CCT, RT, ALS, AMI, Hospital, or IFT?

[STXmedic]

Have you ever worked on a CCT unit? Ever transported a patient that required a vent and multiple medication infusions?

Now if by IFT medics, you're referring to just doing dialysis patients and discharges, yes I agree.

 

[Rykielz]

When I was an EMT, yes I did CCT with a nurse for a little less than a year. I saw some really sick patients, some were on vents, and some just needed monitoring. But there was never a sense of urgency. I think there's just a difference in opinion here.

 

[Futuremedic73]

Which to choose?

If you are in so cal it sounds like the same company that just offered me a job, I agree you should start slow and learn how to truly do the job.

 

[JPINFV]

When I was an EMT, yes I did CCT with a nurse for a little less than a year. I saw some really sick patients, some were on vents, and some just needed monitoring. But there was never a sense of urgency. I think there's just a difference in opinion here.

I find that generally when there's a "sense of urgency," it's because the provider is unable to provide the necessary care. Being unable to provide the necessary care and having the patient be in an emergent situation is not necessarily the same thing.

 

[STXmedic]

I've done both 911 and IFT with CCT as a paramedic (never had RNs transport my patients). I actually did them consecutively for a while. I always learned a lot more, and had to dig deeper into my own knowledge during my CCT calls. Most of the sickest patients I've encountered have been during CCT transports, too. They definitely made me have to stay sharp and on top of my game.

To echo what JP said, "Oh :censored::censored::censored::censored:" moments seem much more often to be provider insecurity and failure to have control over the situation than actual patient conditions.

 

[Flight-LP]

I run about 8-9 calls in a 12 hour shift. Most nights I get at least one critical call. Whether that be a GSW, stabbing, full arrest, etc. Those calls are stressful because you need to act quickly. I think we can both agree than an IFT medic is not going to be nearly as fine-tuned as a medic who runs 9-1-1 only. There's a huge difference between the two.

No, I do not remotely agree with your opinion. GSW and stabbing patients are simple, control bleeding and get to a surgeon. Period.

Cardiac arrests are also somewhat simplistic. You follow an etched in your mind algorithm. If it is successful, you get ROSC and an opportunity to transport them for post integrated cardiac care. If its not successful, they remain dead, you record the time and make the needed notifications, and then go back in service.

A well trained and educated critical care medic will run circles around the typical 911 medic when it comes to practicing medicine and integration within the healthcare system.

Regardless, the OP is inquiring about exposure and experience surrounding her first employment opportunity as a medic. She will blossom and develop from learning the medicine, the adrenaline is natural, no additional learning required as the body will perform that task involuntarily. Lol

 

[Flight-LP]

If the 911 experience is not needed or emphasized why do a lot of HEMS companies in Cali require 2-5 years in a busy 911 system?

You kinda answered your own question. "HEMS companies in CALI". Just as the state is behind in EMS, their HEMS programs that utilize medics aren't on the cutting edge of medicine either. Even in my program, we have had obstacles getting guidelines consistent with our mission need and commensurate with local standards. It was a huge culture shock for them to come into Texas. The 911 emergency experience is a "make CAMTS happy" thing. Professional and safety culture minded programs place little on the medics ability in comparison to personality and character traits.

Now I'm not saying that 911 experience is the devil, I just hate see folks overemphasize a small demographic of medicine that does not make a complete rounded and well educated individual.

 

[Rykielz]

You kinda answered your own question. "HEMS companies in CALI". Just as the state is behind in EMS, their HEMS programs that utilize medics aren't on the cutting edge of medicine either. Even in my program, we have had obstacles getting guidelines consistent with our mission need and commensurate with local standards. It was a huge culture shock for them to come into Texas. The 911 emergency experience is a "make CAMTS happy" thing. Professional and safety culture minded programs place little on the medics ability in comparison to personality and character traits.

Now I'm not saying that 911 experience is the devil, I just hate see folks overemphasize a small demographic of medicine that does not make a complete rounded and well educated individual.

California EMS is a lot different from Texas is what you're saying correct? In Southern California we do not have a CCT Paramedic level. CCT is strictly an RN, 2 EMT's and sometimes an RT. CCT also will not transport a patient that is considered "unfit for transport." So if they're likely to code enroute, they're staying at the hospital. I agree 100% when you say Cali is far behind in their EMS system compared to other states because we are, without a doubt. Is CCT in Texas more intense than their 9-1-1? I believe you when you say it is. But where I'm from it is not the same. 9-1-1 is where you're going to get the most emergent calls. So I personally believe someone who wants to work in emergency medicine needs to be exposed to these stressful situations. Do they sink or float? Not everyone can do this job because it requires a quick thought process and you need to make decisions without questioning yourself. A good 9-1-1 EMS worker can do this, and if they can't they'll be weeded out. Not the case in California if you're doing IFT's. you could train a monkey to do that job.

