a CCT, hence the issue with CCT RNs only being able to provided BLS level care. To finish up with the non-emergent IFT comparison, when was the last time a IFT transport resulted in the EMT-Bs delivering their dialysis patient's baby?


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## VentMedic (Jan 26, 2010)

Akulahawk said:


> What I mean are the RN's that have zero field experience. The ones that have ONLY ED and/or ICU experience. A 10 hour ride on an ambulance every couple of years does not make an MICN good at being a prehospital provider. Most of the protocol manuals I've read limit RN's (including MICN's) to BLS care only, in the field. One allows MICN's to assist, but not direct care. I also find it interesting that CCT-RNs generally have to have an EMT with them in the back unless the RN is also trained as an EMT...
> 
> All the teams I'm familiar with require 3 years ED/ICU experience, with CEN/CCRN/MICN preferred... I've heard statements to the effect that RN's that were not also experienced Paramedics take much longer to train to an adequate level of competency for field work than those that are... and not just from one flight program.


 
We put EMTs out on the street with only 10 hours of ride time in an ambulance. Paramedics are allowed to do advanced procedures with as few as 40 "ALS" patient contacts and in some areas that doesn't even have to done on a transporting ambulance. 

Florida also has a similar "prehospital provider" statute that requires an EMT or Paramedic to be on an ambulance which is why the state, along with others allows the RN to challenge the Paramedic after a 2 week EMT course. 

Do you think the RNs on Calstar just stand around on scene? You seriously have never seen the protocols of a flight nurse nor do you know what they can do on an IFT.   

How long do you think it would take to "train" a Paramedic to perform on a high acuity CCT the same as an experienced critical care RN? Many Paramedics don't even have college level A&P or pharmacology so the foundation education is lacking before "training" the Paramedics for advanced patient care. In CA the Paramedic, even with the expanded scope, can not touch the meds or equipment used for some of the transports. I find it to be a bad situation to where RNs must also accompany the Paramedics for a patient that has a med hanging that the Paramedics can not touch. These RNs are expected to get on an ambulance whether they want to or not and function outside of the hospital to pick up the slack in a lacking EMS system even to get a chest pain patient to a cath lab. 



Akulahawk said:


> As to the "much longer journey" for California Paramedics to provide what you consider "adequate care" during ALS IFT's, I covered when I stated that the field is in it's infancy. In many ways, it's stuck there. That should very much imply that I mean there's a long way to go before California catches up with most of the rest of the country.


 

If you have only worked in California under the scope of practice for the Paramedic in California, then yes you may have a long way to go.

For some Paramedics who have not worked elsewhere, they believe California is the greatest thing in EMS.


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## EMTinNEPA (Jan 26, 2010)

Back to the original topic...

Most flight organizations I've seen require the usual EMT-P certification and current CPR, ACLS, ITLS, PALS, NRP, etc.  They also usually want you to have your NREMT-P, and some require FP-C and/or CCEMT-P.  They also usually want three to five years of experience as a paramedic in clinical and field settings.  However, the reality of it is that it comes down to who you know.  Case in point: the coordinator of my paramedic program is a flight nurse, our clinical coordinator is a flight paramedic, and at least half of our adjunct faculty are either flight nurses or flight paramedics... but there's no way in hell any of us are going to land flight jobs in the near future.


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## Jersey (Jan 26, 2010)

I'm intricately familiar with the process (lets leave it at that)

3 years is usually the minimum, however this has to be in a system that is forward thinking protocol wise, progressive, and BUSY! It is usually good to see medics coming from systems with longer than 5-10 minute transports because those transports dont require much beyond the basics of the protocols.

Usually CCEMTP and FPC are NOT at all required before hiring. It would be nearly impossible to pass the FPC without flight experience (although some have done it).

The rest of the alphabet soup is ACLS, PALS, PHTLS/ITLS/BTLS, NRP, AMLS.

To make yourself ACTUALLY competitive you need all of the above plus instructor certs in the above classes.

THEN it comes down to who you know, the reputation that you've made for yourself in EMS and anything that you've published in the trade mags/journals. Most programs like to see a BA/BS with advanced science courses.

For most programs, the nurses and paramedics are expected to know the exact same things. For a paramedic, this is much more of a learning jump (from initial training) to get a grasp on the complex pathophys, acid/base, med tech, and everything else that is required on a high complexity team.


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## Akulahawk (Jan 26, 2010)

Vent: I'll respond inline, and in red, for clarity.


