Medic Ambulance ALS-RN

EMT Loris

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Does anybody here know about or have experience with the ALS RN program at Medic Ambulance in Solano County, California? I haven't really heard of anything like it anywhere else in California, and it seems like they hire new grad nurses as well which seems very...questionable.
 

CCCSD

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So, they can train. If they’re doing it, they’re probably following regulatory rules.
 

DesertMedic66

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So, they can train. If they’re doing it, they’re probably following regulatory rules.
There aren’t many regulations when it comes to CCT RNs. The main thing is that for CCT the RN usually the only advanced care provider in the ambulance and must feel comfortable with operating a ventilator, cardiac monitor, IV pumps, and other devices all at the same time. Which is not something most new grads are able to do or at least do competently.
 

Akulahawk

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Does anybody here know about or have experience with the ALS RN program at Medic Ambulance in Solano County, California? I haven't really heard of anything like it anywhere else in California, and it seems like they hire new grad nurses as well which seems very...questionable.
While I'm not exactly familiar with their ALS RN program, it's not hard to figure out what this program is. It's not going to be putting new grad RNs in a CCT role. This is basically going to be like putting a new grad RN through an orientation program with the end result being something like a Paramedic with a wider scope of practice. Being that the EMS Agency in Solano doesn't accredit RNs for prehospital work, it's probably more like an IFT-only job, basically a "CCT-Lite" kind of deal, stable-ish patients, out of Paramedic scope meds or meds on a pump, that sort of thing. Just looking over their EMS agreements, it appears that this is exactly what they're doing. CCT doesn't really have much in the way of regulations and whatnot, other than that a CCT-RN must have sufficient knowledge, skills, and ability to run a vent, utilize various patient monitors, and administer medications. That's usually gained through experience working in an ED or ICU for at least 2 years. In short, a CCT-RN can do all the things that an ALS-RN does, but the reverse isn't true, and therefore a new grad most likely wouldn't be hired into a CCT-RN position.
 

Peak

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To play a bit of the devils advocate the field is nowhere for a new grad nurse to start to practice.

The goal of nursing school is to develop a broad base of understanding so that they can then safely and efficaciously develop skills and knowledge to care for more specialized patients. This is best learned in a supportive comprehensive environment (nursing residency programs, extensive orientation, and so on).

To be quite honest the dozen or so times a year I’m put in the position to fly or ride in on the bus I know that my skills have shifted significantly away from the skills of a 911 medic. I ride to provide specialized care (either for specialized equipment or complex specialty patients). The skills to provide fast and specific EMS care without getting distracted by the detail of hospital or clinic medicine is quite hard once you are accustomed to the time and detail allotted in the ED, unit, or other care areas.

If you are considering nursing school as a way to quickly enter into ALS EMS care I would recommend against it. These are two very different set of skills. Also you will have difficulty getting back into traditional nursing roles if it has been several years and you don’t have a strong history of acute care nursing (read as hospital care).
 

supreme

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it's probably more like an IFT-only job, basically a "CCT-Lite" kind of deal, stable-ish patients, out of Paramedic scope meds or meds on a pump, that sort of thing. Just looking over their EMS agreements, it appears that this is exactly what they're doing.

100%, seems to be the equivalent of CCT-P in other counties.

see Alameda county’s CCP for comparison
 

jgmedic

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Did you even click the link?

It breaks down the scope of practice for each role in a IFT setting
I did. And that second link you posted to the AlCo policy was great, the first one was simply the form they use to request a transport, not a CCT policy or scope of practice. So when you come in here with a let me google that for you attitude, sorry.
 

Akulahawk

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To play a bit of the devils advocate the field is nowhere for a new grad nurse to start to practice.

The goal of nursing school is to develop a broad base of understanding so that they can then safely and efficaciously develop skills and knowledge to care for more specialized patients. This is best learned in a supportive comprehensive environment (nursing residency programs, extensive orientation, and so on).

