CCT or ALS?

[BayEMTmaybeP]

hi everyone,

I Just got picked up with a company that does BLS, CCT, and back up 911 ALS/ALS IFT.

I am going to do BLS for a few months to get situated, but then would like to go do CCT or ALS to help prepare me for medic school in the next year or 2.

My question, is it better to do CCT or ALS? I know obviously a combination would probably be best, but I'm wondering if anybody thinks one is better then the other.. My thought process is for ALS I can see the on scene call and assist, but once we load I am driving and unable to see what's going on.

CCT on the other hand, there is a chance I'll drive, or be the EMT in the back with the RN for the transport.

Please go easy on me! Thanks

 

[luke_31]

I don't think you get to just choose what you want to do. That's not how most places work. They typically place you where their needs are greatest and then with seniority you can choose a shift to bid on when there is an opening. I would go ALS though if you have the chance, you will see more of what you would be doing as a medic. CCT you see sicker patients and can learn a lot from the RN, but knowing what you are getting into as a medic would be a better way to go. Who knows you might not want to be a medic after watching what they do for a while.

 

[VentMonkey]

Any and all of it. Pick up overtime in every division, at every level, and with every crew configuration that your service provides.

No clue what your end goal is, but either way, having your hand in each, and every proverbial prehospital "honey jar" will yield many benefits and rewards regardless of your ultimate end goal. This holds true for just about every job title, or description I've ever known.

Some may be more to your liking than others and that's ok; but going in knowing every opportunity fosters growth, expands your resume, and just generally makes you an all around more well-versed provider should be enough to make it a no brainer.

Or, you can sit and wonder from the outside, draw your own assumptions, and nitpick like others do sometimes; your choice.

 

[BayEMTmaybeP]

End goal is paramedic. Just looking for what would be most beneficial for me to assist with that. After 3 months I can do any of the 3 (seniority permitting for bid shift)

 

[VentMonkey]

All of it will be beneficial, as previously stated. Be a zombie, pick brains. Seriously, ask those who seem like they know what they're doing, and who you'd like to emulate. Regardless of their provider level that is the best advice I can give you.

Oh, and never stop picking at their brains either.

 

[hometownmedic5]

So if I'm reading this right, two basics(one driving, one in the back) and an RN constitutes a critical care truck at this organization?

Things that make you go hmmmm...

Most likely, you're not going to walk in and find a buffet of open jobs. They are most likely competitive, so you won't have the choices you think you'll have. Take the bls job, pick up overtime when available in the different areas and see how you feel from there. There's no need, and more importantly no point, in making this decision today. You might just find out that you got your heart set on a pipe dream. Get in the door and find out how things really are before you mentally commit to a particular path.

 

[Jim37F]

So if I'm reading this right, two basics(one driving, one in the back) and an RN constitutes a critical care truck at this organization?

That's how it was at my first private company, and to the best of my knowledge, all the other private companies here in LA/OC staff CCT units as 2x EMTs with a Critical Care RN. These units aren't doing 911 scene responses to RSI people or anything like that, mostly transfers to/from ICUs, ERs, specialty tertiary facilities, etc. Mostly pretty stable, as any sort of med running that's outside the paramedic scope of practice gets a CCT unit. Anything acutely emergent that needed to go to ER and wasn't preplanned was considered a 911 call, not a CCT IFT.

 

[Jim37F]

I started off at my first company doing BLS transfers, but they also had ALS and CCT units, ALS were all 1-and-1 EMT and Medic, CCT was all 2x EMT and a nurse, so it was a lot easier for an EMT to pick up overtime on any of those other units. It was as easy as logging in to the companies scheduling site (I think they used ePro?) And just pick up an opening and as long as someone else with more seniority wasn't trying to pick up the same shift you got to work it.....when the permanent shift bids came around, even though I only had 6 months on or so, I still got a CCT shift no problem).

So yeah, even though I was on a BLS unit, I got to pick up plenty of OT on ALS and CCT (personally I like CCT better because you didn't have to just drive, you could still be in the back with the nurse, and if all the medic units were busy, CCT could still be sent on ALS level calls, so I still got to do both there). Note there was no backup 911, it was all pure IFT, I only had 1 emergent call in the 10 months I was there (before going to a company that did do 911), so looking back, say if the medic units did do backup 911s as staffed 1-and-1 (here in LA you have to be dual medic to be the lead ALS unit, 1&1 Get treated like a BLS ambulance for 911 calls) that might have changed my mental calculus a bit lol

 

[VFlutter]

So if I'm reading this right, two basics(one driving, one in the back) and an RN constitutes a critical care truck at this organization?