 

[JPINFV]

CCT also will not transport a patient that is considered "unfit for transport." So if they're likely to code enroute, they're staying at the hospital.

Emergent CCTs occur all the time, especially if the patient is at a hospital that is unable to provide the level of care that the patient needs.

Not the case in California if you're doing IFT's. you could train a monkey to do that job.

Except in OC the IFT emergency calls are much more stressful for EMTs than 911 emergency calls. You know... since the IFT EMTs don't have a paramedic on scene to make their decisions for them.

 

[Rykielz]

Emergent CCTs occur all the time, especially if the patient is at a hospital that is unable to provide the level of care that the patient needs.


Except in OC the IFT emergency calls are much more stressful for EMTs than 911 emergency calls. You know... since the IFT EMTs don't have a paramedic on scene to make their decisions for them.

1) Sure. Does the facility lack a cath lab? Ya they'll be going asap. That's
the only circumstance that I can think of where you might transport
without the patient being somewhat stable. And even then you'll be
having a lot of bodies hopping on board. This is an AMI transfer which in
LA and OC require "transport teams." Basically meaning 3-4 people
that're above the EMT level hop on board to treat the patient. Which
means you'll likely just be there for the ride and to watch. Stressful? I
don't think so, you're not doing ANYTHING. Compare that to 9-1-1 where
you get an AMI. Who's in the back? Just you and the medic.

2) IFT emergency calls? Like going to a SNF for a routine transfer and the
patient's dead? Nurse says, "Not my patient." Ya that happens
occasionally. But not nearly often enough to say it is overall more
stressful than 9-1-1. You want experience? Do 9-1-1.

 

[Veneficus]

You want experience? Do 9-1-1.

:rofl:

There are not any more sick patients in 911 than in IFT.

I always love these "My d*** is bigger than yours because I work 911" discussions.

Using the AMI example, what does 911 do for them?

Put on some oxygen that has no or harmful effect?

Perhaps they administer some nitro in order to try to differentiate from angina?

Administer some aspirin? If the patient watch tv and do it themselves. (of course most nursing homes will do this too)

Perform a 12 lead and then cath the patient based on its results? Wait...Nope, they just run the diagnostic.

and... Drive the patient to the hospital, just like IFT.

Infact there is nothing in this example that 911 does that IFT doesn't. IFT may even transport to the proper facility because they have to. Unlike 911 who has a far greater chance to go to the closest inappropriate facility.

I can see where taking a patient to a place that cannot help would be stressful though.

Let's talk about sicker patients?

Major trauma, control bleeding and drive to the hospital...

Stragely enough people do this without EMS all the time. What makes this sstressful?

Sepsis? Do you start the patient on antibiotics? Which ones? Oh wait...You don't.

If you realize they are septic at all and not just "some BS sick person who doesn't need an ambulance."

Perhaps you start your dopamine drip after the initial fluid bolus fails? (The only services I have ever seen or personally hung dopamine myself are rural services, how often do they do that in LA?)

Maybe the person is dead and you show up after 8 minutes and start trying to resuscitate, with your ET tubes and epi, and all that crap?

Curiously, what do you do for an OD in 911 of a common medication like atenolol?

How about a patient that missed dialysis? Do you drive them to a hospital that has a dialysis machine? Do you even know which hospitals in your area do?

Now then...

The truth is that 911 is really just a routine job, maybe it takes a few years to get in the routine, but hae you ever seen a "high performance" 911 system?

They talk about how many calls they run a day, but they do the exact same thing for every call. Which means, in a year or so, the excitement will fade and you will be eating your lunch on the way to the next "emergency."

Life on the edge...

You want experience? Work in a hospital.

 

[Amberlamps916]

:rofl:

There are not any more sick patients in 911 than in IFT.

I always love these "My d*** is bigger than yours because I work 911" discussions.

Using the AMI example, what does 911 do for them?

Put on some oxygen that has no or harmful effect?

Perhaps they administer some nitro in order to try to differentiate from angina?

Administer some aspirin? If the patient watch tv and do it themselves. (of course most nursing homes will do this too)

Perform a 12 lead and then cath the patient based on its results? Wait...Nope, they just run the diagnostic.

and... Drive the patient to the hospital, just like IFT.