VentMedic said:


> We put EMTs out on the street with only 10 hours of ride time in an ambulance. Paramedics are allowed to do advanced procedures with as few as 40 "ALS" patient contacts and in some areas that doesn't even have to done on a transporting ambulance.
> And I think that isn't near enough.
> Florida also has a similar "prehospital provider" statute that requires an EMT or Paramedic to be on an ambulance which is why the state, along with others allows the RN to challenge the Paramedic after a 2 week EMT course.
> California allows RN's, PA's, and MD's to challenge the Paramedic License... and it's not a "2-week" course. They must complete, and pass, a 480 hour internship, just like every other Paramedic student. If the challenge student doesn't pass... no Paramedic License will be issued. While an MD can work in the field under his/her own Medical License, an RN (even a well experienced CCRN or CEN) is limited to BLS care... PA's, for all their knowledge and education, are limited to being bystanders... MICN's, if authorized by their County, may be able to provide ALS in the field.
> ...


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## Akulahawk (Jan 26, 2010)

Jersey said:


> I'm intricately familiar with the process (lets leave it at that)
> 
> 3 years is usually the minimum, however this has to be in a system that is forward thinking protocol wise, progressive, and BUSY! It is usually good to see medics coming from systems with longer than 5-10 minute transports because those transports dont require much beyond the basics of the protocols.
> 
> ...


I'd expect that this is more the norm... and done right, at some point, the difference between the two provides becomes more a legal one than a knowledge/education one...


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## VentMedic (Jan 26, 2010)

Akulahawk said:


> Vent: I'll respond inline, and in red, for clarity.
> 
> This one, I'll throw back at you: Vent, do you consider yourself experienced enough, even after many years as an RRT and a Paramedic, to manage high acuity CCT patients as well as an experienced critical care RN? How long did it take for you to get to that point? What would you consider to be "experienced" for purposes of this exercise? 2 years? 15 years? 30 years? I'm well aware that there are meds and equipment that even an "Expanded Scope" Paramedic is not allowed to work with. Appropriate education would (eventually) change that. An experienced Med/Surg RN would not do too well if simply dropped into an ICU and told to have at it.


 


> I'd expect that this is more the norm... and done right, at some point, the difference between the two provides becomes more a legal one than a knowledge/education one...


I do have the advantage to have several thousand hours of ICU experience for all ages with neo/peds being my specialty. However, as a Paramedic I am not allowed to do what either an RN or an RRT can do to the fullest extent of their scope of practice. Thus, as a Paramedic that is not even an argument as to whether I am better than an RN who has several years of experience as an ICU RN. I am very comfortable managing most ICU patients but I am not so stupid to have my ego blind me from seeing how valuable an RN is to a transport situation. 

Right now FL is in the process of changing its statutes for neonatal transport with an increase in hours of neonatal experience for the Paramedic from 2000 to 5000 hours. 2000 hours was almost impossible to get or some found that those claiming to have 2000 hours needed more than 2x more experience. 

Any Paramedic who believes they know more than a critical care RN while having never worked in an ICU is a fool. You can learn some of the academic stuff like acid/base but until you actually have experience in critical care, the difference will be much more than just the title or legalities. These Paramedics who make such a claim are usually the ones who know the least but believe what they have seen on transport of a few critical care patients is all there is to critical care medicine.  


> On a related note: I would hope that the RN that is told to accompany a patient on an ambulance is covered for medical liability by his/her employer while out on the ambulance to the same degree that is provided while working in the hospital.


 
They are covered still by the hospital but it is a very uncomfortable feeling to know that the ambulance is not equiped with the needed medications for some transports and if the hospital doesn't have a premade bag to accompany an RN on a spur of the moment transport, it becomes a questionable task of what can be carried in one's pocket. Not a good situation. If I am also accompanying as an RRT, I have now made a habit of taking at least an airway bag since I can not always depend on what the truck has or the abilities of the Paramedic. Some hospitals do have a CCT bag for our RNs to accompany the patient since this is a common occurence especially in California. While much of CA has CCTs with RNs, there are occasions for a STEMI to be transported further than the "nearest hospital" which unfortunately where some EMS agencies must still take a patient.


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## Akulahawk (Jan 26, 2010)

My responses inline... 


VentMedic said:


> I do have the advantage to have several thousand hours of ICU experience for all ages with neo/peds being my specialty. However, as a Paramedic I am not allowed to do what either an RN or an RRT can do to the fullest extent of their scope of practice. Thus, as a Paramedic that is not even an argument as to whether I am better than an RN who has several years of experience as an ICU RN. I am very comfortable managing most ICU patients but I am not so stupid to have my ego blind me from seeing how valuable an RN is to a transport situation.
> My question wasn't about whether or not you could legally provide the same level of care, it was whether or not you felt that you COULD provide the same level of care, as in remove the legal distinction and scope of practice limitations and then do you feel you could provide adequate management of ICU patients as effectively as an experienced ICU RN. That was what I was asking.
> Right now FL is in the process of changing its statutes for neonatal transport with an increase in hours of neonatal experience for the Paramedic from 2000 to 5000 hours. 2000 hours was almost impossible to get or some found that those claiming to have 2000 hours needed more than 2x more experience.
> So I take it that Florida is essentially making it about as difficult as possible for a Paramedic to be able to do neonatal transports by increasing the required hours from 2000 to 5000, knowing that 2000 hours is almost impossible to get, because some people who claim 2000 hours needed twice the hours? Out of curiosity, how many hours of neonatal experience is needed by an RN, who is fresh out of RN school, to eventually be able to do neonatal transports?
> ...


