CALIFORNIA Title 22 regulations change

[socalmedic]

but when techs can do it for less, why use a nurse?

theres a little more to it than that, sure with the majority of the privates it is a money issue. those of us who have done CCTs with a nurse for any length of time can tell you the horror stories of when nurses have no buiseness in an ambulance. I will name a few below

1. the "MICN with years of CCT Experiance" who demanded that she sit up front and i pop my head through the window if anything happens because she gets car sick...:rofl:
2. the CCT-RN who didnt know how to set up a vent, (the ltv-1200 is not that hard) or work the medsystem 3 transport pump.
3. the nurse who asked us to take another route because the road was "too bumpy"

there are more, but you get the jist, in the 7 years I have been in EMS i have been on hundreds of CCT transports and the nurses in general are well suited for the job. however when you allow anyone with an RN license and an MICN course it is an accident waiting to happen. I am glad that CA is finally getting on board with the rest of the country and seeing that a paramedic can in fact be trained to take the majority of CCT cases. reserve the CCT-RN for the truly critical transfers which are over my head, or better yet, take the ICU nurse who has been caring for that patient with me, I will do all the vent, pump, and misc other stuff that she tells me needs to be done.

 

[DrankTheKoolaid]

And to clarify, that is Field MICN and not base MICN which is totally different.

I see alot of great ideas having been presented over the last six months on proposed regulation. Unfortunately more education isnt high on the list, And with the California Fire Service official position being against more education, it is a losing battle. We need to push for repeated testing both cognitive and psychomotor instead of completing the same exact worthless, CE courses over and over and weed out the bottom end

 

[socalmedic]

And to clarify, that is Field MICN and not base MICN which is totally different.

in these parts they are the same. we only have one full time CCT-RN in the county the rest are on call.

 

[usalsfyre]

Looking at the comments, and then who they're from....I'm not sure who's running EMS out there, but it sure as Shiva isn't paramedics.

They're arguing over monitoring things (heparin, NTG and norepi) paramedics in many other parts if the country are initiating.

 

[AnthonyM83]

In large part, I'm sure it's because paramedics/EMTs aren't as organized as those organizations are. The common paramedic wouldn't even know that those regulations were out for change and public comment. Only the organizations are in the know.

 

[socalmedic]

in the past we have been run by the firefighters special interest groups and the board of nursing. this may all appear small, however this whole thing is enormous for us. two years ago if you had told me there are going to be CCT medics I would have laughed in your face. Dr. Becker is giving us drugs in our basic scope which would previously been allowed only for a CCT. I will take what small anonymity they will allow us, and take baby steps to grow. I am a little disheartened that our minimum education standard of an associates in a health related field was shot down with out even the smallest of explanation. hopefully in 5-10 years we can make changes which will actually affect our status as a "profession".

in response to your statement about pressors, if you really want to know how much of a jump "monitoring nor-epinephrine" is consider the fact that we have a county which recently removed DOPAMINE! meaning no pressers for the crews in riverside.

 

[DrankTheKoolaid]

All of the stuff they are talking about having to do CCT certification for, we have been doing in my area for 15 years as basic scope. This is due to our dual role 911 and CCT ifts from the local podunk to the larger distant facilities.

Rather unfortunate that the rest of the state is going to suffer because of the inept care provided elsewhere. There really needs to be a broader state scope and then let the lemsa medical directors water it down based on local need and training standards.

I will obviously get the cert, but my point is when your in a rural area how are you supposed to be able to attract CCT employees when pay is much better elsewhere

 

[JPINFV]

In other news, OCEMS just released a bunch of new protocols further cementing the fact that the average OC paramedic is apparently a blithering idiot.

 

[socalmedic]

All of the stuff they are talking about having to do CCT certification for, we have been doing in my area for 15 years as basic scope. This is due to our dual role 911 and CCT ifts from the local podunk to the larger distant facilities.

Rather unfortunate that the rest of the state is going to suffer because of the inept care provided elsewhere. There really needs to be a broader state scope and then let the lemsa medical directors water it down based on local need and training standards.

I will obviously get the cert, but my point is when your in a rural area how are you supposed to be able to attract CCT employees when pay is much better elsewhere

dont forget that California still has the "local optional scope of practices" your nothing local will change as your county has been going above and beyond through these alternate channels. its the same way we have been using versed, amiodarone, CPAP, BPAP, cardioversion, pacing, nasotrachial intubation... the basic scope wont change much, they are just moving alot of the optional skills to the basic scope.

for instance, I can already monitor IV nitro and heparin because my LEMSA had it approved through the local optional scope years ago.

I do agree with you that it will be harder for the rural providers to get the training and skills exposure with out having to go to the big city.

 

[Akulahawk]

dont forget that California still has the "local optional scope of practices" your nothing local will change as your county has been going above and beyond through these alternate channels. its the same way we have been using versed, amiodarone, CPAP, BPAP, cardioversion, pacing, nasotrachial intubation... the basic scope wont change much, they are just moving alot of the optional skills to the basic scope.

for instance, I can already monitor IV nitro and heparin because my LEMSA had it approved through the local optional scope years ago.

I do agree with you that it will be harder for the rural providers to get the training and skills exposure with out having to go to the big city.

The one thing that I do not like about moving the optional skills to the basic scope of practice is that the local EMS agencies can still remove skills/procedures/whatever from the basic scope of practice, as they see fit. This results in every county having potentially a completely different scope of practice because they do their own thing. I know that the reality is that most counties will have most of the basic scope of practice of paramedics available and in use, and that some will have local optional scopes that are slightly expanded from that basic scope. Personally, I think that if there is a basic scope of practice, all counties should be required to adhere to that and add to that as needed for their particular situation.

 

[Christopher]

...meaning no pressers for the crews in riverside.

My take after reading the comments is Riverside does not think very highly of its crews and would rather not have them in the first place.

Which is Ok, because the addition of ALS does not necessarily improve any benchmarks. Especially the addition of lousy ALS.