Infact there is nothing in this example that 911 does that IFT doesn't. IFT may even transport to the proper facility because they have to. Unlike 911 who has a far greater chance to go to the closest inappropriate facility.

I can see where taking a patient to a place that cannot help would be stressful though.

Let's talk about sicker patients?

Major trauma, control bleeding and drive to the hospital...

Stragely enough people do this without EMS all the time. What makes this sstressful?

Sepsis? Do you start the patient on antibiotics? Which ones? Oh wait...You don't.

If you realize they are septic at all and not just "some BS sick person who doesn't need an ambulance."

Perhaps you start your dopamine drip after the initial fluid bolus fails? (The only services I have ever seen or personally hung dopamine myself are rural services, how often do they do that in LA?)

Maybe the person is dead and you show up after 8 minutes and start trying to resuscitate, with your ET tubes and epi, and all that crap?

Curiously, what do you do for an OD in 911 of a common medication like atenolol?

How about a patient that missed dialysis? Do you drive them to a hospital that has a dialysis machine? Do you even know which hospitals in your area do?

Now then...

The truth is that 911 is really just a routine job, maybe it takes a few years to get in the routine, but hae you ever seen a "high performance" 911 system?

They talk about how many calls they run a day, but they do the exact same thing for every call. Which means, in a year or so, the excitement will fade and you will be eating your lunch on the way to the next "emergency."

Life on the edge...

You want experience? Work in a hospital.

Inexplicable truth. Ideally many would see this as a warning not to get too caught up in the flashy lights and sirens, fireman pants, extremely archaic and ancient treatments and procedures based on uncontested traditions and continue the debate of "I'm more awesome because I put Mrs. Schmeigelstein on a monitor and hung an IV going code 3" nonsense. C'mon people, strive to be better than this.

 

[Handsome Robb]

ALS can be a lot of different things. If your an EMT you will more then likely be the driver with not much else to do.

Not necessarily true. Very system dependent. Our workload is split about 50/50. Sme days all I do is drive and others all I do is attend. Just luck of the draw.

My partner is an intermediate though so he can do a little more and take more patients from me.

You'll have more of an opportunity to learn on an ALS or CCT rig depending on the crew you're with and you will see sicker patients. Helps learn "sick vs. not sick".

I'd say put CCT as one and ALS as two but that's just me.

FWIW unless dictated by policy most of the medics I know rarely transport code 3. It doesn't make that big of a difference and makes our job in the back much harder. Especially if the driver is too excited.

 

[JPINFV]

1) Sure. Does the facility lack a cath lab? Ya they'll be going asap. That's
the only circumstance that I can think of where you might transport
without the patient being somewhat stable. And even then you'll be
having a lot of bodies hopping on board. This is an AMI transfer which in
LA and OC require "transport teams." Basically meaning 3-4 people
that're above the EMT level hop on board to treat the patient. Which
means you'll likely just be there for the ride and to watch. Stressful? I
don't think so, you're not doing ANYTHING. Compare that to 9-1-1 where
you get an AMI. Who's in the back? Just you and the medic.

Also traumas and OB at non-OB hospitals, and pediatrics/neo-nates at non-specialty hospitals (unless you think that 27 week premi that's intubated and in an incubator is the picture of stable health), and any other time that the hospital can't meet the needs of the patient.

All transports require a transport team. You aren't going to throw a patient into the back of an ambulance with no one else back there. Now if that means that an RN and/or a RT and/or a physician needs to come along (either from one of the facilities or the transport company), then yes. The problem is that in those situations, the only reason an EMT is along for the ride is because county policy requires it... not because they add anything useful. Regardless, though, a lot can be learned during CCTs by EMTs.

2) IFT emergency calls? Like going to a SNF for a routine transfer and the
patient's dead? Nurse says, "Not my patient." Ya that happens
occasionally. But not nearly often enough to say it is overall more
stressful than 9-1-1. You want experience? Do 9-1-1.

Like the SNF is sending the patient to the emergency room for anything from a fall 2 hours ago to abnormal labs to acute pulmonary edema or altered mental status and they don't feel like calling 911. I had more serious patients on my 3 days of field training back when I worked for Lynch than the 16 hours I had ride along with Care (8 on Fullerton 5, 8 on the Buena Park unit just north of Knotts).

