PotatoMedic
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Does anyone use, or know of any agencies that use a CCT Fly Car to supplement their pre-hospital ALS care?
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CCT Fly Car
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PotatoMedic
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Do you know how they want to structure it operationally? I'm wanting to build this kind of level of care at my organization as there is a need, but trying to see how it can expand outside of what I have thought of.
DrParasite
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What is the goal of a CCT flycar? to assist on critical interfacility patients? or to send the CCT truck on ALS 911 calls?
Many CCT providing ALS agencies in NJ will send a CCT truck when the primary ALS unit is unavailable, or when the CCT truck is closer than the ALS unit. Staffing is either an MICN and a paramedic, and sometimes an EMT. NJ required 2 ALS personnel for any ALS response, so an MICN or EMT/RN and a paramedic counts (both have the same alphabet courses required to be a paramedic), and the EMT is usually the driver.
There are some other NJ specific quirks (vehicle licensing, staffing, transport capabilities), but that's it in a nut shell.
Many CCT providing ALS agencies in NJ will send a CCT truck when the primary ALS unit is unavailable, or when the CCT truck is closer than the ALS unit. Staffing is either an MICN and a paramedic, and sometimes an EMT. NJ required 2 ALS personnel for any ALS response, so an MICN or EMT/RN and a paramedic counts (both have the same alphabet courses required to be a paramedic), and the EMT is usually the driver.
There are some other NJ specific quirks (vehicle licensing, staffing, transport capabilities), but that's it in a nut shell.
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PotatoMedic
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The primary function I see is to be do the emergent critical care interfacility transfers that my agency gets on occasion. A lot of these are emergent transfers that the hospitals cct team can't do be it they are busy or the doctor does not want to wait for them to show up. They also tend to be sick on multiple meds and usually vented. Not something that a regular ALS provider in my agency is comfortable with or has ever seen. We do a handful a month at most. But they are low frequency high risk transports that we should address appropriately.
But it would not be cost effective to staff a CCT Fly car for that few trips. So I'm looking at other functions they could help with. One idea is they would carry blood and be dispatched to major trauma such at industrial accidents or large MVA's with extrication. Probably 9/10 times won't be needed but there might be cases where pre-hospital blood would be good.
I'm also thinking they would go and assist with codes as an extra hand. And am seeing if this concept has been done before to see if there are other functions they could fill.
I'm also thinking they could work with education and take training to crews.
Just seeing if someone has made this wheel before... And see if this is even a wheel that needs to be made.
But it would not be cost effective to staff a CCT Fly car for that few trips. So I'm looking at other functions they could help with. One idea is they would carry blood and be dispatched to major trauma such at industrial accidents or large MVA's with extrication. Probably 9/10 times won't be needed but there might be cases where pre-hospital blood would be good.
I'm also thinking they would go and assist with codes as an extra hand. And am seeing if this concept has been done before to see if there are other functions they could fill.
I'm also thinking they could work with education and take training to crews.
Just seeing if someone has made this wheel before... And see if this is even a wheel that needs to be made.
NomadicMedic
EMS Educator
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Penn State life lion has one, they use it when the helicopter can’t fly and need to take a CCT team via ground to meet up with a BLS ambulance. It’s kind of really outside the scope of being 100% legit, but there it is.
DrParasite
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My local EMS agency runs what they call a "Advance Practice Paramedic" program, which sounds similar to what you are proposing (assuming you are referring to a CCT paramedic, not a CCT nurse).
Their primary role is a mix of community paramedicine, overdose prevention, psych redirection, and fall prevention. They also do QA on charts, act as clinical specialists to field crews, and additional ALS resources on major calls. I think they carry Lucas devices too.
Here are questions to ask:
1) can you justify the staffing of an additional person?
2) will the person be available 24/7, or just peak hours?
3) do you have a vehicle for the person to use?
4) what training requirements do you want to implement? Do you want simply require a CCEMTP course, or something additional in house?
5) how are you going to make money off this person? what will happen if they don't make money, will they be laid off in a few months? or, similar to a supervisor, is this a loss you are willing to accept?
6) What will happen when they are on a 911 call, and a CCT job comes in?
7) do they need specialized CCT equipment in their car? can they grab it all and bring it with them into a regular ambulance?
Their primary role is a mix of community paramedicine, overdose prevention, psych redirection, and fall prevention. They also do QA on charts, act as clinical specialists to field crews, and additional ALS resources on major calls. I think they carry Lucas devices too.
Here are questions to ask:
1) can you justify the staffing of an additional person?
2) will the person be available 24/7, or just peak hours?
3) do you have a vehicle for the person to use?
4) what training requirements do you want to implement? Do you want simply require a CCEMTP course, or something additional in house?
5) how are you going to make money off this person? what will happen if they don't make money, will they be laid off in a few months? or, similar to a supervisor, is this a loss you are willing to accept?
