CALLING RIDRYDER (or anyone who can answer)

[Sasha]

Came up in the chat and I was curious. What is the difference between EMT-P and CCEMT-P, drug, equipment and procedure wise?

 

[emtlady76877]

CCEMT-P has taken a course in critical care where as the EMT-P has not.

 

[Sasha]

CCEMT-P has taken a course in critical care where as the EMT-P has not.

I understand the difference, cert wise, what a CCEMT-P is. But what else are they allowed to do, what procedures, drugs, equipment?

 

[Hastings]

In a common sense, it's typically the use of advanced devices, including Ventilators, and devices hospitals would use in critical cases, such as balloon pumps and invasive lines. It's also more Pharmacology, including managing patients under the effects of paralytics and heavy sedation, etc. Other than that, knowledge of lab values and the such, as well as more in-depth physiology.

 

[VentMedic]

I understand the difference, cert wise, what a CCEMT-P is. But what else are they allowed to do, what procedures, drugs, equipment?

It varies from state to state, county to county and company to company.

The scope of practice for Paramedics can vary so widely that some CCTs utilize RNs, either in addition to a Paramedic or as in California with EMT-Bs, to avoid some of the issues.

Some states are also very lax about who puts Critical Care on the side of their trucks. It does however count with reimbursement.

While CCEMTP (Critical Care Emergency Transport Program) is trademarked by the University of Maryland Baltimore County course, there are many that use the initials CCEMT-P with their name after a 4 hour backroom course . It is a certificate course and may be used to show that you have completed a very introductory course to a few basic concepts in critical care medicine.

A few states may require more education than that to be a CCEMT-P in their state and have designated an official state level cert or license above Paramedic. Ohio is an example of that.

For Flight, your company may prefer you also have the FP-C (Certified Flight Paramedic).

Regardless of additional training, your medical director will be writing what you can and can not do within the guidelines of the state.

One medic mill in Florida (a favorite of Reaper and myself) is offering the course that is supposedly UMBC affiliated. However, Florida only has two levels, EMT and Paramedic.

Here is a quote from the UMBC CCEMT-P site:

The Critical Care Emergency Medical Transport course is an intense curriculum of lecture and lab educating designed to prepare the experienced practitioner for the challenges of critical care during flight/ground transport. This course is offered in conjunction with the University of Maryland Baltimore County (UMBC), Department of Emergency Health Services. Highlights of the Critical Care Emergency Medical Transport course will include: a comprehensive course overview; use of portable ventilators; oral, retrograde and nasal intubations; multi-system organ failures; hemodynamic monitoring; multiparameter monitoring; implantable cardioverter and defibrillators; dialysis; high-risk OB and pediatric transports; and case scenarios. Candidates will receive lectures on rapid sequence intubation, intra-aortic balloon pump, and 12-lead ECG monitoring. Students are evaluated with an extensive written examination at the end of the course. Upon successful completion, Critical Care Emergency Medical Transport recognition is valid for three years. Faculty includes regional flight paramedics, nurses, respiratory therapists, and physicians with extensive critical care experience.

 

[stephenrb81]

I know it's a bit of a stretch from what Sasha is asking but isn't there a larger medicare reimbursement if a CCEMTP tech's a critical transfer as opposed to an EMT-P for the same patient simply because of the extra "Critical Care" training? (Providing they meet criteria)

 

[VentMedic]

To keep from rehashing alot of details here is another thread where this was discussed from an article by Dr. Bledsoe.

http://www.emtlife.com/showthread.php?t=8579

or

Here is the direct link to Dr. Bledsoe's article;

The Vanity of EMS

http://www.ems1.com/columnists/bryan-bledsoe/articles/421845-The-Vanity-of-EMS

 

[MSDeltaFlt]

Came up in the chat and I was curious. What is the difference between EMT-P and CCEMT-P, drug, equipment and procedure wise?