If you think 911 is just emergencies and not "I've got anxiety because my boss is yelling at me," "I fell off a ladder... but paramedics did 99% of everything prior to the ambulance arriving," "My doctor told me to go to the hospital, and I don't know of any other way besides calling 911" (little old lady in no acute distress), and a "I'm on a bike that got hit by a car going 2 mph leaving a parking lot, can I sign AMA?" (also mostly handled prior to arrival, but one of the crew members was able tot translate Spanish for the paramedic), then you aren't working as an EMT in OC or LA.

 

[Handsome Robb]

I run about 8-9 calls in a 12 hour shift. Most nights I get at least one critical call. Whether that be a GSW, stabbing, full arrest, etc. Those calls are stressful because you need to act quickly. I think we can both agree than an IFT medic is not going to be nearly as fine-tuned as a medic who runs 9-1-1 only. There's a huge difference between the two.

Really? Do you just scoop and run? Is that how you think EMS is supposed to work? :unsure: OmG hE's gOnNa DiE!!! DrIvE fAsT!!!!!!!!

I agree there's a difference between IFT and 911 but saying a 911 medic is better than an IFT medic is absolutely asinine.

Apparently you've never taken a vented patient with bilateral chest tubes that got homeboy life support to the bandaid station after getting shot in the chest and now needs an emergent transfer to the Trauma Center on the other side of town to meet the trauma surgeon and their team...yup did that one alone in the box...but it was an IFT so it wasn't stressful at all since they stabilized him... -_-

Unstable patients are never transferred out my ***. You can fix numbers all you want but until they receive the necessary definitive care nothing any facility is going to do will "stabilize" them completely.

What about the guy I took from the cath lab at a small PCI capable facility to the "big house" for a CABG who was intubated, on a IABP and multiple pressors? Was he stable? Not one bit. Granted I got a nurse for that one since we can't attend a patient on an IABP here but still not an easy transfer for me and that nurse to handle with the two of us in the back.

How about the guy with a TBI and massive IC bleed who's circling the drain and being emergently transferred to a facility capable of neurosurgery? Yup did that one with only me in the back.

How about the intubated post-arrest pedi transfer I took from the satellite hospital to the PICU at the main campus? Did that alone to.

IFT patients are never sick my ***. You apparently weren't paying too close of attention when you worked on that CCT rig or were just to ignorant to realize the gravity of the situations you and your team were being put in.

One day per week during my internship we were the ALS transfer car. I learned so much on those days, a lot more than sitting on a street corner on a slow day in the 911 system.

Before you start bantering at me I work primarily 911 but we do BLS-CCT IFTs as well seeing as we're the only ambulance service in the county.

Sure lots of IFT calls are routine but to say that you can't get good experience or learn from working IFT is ridiculous and frankly very conceited to say. Ever take time to read the H&P of the IFT patient you're taking? Lots of those patients are extremely sick.

Best thing I was ever told by a 20 year 911 Paramedic the first day after clearing my FTO time as an Intermediate was "This job is 99% bull:censored::censored::censored::censored:, 1% oh :censored::censored::censored::censored:."

Just because you work 911 doesn't make you god. Ever heard the term "Paragod"? It's not a label you want attached to you.

I highly doubt your average 1 "critical" patient per shift you talked about are truly as critical as you really think they are, judging from some of your other posts.

 

[Veneficus]

You can fix numbers all you want but until they receive the necessary definitive care nothing any facility is going to do will "stabilize" them completely.

There is hope...

At least one person has caught on to this...

 

[shfd739]

Really? Do you just scoop and run? Is that how you think EMS is supposed to work? :unsure: OmG hE's gOnNa DiE!!! DrIvE fAsT!!!!!!!!

I agree there's a difference between IFT and 911 but saying a 911 medic is better than an IFT medic is absolutely asinine.

Apparently you've never taken a vented patient with bilateral chest tubes that got homeboy life support to the bandaid station after getting shot in the chest and now needs an emergent transfer to the Trauma Center on the other side of town to meet the trauma surgeon and their team...yup did that one alone in the box...but it was an IFT so it wasn't stressful at all since they stabilized him... -_-

Unstable patients are never transferred out my ***. You can fix numbers all you want but until they receive the necessary definitive care nothing any facility is going to do will "stabilize" them completely.

What about the guy I took from the cath lab at a small PCI capable facility to the "big house" for a CABG who was intubated, on a IABP and multiple pressors? Was he stable? Not one bit. Granted I got a nurse for that one since we can't attend a patient on an IABP here but still not an easy transfer for me and that nurse to handle with the two of us in the back.

