Flight Medic process?

[Akulahawk]

I'm intricately familiar with the process (lets leave it at that)

3 years is usually the minimum, however this has to be in a system that is forward thinking protocol wise, progressive, and BUSY! It is usually good to see medics coming from systems with longer than 5-10 minute transports because those transports dont require much beyond the basics of the protocols.

Usually CCEMTP and FPC are NOT at all required before hiring. It would be nearly impossible to pass the FPC without flight experience (although some have done it).

The rest of the alphabet soup is ACLS, PALS, PHTLS/ITLS/BTLS, NRP, AMLS.

To make yourself ACTUALLY competitive you need all of the above plus instructor certs in the above classes.

THEN it comes down to who you know, the reputation that you've made for yourself in EMS and anything that you've published in the trade mags/journals. Most programs like to see a BA/BS with advanced science courses.

For most programs, the nurses and paramedics are expected to know the exact same things. For a paramedic, this is much more of a learning jump (from initial training) to get a grasp on the complex pathophys, acid/base, med tech, and everything else that is required on a high complexity team.

I'd expect that this is more the norm... and done right, at some point, the difference between the two provides becomes more a legal one than a knowledge/education one...

 

[VentMedic]

Vent: I'll respond inline, and in red, for clarity.

This one, I'll throw back at you: Vent, do you consider yourself experienced enough, even after many years as an RRT and a Paramedic, to manage high acuity CCT patients as well as an experienced critical care RN? How long did it take for you to get to that point? What would you consider to be "experienced" for purposes of this exercise? 2 years? 15 years? 30 years? I'm well aware that there are meds and equipment that even an "Expanded Scope" Paramedic is not allowed to work with. Appropriate education would (eventually) change that. An experienced Med/Surg RN would not do too well if simply dropped into an ICU and told to have at it.

I'd expect that this is more the norm... and done right, at some point, the difference between the two provides becomes more a legal one than a knowledge/education one...

I do have the advantage to have several thousand hours of ICU experience for all ages with neo/peds being my specialty. However, as a Paramedic I am not allowed to do what either an RN or an RRT can do to the fullest extent of their scope of practice. Thus, as a Paramedic that is not even an argument as to whether I am better than an RN who has several years of experience as an ICU RN. I am very comfortable managing most ICU patients but I am not so stupid to have my ego blind me from seeing how valuable an RN is to a transport situation.

Right now FL is in the process of changing its statutes for neonatal transport with an increase in hours of neonatal experience for the Paramedic from 2000 to 5000 hours. 2000 hours was almost impossible to get or some found that those claiming to have 2000 hours needed more than 2x more experience.

Any Paramedic who believes they know more than a critical care RN while having never worked in an ICU is a fool. You can learn some of the academic stuff like acid/base but until you actually have experience in critical care, the difference will be much more than just the title or legalities. These Paramedics who make such a claim are usually the ones who know the least but believe what they have seen on transport of a few critical care patients is all there is to critical care medicine.

On a related note: I would hope that the RN that is told to accompany a patient on an ambulance is covered for medical liability by his/her employer while out on the ambulance to the same degree that is provided while working in the hospital.

They are covered still by the hospital but it is a very uncomfortable feeling to know that the ambulance is not equiped with the needed medications for some transports and if the hospital doesn't have a premade bag to accompany an RN on a spur of the moment transport, it becomes a questionable task of what can be carried in one's pocket. Not a good situation. If I am also accompanying as an RRT, I have now made a habit of taking at least an airway bag since I can not always depend on what the truck has or the abilities of the Paramedic. Some hospitals do have a CCT bag for our RNs to accompany the patient since this is a common occurence especially in California. While much of CA has CCTs with RNs, there are occasions for a STEMI to be transported further than the "nearest hospital" which unfortunately where some EMS agencies must still take a patient.

 

[Akulahawk]

My responses inline...

I do have the advantage to have several thousand hours of ICU experience for all ages with neo/peds being my specialty. However, as a Paramedic I am not allowed to do what either an RN or an RRT can do to the fullest extent of their scope of practice. Thus, as a Paramedic that is not even an argument as to whether I am better than an RN who has several years of experience as an ICU RN. I am very comfortable managing most ICU patients but I am not so stupid to have my ego blind me from seeing how valuable an RN is to a transport situation.
My question wasn't about whether or not you could legally provide the same level of care, it was whether or not you felt that you COULD provide the same level of care, as in remove the legal distinction and scope of practice limitations and then do you feel you could provide adequate management of ICU patients as effectively as an experienced ICU RN. That was what I was asking.
Right now FL is in the process of changing its statutes for neonatal transport with an increase in hours of neonatal experience for the Paramedic from 2000 to 5000 hours. 2000 hours was almost impossible to get or some found that those claiming to have 2000 hours needed more than 2x more experience.
So I take it that Florida is essentially making it about as difficult as possible for a Paramedic to be able to do neonatal transports by increasing the required hours from 2000 to 5000, knowing that 2000 hours is almost impossible to get, because some people who claim 2000 hours needed twice the hours? Out of curiosity, how many hours of neonatal experience is needed by an RN, who is fresh out of RN school, to eventually be able to do neonatal transports?
Any Paramedic who believes they know more than a critical care RN while having never worked in an ICU is a fool. You can learn some of the academic stuff like acid/base but until you actually have experience in critical care, the difference will be much more than just the title or legalities. These Paramedics who make such a claim are usually the ones who know the least but believe what they have seen on transport of a few critical care patients is all there is to critical care medicine.
I do not profess to know more about ICU level care than a Critical Care RN. I do, however, know more about certain areas of medicine than a CCRN or CEN does. The reason for this is simple: my education in those areas is well out of their realm of education. On the other hand, their education in what they do is beyond what I have currently. I certainly respect their expertise.

