grumpy1
Rotor RN
- 18
- 4
- 3
No offense taken, well not much anyway
.All I can say is non-progressive protocols tie hands.
Rsi?
- Thread starter fcfiremedic
- Start date
No offense taken, well not much anyway
.All I can say is non-progressive protocols tie hands.
Melbourne MICA
Forum Captain
- 392
- 13
- 18
Rsi
Hi all
My first post so I'll keep it brief.
We RSI in Melbourne (Australia). Traummatic head injured pts (part of a trial 2004-2008 312 Traummatic HI pts now completed), non-traummatic HI pts, pts susceptible to secondary brain injury from hypoxia eg , hangings, drownings, brief cardiac arrest - epileptics and severe hyperthermia (on consult). All these pts have to have GCS<10. We also STI, respiratory failure pts unresponsive to drugs and BLS ventilation strategies.
Most of the MICA guys in Melbourne who have been around for ~= ten years would have quite a few ETT's under their belt from all these categories.
I've been on MICA 12yrs.
RSI's of any kind are NEVER taken lightly by any MICA types. If it goes south your pt winds up arrested or criked - both undersireable outcomes.
We NEVER RSI on the move - really dumb idea - theres just too much to do and to pay attention to. There's also too much that can go wrong.
Our ETT/RSI success rates for the trial averaged about 98-99%.
We also of course ETT arrests - resp or cardiac. Without being flippant or sounding cocky, cardiac arrests are the ones where you get your practice on technique, approach, scene management etc. A supine immobile non-breathing pt with cords (most of the time) on view grade 1 or 2.
Enough for now. My two bobs worth. G'Day all!!!
Melbourne MICA
Hi all
My first post so I'll keep it brief.
We RSI in Melbourne (Australia). Traummatic head injured pts (part of a trial 2004-2008 312 Traummatic HI pts now completed), non-traummatic HI pts, pts susceptible to secondary brain injury from hypoxia eg , hangings, drownings, brief cardiac arrest - epileptics and severe hyperthermia (on consult). All these pts have to have GCS<10. We also STI, respiratory failure pts unresponsive to drugs and BLS ventilation strategies.
Most of the MICA guys in Melbourne who have been around for ~= ten years would have quite a few ETT's under their belt from all these categories.
I've been on MICA 12yrs.
RSI's of any kind are NEVER taken lightly by any MICA types. If it goes south your pt winds up arrested or criked - both undersireable outcomes.
We NEVER RSI on the move - really dumb idea - theres just too much to do and to pay attention to. There's also too much that can go wrong.
Our ETT/RSI success rates for the trial averaged about 98-99%.
We also of course ETT arrests - resp or cardiac. Without being flippant or sounding cocky, cardiac arrests are the ones where you get your practice on technique, approach, scene management etc. A supine immobile non-breathing pt with cords (most of the time) on view grade 1 or 2.
Enough for now. My two bobs worth. G'Day all!!!
Melbourne MICA
A couple ground services RSI in central MO, but I'm not too sure about the rest of the state, and as with any invasive procedure, should be monitored closely by medical directors.
The medics I work with are able to set up vents, change drips / rates, know what and why they're pushing and actually use the education and skills learned in the CC programs...it's kind of depressing to hear that this is your experience with your (I'm assuming) local CC teams - But I don't think throwing RNs on the truck is the answer here - it seems to me that some more active medical direction is needed to get these teams you're talking about up to speed. I certainly would not want to ignite the "RN v Medic" fire here, but with the proper motivation / training / protocols / clinical experience and oversight there is just no reason those programs couldn't function better. I think I would call the CC program medical director and tell 'em to get off their duff and get involved...maybe not those exact words tho...
The medics I work with are able to set up vents, change drips / rates, know what and why they're pushing and actually use the education and skills learned in the CC programs...it's kind of depressing to hear that this is your experience with your (I'm assuming) local CC teams - But I don't think throwing RNs on the truck is the answer here - it seems to me that some more active medical direction is needed to get these teams you're talking about up to speed. I certainly would not want to ignite the "RN v Medic" fire here, but with the proper motivation / training / protocols / clinical experience and oversight there is just no reason those programs couldn't function better. I think I would call the CC program medical director and tell 'em to get off their duff and get involved...maybe not those exact words tho...
Until there becomes some standard to the Paramedic education and until "CCEMT-P" is truly something more consistent than a patch, it is safer for RNs and/or RRTs to accompany some patients. This is a nationwide problem and not just in one area.
Why do you think RN/RN and RN/RRT teams are used almost exclusively for specialty teams? Paramedics do not have work experience in high acuity critical care patient management.
For other Flight teams, RNs are usually partnered with Paramedics and are very valuable due to their many years of experience with a variety of drips and technology.
Many Paramedics have stated they can "set up" a ventilator and then pull some type of ATV out of the bag.
It is the Paramedics who think they can do everything and believe they have seen everything that are more likely to know the least.
Why do you think RN/RN and RN/RRT teams are used almost exclusively for specialty teams? Paramedics do not have work experience in high acuity critical care patient management.
For other Flight teams, RNs are usually partnered with Paramedics and are very valuable due to their many years of experience with a variety of drips and technology.
Many Paramedics have stated they can "set up" a ventilator and then pull some type of ATV out of the bag.
It is the Paramedics who think they can do everything and believe they have seen everything that are more likely to know the least.
For the record, I DO work side-by-side with RNs for a CAMTS certified Helicopter Service, and I am not implying that all paramedics are equally proficient at their jobs - nor are RNs, MDs, short order cooks or dog catchers, for that matter.
