California Critical Care Paramedic Scope of Practice

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Until very recently I was unaware that California recognized Critical Care Paramedics, or CCP.

It appears this additional certification was established in 2013. I am compiling this information for future reference for others to use.

Scope of practice:
In addition to standard paramedic scope:

1. set up and maintain thoracic drainage systems;
2. set up and maintain mechanical ventilators;
3. set up and maintain IV fluid delivery pumps and devices;
4. blood and blood products;
5. glycoprotein IIB/IIIA inhibitors;
6. heparin IV;
7. nitroglycerin IV;
8. norepinephrine;
9. thrombolytic agents;
10. maintain total parenteral nutrition;

(2) Local Optional Scope of Practice:
(A) Perform or monitor other procedure(s) or administer any other medication(s) determined to be appropriate for paramedic use, in the professional judgment of the medical director of the LEMSA, that have been approved by the Director of the Authority when the paramedic has been trained and tested to demonstrate competence in performing the additional procedures and administering the additional medications.

Provider requirements:

"...holds a current certification as a CCP by the Board for Critical Care Transport Paramedic Certification..."

b) To be eligible to enter a CCP training program an individual shall be currently licensed, and accredited, in California as a paramedic with three (3) years of basic paramedic practice.

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Class Requirements:

Course hours
Chapter 4,section 100159

(d) The total CCP training program shall consist of not less than two-hundred and two (202) hours. These training hours shall be divided into:

(1) A minimum of one-hundred and eight (108) hours of didactic and skills laboratories; and
(2) No less than ninety-four (94) hours of hospital clinical training as prescribed in Section 100152(b) of this Chapter.



Clinical hours
Chapter 4, section 100152

(b) Hospital clinical training, for an approved CCP training program, should consist of no less than ninety-four hours (94) in the following areas:

(1) Labor & Delivery (8 hours),
(2) Neonatal Intensive Care (16 hours),
(3) Pediatric Intensive Care (16 hours),
(4) Adult Cardiac Care (16 hours),
(5) Adult Intensive Care (24 hours),
(6) Adult Respiratory Care (6 hours), and
(7) Emergency/ Trauma Care (8 hours).


Didactic
Chapter 4, Section 100155

The entire text of Section. 100155 is too long, but for required education topics, you can look it up.
 
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VentMonkey

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Lol, they've rendered it nearly impossible by any CCP course standards I've seen. Creighton by far has the most in depth training with a 5 month didactic, clinicals, and cadaver labs.

This is still falling short of the CAEMSA's requirements. Why don't I find this remarkably surprising?
 

CALEMT

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VentMonkey

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Thread bump...

So the only service I found that seems to still actively utilize them to their full capacity would be an AMR ops in NorCal, more specifically, San Leandro.

If there are any NorCal folks on here who have worked as one, or with one, or knows one, I'd like to hear from you all.

I'm contemplating pitching this idea to our county's EMS medical director, and I'd like some info on the AlCo CCP accreditation process firsthand, and aside from what's already listed on AlCo County's EMS website, thanks.
 

Summit

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Aprz

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Thread bump...

So the only service I found that seems to still actively utilize them to their full capacity would be an AMR ops in NorCal, more specifically, San Leandro.

If there are any NorCal folks on here who have worked as one, or with one, or knows one, I'd like to hear from you all.

I'm contemplating pitching this idea to our county's EMS medical director, and I'd like some info on the AlCo CCP accreditation process firsthand, and aside from what's already listed on AlCo County's EMS website, thanks.
In my opinion, the CCT P stuff was a total flop in Alameda County before I left there. It didn't work at Patient Plus. It didn't work at Rural/Metro IFT. I don't know how it is at AMR Norcal/Sutter now, if they utilize them better. I was there when Rural/Metro IFT had the contract with Kaiser (they only had the contract with Kaiser and Palo Alto Medical Foundation in Fremont), and Kaiser usually refused to use CCT P units for CCT P calls.

The next time I see one of those CCT P medics, I'll ask them. I know one who was on her way to doing it (before Rural/Metro IFT got the Kaiser contract), but then AMR IFT shutdown (she stayed with AMR instead of going to Rural/Metro San Jose). I don't have direct contact with one that was actually working as a CCT P, but I know his old partner, and I'll probably shoot him a message for you.
 

hometownmedic5

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Wow. Literally all of that is within the basic scope of a Paramedic in Massachusetts. It's interesting to see the difference in protocols across the country.
 

Tigger

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Wow. Literally all of that is within the basic scope of a Paramedic in Massachusetts. It's interesting to see the difference in protocols across the country.
Have MA paramedics always been able to take TPA? I feel like I remember Brewster not being ok with that.
 

hometownmedic5

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I don't know of a Brewster policy against it, and that would go back 3 years and I've taken it without issue. That being said, maybe 4 years ago they did.

On a state level, medics can take it. It has to be pumped, you have to discard the excess beyond the ordered dose, and you need med control. There are very few drugs we can't take by protocol and virtually nothing we can't take with med control.
 
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Where I'm at right now we have no restrictions on what we can take on transfers.

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Tigger

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I don't know of a Brewster policy against it, and that would go back 3 years and I've taken it without issue. That being said, maybe 4 years ago they did.

On a state level, medics can take it. It has to be pumped, you have to discard the excess beyond the ordered dose, and you need med control. There are very few drugs we can't take by protocol and virtually nothing we can't take with med control.
That is similar to Colorado, though we still can't take TPA without a waiver or RN.
 

VentMonkey

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In my opinion, the CCT P stuff was a total flop in Alameda County before I left there. It didn't work at Patient Plus. It didn't work at Rural/Metro IFT. I don't know how it is at AMR Norcal/Sutter now, if they utilize them better. I was there when Rural/Metro IFT had the contract with Kaiser (they only had the contract with Kaiser and Palo Alto Medical Foundation in Fremont), and Kaiser usually refused to use CCT P units for CCT P calls.

The next time I see one of those CCT P medics, I'll ask them. I know one who was on her way to doing it (before Rural/Metro IFT got the Kaiser contract), but then AMR IFT shutdown (she stayed with AMR instead of going to Rural/Metro San Jose). I don't have direct contact with one that was actually working as a CCT P, but I know his old partner, and I'll probably shoot him a message for you.
Do you know what kind of extra training these paramedics were put through? According the CAEMSA website it's pretty specific.
 

RocketMedic

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Imo, this is actually a great and fairly minimalist framework to build off in comparison to most "critical care" classes. Just because I once was good at UBMC PowerPoint does not qualify me in the slightest to go mucking about with some of the things we talked about.
 

VentMonkey

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Right, and that's exactly what interests me the most. It seems as though, on paper, it's a solid outline and guide to understanding the fundamentals of a critical care paramedic regardless of the state it is in.

Sure, I can move to Timbucktu and practice freely and nearly autonomously, but without a proper understanding of what it is I am doing beyond that of a standard paramedic, where does this leave me?

I guess as many times as we talk about furthering a paramedics education I can't help but find some irony in having a policy on it here. After all, we're almost always going on about how much more education, and/ or training paramedics need. This is at least a step in the right direction.
 

RocketMedic

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Who uses these, and who offers this training?
 

RocketMedic

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I know this might be breaking from the mold, but I really don't feel super-comfortable with taking truly critical patients alone in any event.
 
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I know this might be breaking from the mold, but I really don't feel super-comfortable with taking truly critical patients alone in any event.
If they're THAT sick, they probably shouldn't leave the hospital. And if they do, it shouldn't be by ground.

That said, **** happens.

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