6) What will happen when they are on a 911 call, and a CCT job comes in?
7) do they need specialized CCT equipment in their car? can they grab it all and bring it with them into a regular ambulance?
OP
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PotatoMedic
Has no idea what I'm doing.
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I appreciate the info. Definitely a good mix of questions which I've either thought about and addressed or am trying to figure out at the moment.
1: if I can find a way to justify the resource. The need is there but the need can't justify the cost unless I find more of a mission than just cct.
2: 24/7 is the goal. We really only do ift when the hospitals cct is not available and they need an emergent transport. Plus if another mission would be to assist on cardiac arrests (replace the supervisor if they are the closest) they need 24/7 coverage
3: we have some spare actually
4: probably only require that they have the ibsc fpc or ccpc as that is what the state requires for critical care scope. I'd like to also work with the hospitals to get educated on their pumps so we wouldn't need to switch to our pumps. And better vent education.
5: were tax funded (sorta). Mostly trying to justify the cost.
6: my thoughts are they would purely be assisting on 911. But would need to make sure there are not any abandonment issues if they need to leave. But with there only being 2-3 ifts a month it would be a fairly rare occurrence.
7: we have been doing these ifts with the equipment we already have. I just feel we are doing them by just praying nothing bad happens. So equipment wise they would have a lucas and a few extra pumps (we only carry one single channel on the rigs.). We already have vents. But more can be identified as I keep working on this to see if it is even something pursuing.
Going to sit with management later to see if they can see any value in the idea.
1: if I can find a way to justify the resource. The need is there but the need can't justify the cost unless I find more of a mission than just cct.
2: 24/7 is the goal. We really only do ift when the hospitals cct is not available and they need an emergent transport. Plus if another mission would be to assist on cardiac arrests (replace the supervisor if they are the closest) they need 24/7 coverage
3: we have some spare actually
4: probably only require that they have the ibsc fpc or ccpc as that is what the state requires for critical care scope. I'd like to also work with the hospitals to get educated on their pumps so we wouldn't need to switch to our pumps. And better vent education.
5: were tax funded (sorta). Mostly trying to justify the cost.
6: my thoughts are they would purely be assisting on 911. But would need to make sure there are not any abandonment issues if they need to leave. But with there only being 2-3 ifts a month it would be a fairly rare occurrence.
7: we have been doing these ifts with the equipment we already have. I just feel we are doing them by just praying nothing bad happens. So equipment wise they would have a lucas and a few extra pumps (we only carry one single channel on the rigs.). We already have vents. But more can be identified as I keep working on this to see if it is even something pursuing.
Going to sit with management later to see if they can see any value in the idea.
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PotatoMedic
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I'm also trying to see what other ways can we safely do emergent CCT transports with providers who have no critical care knowledge.
fm_emt
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This is something we're working on but there are some political hurdles in the way. The plan is to have a fly car with a CCP that can hop onto an ALS truck if a transfer comes out.
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A couple of private non-911 companies do something similar here in Sacramento. Mostly what they do is staff/stock a fly-car with the CCT "stuff" and when a CCT call is requested, they can send whatever unit (BLS or ALS) is closest and simultaneously send the fly-car to wherever the need is. Most companies just simply have a dedicated CCT unit as the call volume is there. The ultimate back-up CCT is calling 911 and sending (usually) an ED RN or an ICU RN along. Those units basically share patient care, leaving the RN to manage the vent/meds that are outside the medic's scope. The 911 units hate those runs but they do them because they know it's about the patient and the run is very time-sensitive or they wouldn't have been called and nobody else was available.
So right now it's just a CCT ambulance. I carry 6 Sapphire pumps, a Hamilton T1, and a box with Roc/versed when I have that truck. It's IFT purposes only, unfortunately I can't use any of that stuff for 911.
The longer term goal from what it sounds like right now is a SUV that will have blood, ultrasound, RSI, and the stuff mentioned above. They'll be used similar to how supervisors are now as well as meeting with an ambulance for CCT IFT. I'm sure there are plenty of other details I'm forgetting, but this is the broad concept I've heard so far.
FiremanMike
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How are you going to staff if? Don’t you need an RN on board for it to be a micu?
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PotatoMedic
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Single medic fly car. Every state is different. We also would probably continue doing them under the emergency statute we have been but now with a CCT medic and regular medic in the back.
DesertMedic66
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Different states have different rules for what constitutes a CCT/MICU. In some areas that role can be filled by a CCT trained/certified paramedic while others require a RN.
At my agency, all ambulances are setup for 911 or cc transfers. All of our supervisors and 3/4 of our medics have critical care certs. They will swap out or ride in with the ambulance medic if it is a critical care patient (911 or transfer) and a regular medic, or ride in for extra help. Overall works well.