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## Rob123 (Jan 26, 2010)

Akulahawk said:


> *Candidates for Flight Paramedic should be prepared for the position by meeting the following criteria:*
> <snipped>
> • Must maintain a duty weight of less than 205 lbs. (body weight plus uniform and equipment).


 
Off topic... or is it back on topic
I'm pretty tall and don't show my weight.
But I guess it's time for me to hit the gym. :blush:


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## Jersey (Jan 26, 2010)

Knowing Vent's knowledge from another flight specific forum, I'd be careful about questioning his abilities as a provider


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## akflightmedic (Jan 26, 2010)

Jersey said:


> Knowing Vent's knowledge from another flight specific forum, I'd be careful about questioning his abilities as a provider



HER abilities...


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## Jersey (Jan 26, 2010)

Vent, my apologies. I owe you a beer if you're ever in the area!


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## fire_911medic (Jan 26, 2010)

LOL @ Jersey - I'd worry about having to buy Vent a whole case for calling her a him!  

There are several here with good resources and I don't think this was meant to go into a RN vs RRT vs Medic discussion and unfortunately I think that's the direction it ended up going.  I'm not that familiar with Cali's requirements as I know they operate much differently than where I am based which is exclusively RN/Medic config with clearly defined roles for each and  complimenting each other in certain areas.  An ICU nurse can be a wealth of resource for meds that are not commonly seen within the prehospital environment.  If I'm not familiar with it - I'd be glad to be partnered with one who does.  The course that most utilize to get ground medics to flight intro level is the CCT course which is not that long and basically gives a rough overview of things you're going to see.  It's up to the individual medic to educate themself further and get a solid understanding of things if they plan to be competitive in the flight environment.  However, their comfort zone is prehospital and especially airway and that being said, it is of definite benefit to have that to a  program.  Considering the majority of air services are IFT's with about a 70 IFT/30 Scene split (more or less depending on individual base) I think the push in the future will be more towards a better rounded medic if they are to remain in this environment.  And as to the comment of should we require medics to do time in the ICU - YES !  And it is part of the required rotations for flight programs in this area in addition to others for that very reason.  Both have their place and can adapt to the environment - I think it's unfair to play a "this is better than that"


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## VentMedic (Jan 26, 2010)

Akulahawk said:


> My responses inline...
> 
> So I take it that Florida is essentially making it about as difficult as possible for a Paramedic to be able to do neonatal transports by increasing the required hours from 2000 to 5000, knowing that 2000 hours is almost impossible to get, because some people who claim 2000 hours needed twice the hours? Out of curiosity, how many hours of neonatal experience is needed by an RN, who is fresh out of RN school, to eventually be able to do neonatal transports?


 
It would be very rare for  a new grad RN or RRT to get into a neonatal unit right away.  Some may require a minimum of 2 years of general experience before applying to a specialty unit.  Once they are accepted into a specialty unit like NICU, they will have to work 3 - 5 years before being eligible to apply or "invited" to apply to the Specialty Transport team.  Once on the team they will spend another year in the classroom and the labs perfecting their skills and knowledge under the watchful eyes of the medical director and other neonatologists.  This will also be done while still working in the NICU. Once they have met the requirements they will then do several transports with a preceptor until they are approved by the medical director to become a full team member.  Specialty Teams don't just go across town for a sick baby but may go to another country for a long distance transport.  

To answer your question, for "hours", you may be talking around 10,000 hours with numerous patient contacts per shift.  RNs in the NICU will take care of 2 - 3 patients for 8 - 12 hours.  If they have med-surg experience either adult or pedi, they may have 5 - 10 patients per shift for 8 - 12 hours.    Thus, if you add up actual patients and the number of contact hours, you may find that 10,000 is a low number for most RNs (and RRTs) on these teams.


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## VentMedic (Jan 26, 2010)

Jersey said:


> Vent, my apologies. I owe you a beer if you're ever in the area!


 
Thank you. However, I'm retiring to Sonoma and have advanced to "fine wine". I've been practicing for many years to hold a wine glass gracefully by intubating neonates.


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## Akulahawk (Jan 28, 2010)

Thank you, Vent. That very much easily answers my question. Is Florida using contact hours or simply hours spent on shift, on the floor? The reason I ask is because if you're multiplying the patients by the hours on the floor, a 10 hour shift with 8 patients = 80 contact hours, where you've been on the clock only actually 10 hours (probably feels like 80 at times though). Which way is Florida doing the calculations?


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