UMBC's CCEMT-P's are educated more on the lines of the ICU setting and with regards to altitude physiology. You're trained on X-Ray, labs, ABG interpretation, some more advanced vent management (meaning all of the different modes you would find being used in the ICU) along with IABP, A-line placement/mgmt, chest tube placement/mgmt, RSI, surgical cric, retrograde intubation, central line placement/mgmt (sub-clavian, fem TLC's, and I think IJ's). Let's not forget to mention all the drips that come with them. Not just mgmt, but also starting and titration. You're also being trained to handle not just all these on your pt, but having to understand the patho-physiology of each and every type of pt that would need to be on these things.

Couple the above with the physics of altitude. The stressors of flight: Temp, vibration, moisture (lack thereof), noise, G-forces, altitude, Boyle's, Charle's, Henry's Law and so on and so forth; and how they can and will effect all of those pt's; not to mention you and your crew. It's easy to see Dr. Bledsoe's point of view stating that that short class and thinking you're ready for all of these situations can be considered Dillusions of Grandeur... and yes, I put those same credentials behind my name as well.

The above reads like I went on a rant, but I hope I made myself clear and answered your question.

 

[VentMedic]

Grandeur... and yes, I put those same credentials behind my name as well.

When asked what CCEMT-P stands for, do you say
Critical Care Emergency Transport Program certificaton? (which is also open to RNs and RRTs)
or
Critical Care EMT-Paramedic, which is a license level in a couple of states?

 

[Sasha]

RSI, surgical cric, retrograde intubation,

Those three are being taught as part of our regular paramedic education. I've seen RSI in the hospitals many times and quite frankly it scares the crap outta me!

 

[MSDeltaFlt]

When asked what CCEMT-P stands for, do you say
Critical Care Emergency Transport Program certificaton? (which is also open to RNs and RRTs)
or
Critical Care EMT-Paramedic, which is a license level in a couple of states?

Nobody ever asks me. They couldn't really care less. It's also not even recognized in any of the states I work in. So I guess it's a mute point.

 

[VentMedic]

Didn't mean to pick on ya Mike.

But you are correct. It can be a mute point as to what the letters mean or don't mean.

I do get amused by the play on letters that can be meant to change the meaning. By inserting the (-) it can mean something very different.

There are a few RNs and RRTs that do add CCEMTP to their other letters at the end of their name. They mainly work at independent agencies not associated directly with hospitals such as the fixed wing program in NC. Those that are hospital based usually don't bother with the extra letters even if they take the course.

I will ask some where they got the initials CCEMT-P since the UMBC (CCEMTP) program is expensive and not that easily found in this area. Usually they say it can be used since they do interfacilty transports although many require an RN and/or RRT to accompany to take care of the meds and technology. The "CCEMT-P" may have little or no extra CC training or education. We had one of our Specialty team drivers who happened to be a Paramedic try to insist on having those letters placed on his name tag even though he had little direct involvement in patient care. I suppose that is why I have a skewed opinion of the letters.

 

[MSDeltaFlt]

Didn't mean to pick on ya Mike.

But you are correct. It can be a mute point as to what the letters mean or don't mean.

I do get amused by the play on letters that can be meant to change the meaning. By inserting the (-) it can mean something very different.

There are a few RNs and RRTs that do add CCEMTP to their other letters at the end of their name. They mainly work at independent agencies not associated directly with hospitals such as the fixed wing program in NC. Those that are hospital based usually don't bother with the extra letters even if they take the course.

I will ask some where they got the initials CCEMT-P since the UMBC (CCEMTP) program is expensive and not that easily found in this area. Usually they say it can be used since they do interfacilty transports although many require an RN and/or RRT to accompany to take care of the meds and technology. The "CCEMT-P" may have little or no extra CC training or education. We had one of our Specialty team drivers who happened to be a Paramedic try to insist on having those letters placed on his name tag even though he had little direct involvement in patient care. I suppose that is why I have a skewed opinion of the letters.

No offense taken.

As you know full well being trained in two separate disciplines that you chart the appropriate credentials according to the job description you are clocked in on and working at that time. I list all of those credentials behind my name on my badge, my name tag, my business cards, and even on forums as listed below. I do that, not just because I am proud of my accomplishments (being someone who entered college on academic probation[did you know you can do that?]), but to also improve the value of my CV. I will NOT, however, write all of that on any of my charts. You cannot chart on a legal document credentials of a job description that is not recognized by your state or employer.

