Medic Ambulance ALS-RN

[Akulahawk]

Besides the 1 week orientation

That sounds like a sentinel event just waiting to happen

I tend to agree. About the only time that I would even consider doing a 1 week orientation for an RN doing CCT and taking ALS calls when the ALS trucks aren't available would be if the RN already has experience as a Paramedic. Otherwise you're betting that the EMTs are able to watch out for scene hazards that the RN might not even consider (among other operational concerns). I just think that a single week orientation on a truck for a CCT RN and then sending them out to occasionally pick up an ALS call, let alone CCT calls, could very easily end up with a sentinel event.

 

[BobBarker]

I tend to agree. About the only time that I would even consider doing a 1 week orientation for an RN doing CCT and taking ALS calls when the ALS trucks aren't available would be if the RN already has experience as a Paramedic. Otherwise you're betting that the EMTs are able to watch out for scene hazards that the RN might not even consider (among other operational concerns). I just think that a single week orientation on a truck for a CCT RN and then sending them out to occasionally pick up an ALS call, let alone CCT calls, could very easily end up with a sentinel event.

A majority of the ALS calls we get because we are IFT simply more stable than CCT or don’t require drips, blood and/or vent. An intubated stemi pt would be CCT where as if they weren’t intubated it would be ALS going to the stemi center.

 

[Rano Pano]

A majority of the ALS calls we get because we are IFT simply more stable than CCT or don’t require drips, blood and/or vent. An intubated stemi pt would be CCT where as if they weren’t intubated it would be ALS going to the stemi center.

When you say RNs taking ALS calls you’re referring to transfers, right? I remember LA county CCT cars being dispatched to 911 and the RN would just stay in the rig. The county
allow them to do anything past BLS on a 911 scene, right?

 

[BobBarker]

When you say RNs taking ALS calls you’re referring to transfers, right? I remember LA county CCT cars being dispatched to 911 and the RN would just stay in the rig. The county
allow them to do anything past BLS on a 911 scene, right?

Correct, transfers. We rarely do backup. If on scene of a still alarm, RN’s can use up to the ALS scope of practice.

 

[supreme]

I tend to agree. About the only time that I would even consider doing a 1 week orientation for an RN doing CCT and taking ALS calls when the ALS trucks aren't available would be if the RN already has experience as a Paramedic. Otherwise you're betting that the EMTs are able to watch out for scene hazards that the RN might not even consider (among other operational concerns). I just think that a single week orientation on a truck for a CCT RN and then sending them out to occasionally pick up an ALS call, let alone CCT calls, could very easily end up with a sentinel event.

ALS meaning ALS 911 calls or ALS IFT calls?

Technically, California allows RN's to response to ALS prehospital calls.

1797.56.​

“Authorized registered nurse,” “mobile intensive care nurse,” or “MICN” means a registered nurse who is functioning pursuant to Section 2725 of the Business and Professions Code and who has been authorized by the medical director of the local EMS agency as qualified to provide prehospital advanced life support or to issue instructions to prehospital emergency medical care personnel within an EMS system according to standardized procedures developed by the local EMS agency consistent with statewide guidelines established by the authority. Nothing in this section shall be deemed to abridge or restrict the duties or functions of a registered nurse or mobile intensive care nurse as otherwise provided by law.

1797.52.​

“Advanced life support” means special services designed to provide definitive prehospital emergency medical care, including, but not limited to, cardiopulmonary resuscitation, cardiac monitoring, cardiac defibrillation, advanced airway management, intravenous therapy, administration of specified drugs and other medicinal preparations, and other specified techniques and procedures administered by authorized personnel under the direct supervision of a base hospital as part of a local EMS system at the scene of an emergency, during transport to an acute care hospital, during interfacility transfer, and while in the emergency department of an acute care hospital until responsibility is assumed by the emergency or other medical staff of that hospital.

 

[Akulahawk]

ALS meaning ALS 911 calls or ALS IFT calls?

Technically, California allows RN's to response to ALS prehospital calls.

1797.56.​

“Authorized registered nurse,” “mobile intensive care nurse,” or “MICN” means a registered nurse who is functioning pursuant to Section 2725 of the Business and Professions Code and who has been authorized by the medical director of the local EMS agency as qualified to provide prehospital advanced life support or to issue instructions to prehospital emergency medical care personnel within an EMS system according to standardized procedures developed by the local EMS agency consistent with statewide guidelines established by the authority. Nothing in this section shall be deemed to abridge or restrict the duties or functions of a registered nurse or mobile intensive care nurse as otherwise provided by law.

1797.52.​

“Advanced life support” means special services designed to provide definitive prehospital emergency medical care, including, but not limited to, cardiopulmonary resuscitation, cardiac monitoring, cardiac defibrillation, advanced airway management, intravenous therapy, administration of specified drugs and other medicinal preparations, and other specified techniques and procedures administered by authorized personnel under the direct supervision of a base hospital as part of a local EMS system at the scene of an emergency, during transport to an acute care hospital, during interfacility transfer, and while in the emergency department of an acute care hospital until responsibility is assumed by the emergency or other medical staff of that hospital.