Things that make you go hmmmm...

I do not see anything wrong with this other than your obvious disdain of RNs.

Who is better suited for ICU to ICU critical care transport? The ICU nurse that spends hours a day at the bedside with these critical patients and are experts at the devices used in their care? Or a street medic who just took a CCEMTP course with no practical experience like many companies try to pass off as CCT.

I think the Medic/RN Team is ideal and I have no doubt that many Medic/Medic or EMT/Medic CCT teams are quite capable but you implying that a EMT/RN transport isn't critical care is funny. Many Peds CCT teams run RT/RN. Is anyt configuration without a medic subpar in your opinion?

 

[VentMonkey]

@Chase that wasn't how I read his post, but I'll let him clarify.

With that, I come from the same area @Jim37F is describing, and most of California (except us and perhaps a few others) operates this way. Typically, it works out fine as most RN's these companies hire are seasoned ICU RN's, as you've stated.

They really don't need the EMT, or even paramedic back there usually unless the patient is truly critically ill, and at a higher-than-normal risk for CTD. The more proactive teams, regardless of provider level work as just that, a team. This is where you come in, OP. You can learn a lot from these calls even as a basic--->street paramedic to-be.

For the double BLS/ RN team this means the RN shows them how to enter initial setting on the vent, and/ or input the IV pumps info; they'll give them a once over once the patient is prepped for transport, and on the gurney.

For us, it's somewhat similar. I'm usually setting up the vent, checking the ETT, and grabbing whatever paperwork, or info I can in order to ease their workload. Crew configuration hardly matters with regards to a team approach.

That said, I am by no means "well versed" in the various ICU syndromes common to most ICU RN's; I'm a zombie, too.

 

[hometownmedic5]

Yeah, evidently you need clarification.

My dislike of this system isn't that it involves nurses. It's that there is one provider capable of als on what is billed as a critical care transport. It doesn't meet the standards of what we consider CCT in massachusetts(medic/RN configuration with allowances for RRT/MD additions).

Of course, there are regional differences in what is considered a CC call, so perhaps its a nomenclature problem. I worked with a guy awhile back who was from Illinois IIRC. one day in the coffee room we got to talking about regional differences and he told me that what we call an als call(monitor, <4 infusions, vent, 1 pressor, blood and so on), was CCT back home. He said they couldn't take anything running beyond fluid and abx. Vents, blood, pressors and so on were CC.

So if that's the type of system then sure, one als provider is fine; but a system where one provider(nurse or medic) and a basic in the back with a super sick pt receiving multiple als interventions to me is grossly inadequate.

I'm not sure why you think I'm anti nurse. I'm not. I'm simply not as enamored with nurses as some people are, and as some nurses seem to think we all should be. I respect that nurses have a superior education to me and have fought an uphill battle to get where they are professionally; but none of that means I'm some slack jawed yokel bumbling around the hospital(which is how many nurses treat us). Maybe that doesn't apply to you personally, but it happens.

 

[DrParasite]

; but none of that means I'm some slack jawed yokel bumbling around the hospital(which is how many nurses treat us). Maybe that doesn't apply to you personally, but it happens.

wait, so this isn't you? I thought you said your name was Cletus?

I've been on more "CCT" runs than I care to admit..... most were nurse, medic, and EMT, and for most of them, having the medic there was a waste of time. Most private agencies in NJ run CCT units as 2 EMTs and an RN; ALS agencies (if they have a CCT units) will replace one EMT with a paramedic and the RN with an MICN so they can do CCT runs and 911 ALS runs (if available, and if needed). However, if the RN felt they had a very unstable person, they were permitted to ask for an additional ALS provider if one was available.

to the OP, pick up both, more experience and exposure to different aspects of EMS are always good thing, especially when you want to do more than just be an EMT.

 

[GMCmedic]

At the place i started CCT was a billing joke.

Pump with normal saline? CCT

Wound vac? (Not in the medic scope of practice here but thats another argument) CCT

A CNA is riding with a patient to a doctors appointment? CCT

My first day as a medic i was handed a narc box and told to complete my vent and CCT training when I got around to it. 2 hours later I was doing a vent transfer using the cpap setting.

Two techs and an RN sounds more CCT capable than that.

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[EpiEMS]

A CNA is riding with a patient to a doctors appointment? CCT

How'd they justify that one?

 

[NomadicMedic]

How'd they justify that one?

They both started with a "C"

 

[GMCmedic]

How'd they justify that one?

That AMR shop will bill anything and everything.

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