Flight Paramedic, Ask Me Anything

Our term for that is anesthesiologist.
 
Who makes the decision where you land? In my area all of a sudden the local HEMS is refusing to land at the top of a mountain pass (6800') because the spot isn't big enough: 2 years ago they had 2 3,000 drop tanks, up to 3 tankers (2 semi tankers) an engine filling helicopters and when I drove by 3 helicopters on the ground getting filled at the same time. But there is not enough room to land there.

They told one of our crews to take the patient (on another run) to the local airport (55 miles from us through stupid traffic and roads: the crew had the patient on the ambulance for over 100 minutes; if they would have gone the other way to the Level I it would have taken less than 90 minutes to get to the hospital.

They are now wanting to come to us to land at our helipad; but that can mean we are sitting and waiting up to 30-40 minutes for them to come. I hate that, and if I get told that I will disregard them and ground transport.
 
johnrsemt said:
Who makes the decision where you land? In my area all of a sudden the local HEMS is refusing to land at the top of a mountain pass (6800') because the spot isn't big enough: 2 years ago they had 2 3,000 drop tanks, up to 3 tankers (2 semi tankers) an engine filling helicopters and when I drove by 3 helicopters on the ground getting filled at the same time. But there is not enough room to land there.

They told one of our crews to take the patient (on another run) to the local airport (55 miles from us through stupid traffic and roads: the crew had the patient on the ambulance for over 100 minutes; if they would have gone the other way to the Level I it would have taken less than 90 minutes to get to the hospital.

They are now wanting to come to us to land at our helipad; but that can mean we are sitting and waiting up to 30-40 minutes for them to come. I hate that, and if I get told that I will disregard them and ground transport.
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The pilot will make the final decision. HEMS is getting more strict on landing zones due to safety. The accreditation programs and FAA are also creating stricter rules focusing on safety. A lot of the small-town helipads around here have been shut down recently due to them not meeting new(er) requirements. At the end just remember that they are refusing to do specific things for a good/legit reason.
 
I'm not very familiar with the CCP-f of cfcp or whatever it is (I'm not american). Can you get a little more into the education across the board in the USA for this (or is it state dependent). How long is it? Clinical time? Do you think it's adequate? The future?
 
blindsideflank said:
I'm not very familiar with the CCP-f of cfcp or whatever it is (I'm not american). Can you get a little more into the education across the board in the USA for this (or is it state dependent). How long is it? Clinical time? Do you think it's adequate? The future?
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CCP-C and FP-C are credentialing exams that anyone can take. They are developed and administered by the Board for Critical Care Transport Paramedic Certification (BCCTPC), which is an offshoot of the old (technically a separate organization, but in reality basically just the examination validation and administration arm) of the International Association of Flight & Critical Care Paramedics, which until fairly recently was just the International Association of Flight Paramedics, and before that (way back in the stone age, when I first joined and was one of the first Certified Flight Paramedics, before the BCCTPC came about) was the National Flight Paramedic's Association.

Anyway, the exam processes neither provide or require any particular education or experience beyond your basic paramedic credential. You simply sign up for the exam, study for it using one of the commercially-available cram programs, and take the test.

There are several critical care educational programs that are intended primarily for paramedics, by far the most well-known of which is the Critical Care Emergency Medical Transport Program (CCEMTP), which is an 80-hour course developed by the University of Maryland in Baltimore County and taught under license at locations all over the country. Other programs are taught by Creighton University and the University of Florida. Cleveland Clinic has a program as well. IME the quality of the CCEMTP program varies widely depending on where and by whom it is taught, and I have no experience with but have heard good things about all the others. There are others out there but these are the only "nationally recognized" ones that I am aware of.

Many paramedics take one of the aforementioned courses as part of their preparation for the FP-C or CCP-C exams, but again, they are not required.
 
What is the interview process like? And also, what tests do you have to go through to show that you're compentent enough in your skills and knowledge? Do you test in front of MDs and given a scenerio where you have to explain what you would do?
 
cointosser13 said:
What is the interview process like? And also, what tests do you have to go through to show that you're compentent enough in your skills and knowledge? Do you test in front of MDs and given a scenerio where you have to explain what you would do?
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The process of getting hired where I work is very intense. Please remember this is where I work and it may differ elsewhere. It should give you an idea tho.

The first step, after applying, is to take a multiple choice test. The questions range from BLS to Critical Care. They give the same test to everyone that applies and use the results to place you. If you place high enough you will then be granted an interview. The interview will be with the Director of Operations, Chief Flight Nurse, Medical Director (ours is a trauma surgeon), and a couple members of the flight team. If they like the test and interview results you will be offered a probationary position. After accepting the position you will be placed on probation for a month. For this month you will ride as a third medical crew member. They will also require you to complete several hours of online education, along with hands on training during this time. (This was one of the most intense months of my life.) After that month is up you will then be required to complete an Flight Readiness Review. This is a two hour "test". The Medical Director, Director of Operations, Chief Flight Nurse, and Chief Flight Paramedic will drill you. You be tested on your overall knowledge and skills... scenarios, setting up and using equipment, protocols and policies, etc. If they like what they see you will then be given the job! Yay!