Case in point: When I'm working as a respiratory therapist, I'll chart on a pt's chart M. Hester, RRT. When I'm flyhing or on the ground truck as a paramedic, I'll chart on my pt's chart M. Hester, NREMT-P. No more. No less.

I think I'm starting to stray a little off topic, but you get my point.

 

[jedirye]

Well, I'd call it a moot point... But you can call it what you may.

 

[VentMedic]

Well, I'd call it a moot point... But you can call it what you may.

That depends.

Mute point: No need to discuss it anymore.

Moot point: can be be an unsolved case and is used commonly in law cases

I think the point here is "who cares?" Letters behind the name can be over used to a point where they become meaningless if not used appropriately or they are not understood as to the weight they carry or not.

CCEMTP can mean Critical Care Emergency Transport Program with letters that can be used by Paramedics, MDs, RNs and RRTs.

CCEMT-P can mean Critical Care EMT-P and can be a title handed out to whoever by whatever agency even if the state does not have a license level for it.

 

[daedalus]

CCEMT-P can mean Critical Care EMT-P and can be a title handed out to whoever by whatever agency even if the state does not have a license level for it.

Similar to those who possess WEMT and believe they get to practice any kind of medicine they want because in their mind it is a "license upgrade" that over rides state protocol.

I made the decision to create the DCT-EMT cert. Its the Daedalus chest thoracotomy certification for EMTs that allows them to preform open chest procedures in the field. For 2000 USD plus tax, ill hand you the card and a neat wall mounted certificate. PM me for more information.

 

[marineman]

At my service everybody plays with the same rulebook and my state doesn't recognize CCEMT-P as a seperate level but they still pay an extra $3/hour just for taking the class.

 

[Medic9]

In NY there are several levels of certification and of course with those levels come different things that can be done. I am an Advanced EMT- Critical Care, that is below a paramedic but above an EMT-B. I can do many of the same things a paramedic can do, some they have a standing order for and I have to call Med-Control and speak to the on-line doc to get permission. It all depends on the region you are in.
If you ask me its too confusing!

 

[MasterIntubator]

I'll share my point of view..... I took the UMBC course, mainly because I had an extra 1000 some dollars from my tax return :glare:. What I learned was nothing more than hospital based critical care training you can gain from in-service training.

The course is intense, you learn ( or supposed to learn ) all the lab values and what they mean, thorough acid/base chemistry, advanced pharmacology, advanced ECG/12-leads and more path physiology than some medics even want to tackle. Its the same stuff you learn in P class, just more in depth, and with the perks of dealing with interfacility equipment that standard road medic will most likely never ecounter ( Balloon pumps, vents - and I say that about the univents that have more than 2-3 knobs ), central lines and a few other toys.

Did it help me in the field on the ambulance? Not really. I am not able to do any more than what I was as a P. I would say less than 10% of the class info is applicable to 911 folks.

Does it help for interfacility transports with critical folks on machines? Yup. And you get picked first choice for having the experience on those runs.

But if your service only does 911 runs and does not touch interfacility folks.... its pretty much another course to have as a sert craving badge bunny.

Did I take it as a badge bunny? Yes and no. I take classes for the experience and to well round my education. If they have made a 4 letter class, I took it.

The class was hard. Unlike the P test, the CC test actually made me think. I also found that different course instructors give varied instruction.
My first course at UMBC was an intense 84 hour course and had higher failure rate.
The second one a few years later I sat in on for my CC credits, the satelite course was less intense and the instructor actually graded on a curve.

Do I agree with that? No. No course should ever dumb down to make sure everyone could pass. But... I voiced my issue and carried on with a fresh 3 years.

As with any course...... it is all what YOU make of it.

 

[VentMedic]

an Advanced EMT- Critical Care, that is below a paramedic but above an EMT-B.

I mean no offense to you...but those words do not go together.

I agree, confusing!