To be quite honest the dozen or so times a year I’m put in the position to fly or ride in on the bus I know that my skills have shifted significantly away from the skills of a 911 medic. I ride to provide specialized care (either for specialized equipment or complex specialty patients). The skills to provide fast and specific EMS care without getting distracted by the detail of hospital or clinic medicine is quite hard once you are accustomed to the time and detail allotted in the ED, unit, or other care areas.

If you are considering nursing school as a way to quickly enter into ALS EMS care I would recommend against it. These are two very different set of skills. Also you will have difficulty getting back into traditional nursing roles if it has been several years and you don’t have a strong history of acute care nursing (read as hospital care).
I'm very much in agreement. This isn't a good way to get into ALS field care. From what I can tell, this is basically a way to put an ACLS-trained RN (even if new grad) in the back of an ambulance so you can take CCT-P level patients without having to train-up some Paramedics to a CCT-P level. It also appears that the ALS-RN trucks aren't used in field care, just IFT that's out of scope of a Paramedic but doesn't need quite the specialty knowledge of a CCT-RN.

I have read a review or two that claim that the ALS-RN is only provided a few days of orientation before being turned loose. I'm not comfortable with that at all. Paramedics at least go through a 480 hour internship (in California anyawy) and then through an FTO process before being turned loose. The only way that I would even consider putting a new grad RN on an ALS truck as an "ALS-RN" would be if that new grad was already working as a Paramedic with some experience doing that (perhaps 2-4 years).

Incidentally, one of the reasons I'm considering going back to Paramedic work is precisely because I want to work on that particular skillset.
 

Peak

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Incidentally, one of the reasons I'm considering going back to Paramedic work is precisely because I want to work on that particular skillset.
I have become soft and like indoor plumbing too much to want to go back to the streets for anything more than an occasional transport or facilitating one of the specialty programs.
 

DrParasite

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In my experience (which is, admittedly, very limited), many CCT runs are simply an IFT run with the patient on a cardiac monitor. very stable patient, high probability of an uneventful trip. There are some complicated runs (patient on multiple drips, dissecting aneurism, or the patient who is actively trying to die, etc) but those are both the minority and you usually know about them before you pick up the patient.

I've been on CCT runs with RNs who are borderlining on incompetent in the back of the truck. They were PICU nurses, who knew PICU stuff, and were great in a PICU environment with PICU equipment, but the ambulance was not a PICU, despite having similar equipment. So no, I would not want a random nurse on a 911 truck as an ALS provider, unless they were comfortable in that role and an experienced ALS provider had evaluated them and approved them to function in that role (similar to paramedic credentialing/internships).

That being said, I have worked with plenty of nurses who were great as paramedics. usually they had EMT or paramedic experience before they went to nursing school, so they could deal with unexpected hiccups, but not always. As a general rule, I would not want a new grad (or even an experienced med/surg nurse, ortho nurse, or psych nurse) on a 911 truck, who had no EMS experience. I like the idea of 2 years of ER/xICU experience prior to an EMS evaluation/internship/credentialling to function as an ALS provider; doing otherwise is a recipe for disaster, for the provider, the agency and the patient.
 

VFlutter

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I have no first hand experience however with talking to friends in CA it seems that like stated above many of the "CCT-RN" transfers are typical ALS stuff and not what most would consider actual critical care.
 

BobBarker

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We do CCT and ALS in la county at the company I work for, all IFT. CCT nurses require a minimum of 2yrs ER/ICU experience and I know none who have less than 4 and who are still actively work part time for hospitals.
Majority of the cct calls are vent/drip calls that are non-emergency and simply transfer to our equipment and transfer back at destination, fairly easy. Unfortunately, a lot of the daily code 3 calls we get are for cct is simply because the pt can't go ALS with a drip/blood/vent and the facility does not have or want an RN to jump on board the ALS ambulance to monitor what a medic can't. Our RN's also handle ALS calls all the time on cct rigs when our als rigs are busy.
No ALS-RN here in la county, CCT is 1 RN and 2 EMT's although I think the perfect staffing would be 1 RN, 1 Medic and 1 EMT.
Besides the 1 week orientation, 2yrs ER/ICU experience and annual required competency training, I don't know what other regulations are in place
 

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