For the next 6 months, to one year, you will attend multiple advanced courses and training sessions. They have timelines in place for you to complete everything. They also require you to be FP-C within two years of hire.

Don't let what I have said discourage you. The process is set up like it is for a reason. It will let you know if you are ready. If your'e ready, great! If not, you learn from the experience, fix what needs to be fixed, and reapply. They know not everyone will make it the first time through. If they see you are trying and have improved they will gladly give you another chance in the future.
 
My god. I haven't seen you in forever Dek. You going to stay around? :p And shouldn't you be enjoying your vacation right now!
 
I applaud you for volunteering to answer additional questions. I feel like Remi and I have answered the same questions, multiple times. I also commonly refer people over to Flight Web, as a lot of the topics have already been answered there as well.
 
What's the height/weight restrictions for employees? Patients?

I don't know if I'd like HEMS just because it seems like all the dirty work is done when we transfer care.. We have lines started, CATs applied, ETs inserted, RSI achieved, or we've already done our needle decompression, applied dressings..Our critters don't do extrication, everything is ready for them when they land. Do you do much care on scenes? Or is it already done?

We're lucky, my service has 5 choppers at our disposal, I probably get to do more hot loads than most.. I did my academy with the new Air Care hires -RNs and CCPs, so I spent 2 weeks in a classroom listening to our director (also a trauma surgeon) lecture and teach and Power Point about paralytics, sedatives and pain control. I couldn't help but wonder if that's the majority of their tasks? RSI and pain control? Respectfully speaking, how dirty do you actually get?
 
Height and weight restrictions will depend on the program, and typically what airframe they're flying in. My program has all Airbus H145's and former EC135's. We are limited to a height of no greater than 6 foot 2 inches, and a weight of 210lbs. Generally our program will do up to 400lbs in a EC135, depending on girth, and we just recently transported a 786lb patient in one of our H145's, which I was a part of for that transfer. Although that type of weight isn't typical, and does take some additional planning and equipment to be done safely, we do it.

On scenes it can be a bit more difficult because we don't get patient information or weight prior to landing in most cases. If we need to we can always ditch our spare seat, equipment, our second litter, and have the pilot burn fuel if we arrive on a scene and the patient is extremely obese. Factor's like summer temperatures, fuel load, and crew weight will all play into how much we can take, we brief those factors at the start of the shift, and make adjustments as needed.

As far as skills done on scene runs, it really depends on the area and services the air medical vendor is servicing. If the majority of the services are like what you described, then chances are they aren't doing much and are just a fast/expensive ride to the hospital. In the area I fly in, the ground services do not have RSI, so typically when we are called the providers are calling for that capability. They also have extended ground transport times, and we have an expanded scope and pharmacological inventory, blood and FFP on the aircraft vs. the ground services, so all of that comes into play. I have been to scenes where there is an extended extrication, or special rescue scenario (man vs. train) and we are right there in the sauce providing care, so it just depends. We also do medical scene runs, so for example we might start a Nitro infusion and titrate during transport, give Metoprolol, and start remote ischemic conditioning, where the ground service can only given SL NTG.

Before I started flying I worked for the fire department, and did critical care transport. I still work fire department part-time. With that being said, I have seen my share of scene calls, and am kinda over the "thrill and excitement" part of it, so I could really care less what we fly and go pickup. Our inter-facility transfers are generally much sicker, and require more interventions then MOST of our scene patients. There's obviously only so much you can do in trauma, they need cold steel and bright lights, neither of which we have in the aircraft.

There are a tons of remote programs that are doing central line placement, chest tube insertion, etc. Just really depends on the capabilities of the ground services, transport distances, and need for such skills. I would say we are middle of the road for skills, protocols, and transport times, compared to most programs.
 
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The question I want to know, but no one ever answers is pay. What is it? I know it'll vary area to area but ball park? More or less than ground? Pay DOE? How are raises and shifts? Do you alternate calls with the RN? You run scene calls, RN does transports? How does all of that work? Can you RSI?
Thanks in advance
 