The MICN is a Base Hospital ED RN that has received some additional education and (typically) an 8 hour OBSERVATION ride-along. Sure the MICN might be technically authorized to provide prehospital care but they're primarily used to provide instructions to prehospital providers because they're working at a base hospital and are assigned to answer the prehospital radio/phone. If the RN isn't working at a base hospital, that base hospital isn't going to be able to sponsor them for MICN. Now then, MICN isn't the ONLY kind of RN that provides prehospital field care. Those are usually flight nurses that receive recognition through an agreement with various LEMSAs and the flight provider. That agreement basically relies on the flight provider doing adequate orientation and training of their RNs in performing field care. Since flight providers aren't usually limited to a single county, they're not going to typically access the base hospitals for prehospital orders as their own standardized procedures will be used instead of the prehospital ALS orders. This also means that the LEMSAs aren't going to be the ones accrediting those field RNs. An MICN is going to be effectively bound to their LEMSA orders. On a more practical level, I've not heard of (recently for certain) an MICN training course (which takes place over 1-2 days) doing much (if any) advanced airway management training.

 

[fm_emt]

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.

Having talked to some, this is how it seems. I am unsure why they can't use a Paramedic for most of these. We took vent & drip patients quite often in Texas and other non-California states. Is there a benefit to the company on the billing side to use a CCT-RN instead? Or is this a case of "it's just how it's done here" instead?

 

[Akulahawk]

many of the "CCT-RN" transfers are typical ALS stuff and not what most would consider actual critical care.

Having talked to some, this is how it seems. I am unsure why they can't use a Paramedic for most of these. We took vent & drip patients quite often in Texas and other non-California states. Is there a benefit to the company on the billing side to use a CCT-RN instead? Or is this a case of "it's just how it's done here" instead?

It's basically a "that's how it's done here" because the RN lobby didn't want Paramedics to encroach too much into "their" areas. Seriously. If California Paramedics suddenly could do the things that Tx Paramedics do, the majority of the need for CCT-RN trucks would disappear overnight.

 

[DesertMedic66]

It's basically a "that's how it's done here" because the RN lobby didn't want Paramedics to encroach too much into "their" areas. Seriously. If California Paramedics suddenly could do the things that Tx Paramedics do, the majority of the need for CCT-RN trucks would disappear overnight.

This. Even on the flight side we are facing issues. We have been trying to get a statewide expanded scope for flight medics that our flight nurses are in complete agreement with however we hit roadblocks at every step.

 

[BobBarker]

It's basically a "that's how it's done here" because the RN lobby didn't want Paramedics to encroach too much into "their" areas. Seriously. If California Paramedics suddenly could do the things that Tx Paramedics do, the majority of the need for CCT-RN trucks would disappear overnight.

Orange county started allowing medics to transport vents and some drips including antibiotics

 

[Akulahawk]

Orange county started allowing medics to transport vents and some drips including antibiotics

When did OC add in the ability to monitor drips, specifically antibiotics? I looked and found only monitoring of heparin, nitroglycerin, and TPA.

 

[BobBarker]

When did OC add in the ability to monitor drips, specifically antibiotics? I looked and found only monitoring of heparin, nitroglycerin, and TPA.

IFT-SO-3 Policy says they can monitor preset antibiotic, antiviral and antifungal agents administered by the sending facility. It was revised 10/23/19 and that's actually BLS. ALS adds what you mentioned plus dopamine, lidocaine, amio, benzos and mag.

 

[BobBarker]

Having talked to some, this is how it seems. I am unsure why they can't use a Paramedic for most of these. We took vent & drip patients quite often in Texas and other non-California states. Is there a benefit to the company on the billing side to use a CCT-RN instead? Or is this a case of "it's just how it's done here" instead?

Last I heard an ALS call on our contract runs for $500-$700 where as a CCT call could generate 2-3x that.

 

[Akulahawk]

IFT-SO-3 Policy says they can monitor preset antibiotic, antiviral and antifungal agents administered by the sending facility. It was revised 10/23/19 and that's actually BLS. ALS adds what you mentioned plus dopamine, lidocaine, amio, benzos and mag.

Looks like OC EMS took advantage of the EMT Optional Scope and managed to get all that through the EMSA approval process. That's significantly wider (for BLS anyway) than anything I've heard of recently for California EMTs.

 

[BobBarker]

Looks like OC EMS took advantage of the EMT Optional Scope and managed to get all that through the EMSA approval process. That's significantly wider (for BLS anyway) than anything I've heard of recently for California EMTs.

Yup, considering we couldn't even transport mag with a preclampsia patient last night in la county as ALS.

 

[Jim37F]

Yet another reason why when people ask me if I'm interested in eventually moving back to LA I just kinda laugh and say "no" (even though I'm just a BLS hose monkey lol... the other day one of our EMS medics asked if one of us wanted to start an IV because he knew I used to be an EMT, and he just kinda assumed that was a normal thing, since EMTs here can do that, and I had to briefly explain that back in CA I probably wasn't even allowed to look at the BSG lancets much less start any IVs lol)