How about the guy with a TBI and massive IC bleed who's circling the drain and being emergently transferred to a facility capable of neurosurgery? Yup did that one with only me in the back.

How about the intubated post-arrest pedi transfer I took from the satellite hospital to the PICU at the main campus? Did that alone to.

IFT patients are never sick my ***. You apparently weren't paying too close of attention when you worked on that CCT rig or were just to ignorant to realize the gravity of the situations you and your team were being put in.

One day per week during my internship we were the ALS transfer car. I learned so much on those days, a lot more than sitting on a street corner on a slow day in the 911 system.

Before you start bantering at me I work primarily 911 but we do BLS-CCT IFTs as well seeing as we're the only ambulance service in the county.

Sure lots of IFT calls are routine but to say that you can't get good experience or learn from working IFT is ridiculous and frankly very conceited to say. Ever take time to read the H&P of the IFT patient you're taking? Lots of those patients are extremely sick.

Best thing I was ever told by a 20 year 911 Paramedic the first day after clearing my FTO time as an Intermediate was "This job is 99% bull:censored::censored::censored::censored:, 1% oh :censored::censored::censored::censored:."

Just because you work 911 doesn't make you god. Ever heard the term "Paragod"? It's not a label you want attached to you.

I highly doubt your average 1 "critical" patient per shift you talked about are truly as critical as you really think they are, judging from some of your other posts.

You beat me to this. It's to the point id rather do CCT calls because they are so sick

.my CCT patients are sicker than 95-100% of my 911 patients any given shift.

The above mentioned CCT examples are nearly every shift for our CCT units and they are much more difficult than 911 calls.

 

[Handsome Robb]

There is hope...

At least one person has caught on to this...

Only learn from the best. Despite popular belief I am paying attention over here. Thought about citing you in it but I figured you'd cite yourself eventually.

You beat me to this. It's to the point id rather do CCT calls because they are so sick

.my CCT patients are sicker than 95-100% of my 911 patients any given shift.

The above mentioned CCT examples are nearly every shift for our CCT units and they are much more difficult than 911 calls.

I'm taking all of the above calls as a "regular" solo medic so they technically can't be called or billed as a CCT. I'm not a CC-P yet. Haven't held a class here for a couple years. They told me it was supposed to happen last fall but didn't now they said this spring/summer. We will see if it really happens.

Most of our IFTs aren't as bad as the ones I described above but it isn't unheard of to go code 3 to one of our smaller hospitals, walk in, have staff waiting to slide them over, hook 'em up while I set up my janky little vent, give me a report then give us a slap on the *** and a "drive like the wind, turbo".

Generally will have a 911 call from a SNF with a vented patient or taking one back to the SNF 2-4 times per week.

 

[shfd739]

Only learn from the best. Despite popular belief I am paying attention over here. Thought about citing you in it but I figured you'd cite yourself eventually.



I'm taking all of the above calls as a "regular" solo medic so they technically can't be called or billed as a CCT. I'm not a CC-P yet. Haven't held a class here for a couple years. They told me it was supposed to happen last fall but didn't now they said this spring/summer. We will see if it really happens.

Most of our IFTs aren't as bad as the ones I described above but it isn't unheard of to go code 3 to one of our smaller hospitals, walk in, have staff waiting to slide them over, hook 'em up while I set up my janky little vent, give me a report then give us a slap on the *** and a "drive like the wind, turbo".

Generally will have a 911 call from a SNF with a vented patient or taking one back to the SNF 2-4 times per week.

We do the SNF thing regular too.

Those run like the wind to the next hospital, on a vent, on multiple meds etc happen to us on average once a shift. Sometimes more, sometimes less.

Worse when the local HEMS is grounded due to weather. Then we go 3+ hours away to pick up then return.

I did the same calls as a non CCT medic for years because i was the only one on our day shift willing to do them. I feel ya lol.

 

[Handsome Robb]

We do the SNF thing regular too.

Those run like the wind to the next hospital, on a vent, on multiple meds etc happen to us on average once a shift. Sometimes more, sometimes less.

Worse when the local HEMS is grounded due to weather. Then we go 3+ hours away to pick up then return.

I did the same calls as a non CCT medic for years because i was the only one on our day shift willing to do them. I feel ya lol.

It's not that I choose to do them, they get assigned and there isn't anything you can do about it. I just have this giant black cloud and tend to get the really sick ones.

Occasionally you'll get one of our flight crews in a ground ambulance but that's pretty rare. We do have CC-Ps roaming around with pumps and wider protocols as far as ITTs (In Town Transfers, basically our version of a CCT) go.