Angel said:
The question I want to know, but no one ever answers is pay. What is it? I know it'll vary area to area but ball park? More or less than ground? Pay DOE? How are raises and shifts? Do you alternate calls with the RN? You run scene calls, RN does transports? How does all of that work? Can you RSI?
Thanks in advance
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Again, a lot of these questions are going to depend on the area you work in, so keep that in mind, however I would say pay for most places might come in around the ground services wages, or a bit less. Unfortunately the thing with most flight programs is the applicant process and pool is super competitive. Therefore they can pay people less money to do the job because a lot of people just want to fly. Why pay people 30 an hour when you have 150 applications and a lot of those people are willing to do it for 20. It's certainly not a career you are going to get rich at, but neither is ground based EMS. If pay is a factor look into Hospital Based services. They typically will pay better, and some are union base, which you can actually make a decent living on. I chose my service for multiple reasons, however because they are a top tier service, and they have that applicant pool, they don't pay well compared to other programs. When you look at my hourly salary I make less then when I graduated paramedic school, but we work 24 hour shifts, I work 8 days a month, and have built in overtime so that helps. There are also plenty of shifts where I get paid and we don't fly, or are down for weather, so I take all of that into account when I look at how much I make vs. how much I am making. I work part-time at the Fire Department to supplement. Raises are yearly, this year 4% merit based. Moral of the story if your looking at flight for money, you're doing it for the wrong reasons, and putting your safety potentially at risk to go with a higher paying program isn't always a great decision either.

As far as alternating calls I am not sure I understand what you're asking? We work as a team and tackle all calls together, and we split the patient care chart. One call I will do care (which is basically all skills/interventions, patient packaging, etc) while the RN obtained report, paperwork, etc, then we switch for the next flight. RN and Medics are equal provider's in my system, there isn't anything one person does the other can't. Our protocols are universal, and during orientation people are trained to the level that we should be able to remove our nametags and the sending facility shouldn't be able to pick out who the nurse is and who is the medic. It works well for us. Medics generally will orient with an RN, and RN's orient with medics, which does a good job in bridging the gaps in knowledge deficits. We discuss at the beginning of the shift where each provider is with intubation requirements for the quarter, that way we know who will be the first to tube if we get a mission where the patient requires intubation. All provider's are RSI qualified prior to completion of orientation, with a difficult airway course, a minimum of 12 live intubations, and 2 pediatric intubations prior to graduation, quarterly O.R. time requirements there after.
 
Angel said:
The question I want to know, but no one ever answers is pay. What is it? I know it'll vary area to area but ball park? More or less than ground? Pay DOE? How are raises and shifts? Do you alternate calls with the RN? You run scene calls, RN does transports? How does all of that work? Can you RSI?
Thanks in advance
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I am going to echo everything CANMAN said.

My wage is a little less then I made on the streets. I make more per hour but work less hours. There are not the opportunities to work work overtime like on the streets. As CANMAN said, flight services know they can pay less and still find applicants. If you don't like the wage there are 50 more people that will. As with anything EMS related, you don't do it for the money.

Every call is run as a team. At the end of training, the flight medic and the flight nurse should be able to do each other's responsibilities. Having said that, there will always be certain things that one is better at then the other due to prior experience. That is why flight services run a nurse/medic team.
 
Gotta love our flight medics who have the same exact protocols as every single ground medic.
 
Well I work because I have bills and need the check so I guess you can say I do it for the money.
Considering you do exactly the same as the nurse but get paid less does seem a but unfair but that is what I suspected.
I asked because I am considering just doing nursing but I still want to fly (eventually maybe) and am curious what the difference would be, not much from what you all are saying.

Thanks for the response.
 
What's the real attraction to flight? There are many ground services that have the same, if not better protocols, do the exact same calls and don't have the risk of the airship crashing.
Many ground CCT medics also receive excellent pay and benefits packages.

Is the just "the helicopter" that makes it attractive? I'll admit, when I was younger, the excitement of seeing Hartford Hospital LifeFlight do a scene call was pretty cool, after becoming a medic and running a large number of calls, the excitement and allure of the flight job wore off pretty quickly.
 
DE you are hitting the nail on the head...one which many people will attempt to deny or justify. At the end of the day, there is a need to have the ego stroked. Absolutely, in our field there are some with bigger egos than others...however the fact remains very few people enter medicine on a totally altruistic concept.

There is nothing wrong with this. If you are providing competent, high quality care...revel in your ego. Some do not know how to revel in private, they project it too far and too loud...but we deal with those types as well. Trauma surgeons being at the top. :)

A lot of what I did in my life and my career was all about making me feel better. Patients benefited from it, but it truly was all about me and how it made me feel. I enjoy providing healthcare, I truly do. I love chaos and making everything as controlled as possible by rapid decision making and delegation and oversight. This makes me happy. EMS gave me that. When I felt tapped out in EMS, I moved onto flight. Flight brought new demands, new challenges. I had to elevate my game and learn more.

The pay was not much more and in some places it was less...so I went extreme remote. It was status. I did not mind being "at the top". I was decent at what I did, by no means was I great. So many others were better than me...but I was still flying!

So in short...majority of people fail to admit that they are human. Obviously I have no data to support this, just years of observations and my own self analysis.

The allure of flight was status and ego. It made me feel good and pushed me to keep getting better.
 
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