They are covered still by the hospital but it is a very uncomfortable feeling to know that the ambulance is not equipped with the needed medications for some transports and if the hospital doesn't have a premade bag to accompany an RN on a spur of the moment transport, it becomes a questionable task of what can be carried in one's pocket. Not a good situation.
If the ambulance doesn't have the necessary equipment/meds, there's no transport bag available, and you can only fit so much meds in your pockets and you find that don't have what you need during transport, who then bears the liability? You're darned right that's not a good situation! I think your solution is a good one... make your own kit, tailored to what you need.
If I am also accompanying as an RRT, I have now made a habit of taking at least an airway bag since I can not always depend on what the truck has or the abilities of the Paramedic. Some hospitals do have a CCT bag for our RNs to accompany the patient since this is a common occurrence especially in California. While much of CA has CCTs with RNs, there are occasions for a STEMI to be transported further than the "nearest hospital" which unfortunately where some EMS agencies must still take a patient.
And those STEMI patients, well, they get to wait in an ED that does not have access to a Cath Lab, while an appropriate transfer is worked out... all because that County's EMS system hasn't figured out that for STEMI, the closest facility isn't always the most appropriate one...

 

[Rob123]

Candidates for Flight Paramedic should be prepared for the position by meeting the following criteria:
<snipped>
• Must maintain a duty weight of less than 205 lbs. (body weight plus uniform and equipment).

Off topic... or is it back on topic
I'm pretty tall and don't show my weight.
But I guess it's time for me to hit the gym. :blush:

 

[Jersey]

Knowing Vent's knowledge from another flight specific forum, I'd be careful about questioning his abilities as a provider

 

[akflightmedic]

Knowing Vent's knowledge from another flight specific forum, I'd be careful about questioning his abilities as a provider

HER abilities...

 

[Jersey]

Vent, my apologies. I owe you a beer if you're ever in the area!

 

[fire_911medic]

LOL @ Jersey - I'd worry about having to buy Vent a whole case for calling her a him!

There are several here with good resources and I don't think this was meant to go into a RN vs RRT vs Medic discussion and unfortunately I think that's the direction it ended up going. I'm not that familiar with Cali's requirements as I know they operate much differently than where I am based which is exclusively RN/Medic config with clearly defined roles for each and complimenting each other in certain areas. An ICU nurse can be a wealth of resource for meds that are not commonly seen within the prehospital environment. If I'm not familiar with it - I'd be glad to be partnered with one who does. The course that most utilize to get ground medics to flight intro level is the CCT course which is not that long and basically gives a rough overview of things you're going to see. It's up to the individual medic to educate themself further and get a solid understanding of things if they plan to be competitive in the flight environment. However, their comfort zone is prehospital and especially airway and that being said, it is of definite benefit to have that to a program. Considering the majority of air services are IFT's with about a 70 IFT/30 Scene split (more or less depending on individual base) I think the push in the future will be more towards a better rounded medic if they are to remain in this environment. And as to the comment of should we require medics to do time in the ICU - YES ! And it is part of the required rotations for flight programs in this area in addition to others for that very reason. Both have their place and can adapt to the environment - I think it's unfair to play a "this is better than that"

 

[VentMedic]

My responses inline...

So I take it that Florida is essentially making it about as difficult as possible for a Paramedic to be able to do neonatal transports by increasing the required hours from 2000 to 5000, knowing that 2000 hours is almost impossible to get, because some people who claim 2000 hours needed twice the hours? Out of curiosity, how many hours of neonatal experience is needed by an RN, who is fresh out of RN school, to eventually be able to do neonatal transports?

It would be very rare for a new grad RN or RRT to get into a neonatal unit right away. Some may require a minimum of 2 years of general experience before applying to a specialty unit. Once they are accepted into a specialty unit like NICU, they will have to work 3 - 5 years before being eligible to apply or "invited" to apply to the Specialty Transport team. Once on the team they will spend another year in the classroom and the labs perfecting their skills and knowledge under the watchful eyes of the medical director and other neonatologists. This will also be done while still working in the NICU. Once they have met the requirements they will then do several transports with a preceptor until they are approved by the medical director to become a full team member. Specialty Teams don't just go across town for a sick baby but may go to another country for a long distance transport.

To answer your question, for "hours", you may be talking around 10,000 hours with numerous patient contacts per shift. RNs in the NICU will take care of 2 - 3 patients for 8 - 12 hours. If they have med-surg experience either adult or pedi, they may have 5 - 10 patients per shift for 8 - 12 hours. Thus, if you add up actual patients and the number of contact hours, you may find that 10,000 is a low number for most RNs (and RRTs) on these teams.

 

[VentMedic]

Vent, my apologies. I owe you a beer if you're ever in the area!

Thank you. However, I'm retiring to Sonoma and have advanced to "fine wine". I've been practicing for many years to hold a wine glass gracefully by intubating neonates.

 

[Akulahawk]

Thank you, Vent. That very much easily answers my question. Is Florida using contact hours or simply hours spent on shift, on the floor? The reason I ask is because if you're multiplying the patients by the hours on the floor, a 10 hour shift with 8 patients = 80 contact hours, where you've been on the clock only actually 10 hours (probably feels like 80 at times though). Which way is Florida doing the calculations?