My question is: why aren't the "many" paramedics who you refer to held accountable? Ditto for the "some" who "probably have no idea what they actually have running"? They (should) have medical direction and oversight, just as RNs do. If it's 'standards' we're after, we should look no further than the physician who signs his or her name to the protocols and procedures of that service, or perhaps their Clinical Supervisor (providing there is one...)
If anyone - Medic or RN - is out there ingoring or turning off pumps because they don't understand them, that indeed is a problem, and needs to be addressed. Just as an RN has to learn those tools, so should a medic who works with them...again, I submit that this is a medical oversight problem, not a paramedic one.
I'm not going to be an appologist for paramedics who think they "can do everything and believe they have seen everything", as we all know how dangerous that can be. However it is not solely paramedics who act this way. I have seen many the cocky RN get schooled in the field as well. Numerous times involving RSI, not so surprisingly.
I don't mean to be argumentative - but when I hear phrases like "some paramedics", or "many paramedics" I feel the need to defend my profession.***
As for me, I am well aware the more I know, the more I realize I don't know. And I will have seen everything when my own ECG goes, "beeeeeeeeeeeeeeeeeeeep".
*** "All broad sweeping generalizations are wrong"
My question is: why aren't the "many" paramedics who you refer to held accountable? Ditto for the "some" who "probably have no idea what they actually have running"? They (should) have medical direction and oversight, just as RNs do. If it's 'standards' we're after, we should look no further than the physician who signs his or her name to the protocols and procedures of that service, or perhaps their Clinical Supervisor (providing there is one...)
If anyone - Medic or RN - is out there ingoring or turning off pumps because they don't understand them, that indeed is a problem, and needs to be addressed. Just as an RN has to learn those tools, so should a medic who works with them...again, I submit that this is a medical oversight problem, not a paramedic one.
I'm not going to be an appologist for paramedics who think they "can do everything and believe they have seen everything", as we all know how dangerous that can be. However it is not solely paramedics who act this way. I have seen many the cocky RN get schooled in the field as well. Numerous times involving RSI, not so surprisingly.
I don't mean to be argumentative - but when I hear phrases like "some paramedics", or "many paramedics" I feel the need to defend my profession.***
As for me, I am well aware the more I know, the more I realize I don't know. And I will have seen everything when my own ECG goes, "beeeeeeeeeeeeeeeeeeeep".
*** "All broad sweeping generalizations are wrong"
*** "All broad sweeping generalizations are wrong"
The only thing broad in my post is the fact that there is no standard foundation for education in EMS. That is broad across the U.S. You can have the 3 month wonder or the 2 year degreed. As a medical director it would be very difficult to give very broad privileges to some Paramedics who have only the bare minimum requirements and from educators who would not be educators in any other profession even to teach A&P. There may be some who have only put 3 months effort into obtaining their Paramedic that may not be willing to put that much more effort into advancing the education later to extend their practice.
If the Flight job says 3 years of experience in EMS, busy service or not, their experience will be as broad as their educational differences. The RN will have at least a two year degree and flight jobs are usually very specific about the number of years, where and what specific type of meds and technology the RN is experienced with. It may be hard to ask the same of many paramedics that are from states or counties (California) with limited scopes.
The certifications for RNs are also nationally recognized with the standardized requirements.
There are Paramedics wearing a CCEMT-P patch after an 8 hour inservice in the back room of their ambulance company. This is NOT just my area. This is on both coasts and inbetween.
EMS has over 50+ different certs and licenses for the numerous levels recognized besides the "specialty" certs that some states and organizations make up without any national testing or credentialing criteria. Heck, the NREMT is not even recognized in all 50 states.
There are "broad" differences between being trained, educated and experienced.
It is a paramedic problem if they feel they are "entitled" to certain privileges after just doing the bare minimum to get their patch and continuing to do the bare minimum to keep the patch.
Flight can have a little more control and medical oversight, but if you notice in my original post I referred to CCTs which can be just about any type of ALS truck. A truck with an EMT-I can also be called ALS in some areas. There are few stanards for some ground crews and they are much more affected by their state's or county's scope of practice. For some flight crews, there is also a problem with with some companies just hiring warm bodies for Paramedic positions.
If a flight company hires an RN that cannot manage a med pump, then that company was probably just looking far someone with a license to fill a position and not a professional.
...the phrase "all broad sweeping generalizations are wrong" is itself a broad, sweeping generalization... that's why the smiley face is next to it - didn't mean to offend.
I don't know where anyone's getting a CCEMTP patch in 8 hours, but the programs are very closely monitored by UMBC (the actual CCEMTP, I can't speak for others) I know this because I've coordinated one - huge pain in the $#@. Alas, there are now bridge programs online for RN that can, and have been finished in 4-6 months - if you have the money. If ANY CC program - flight or ground - is only hiring warm bodies there's a problem. No argument there, I guess I'm fortunate to not work for one of those.
Just so we're comparing apples to apples, and oranges to oranges, know that I do agree with you - to a point - that there needs to be a more comprehensive standard nationwide for Paramedics. There are way too many out there (yes, I said "many") that gripe about not being treated as professionals, and yet do not consistently behave that way.
BUT - and I'm standing by this regardless of what any 'national standard' may someday say, I firmly believe that if any institution is going to slap a 'critical care transport' sticker on the side of a vehicle, they had better be able to back it up completely, with comprehensive credentials, regular testing, regular ICU rotations, etc.. I know of some companies that merely require a week's training to hop on and go - and again, I am fortunate to not work for a company like that (3+ months of full time clinical rotations are required for us ) These are requisites for any CAMTS service, and relying on a national standard is not enough to guarantee that, just as having alphabet soup behind your name doesn't automatically make you an ICU guru. I think a national standard would be inneffective in most CC programs; in part because of the differences in medical services (type / level) and in part because of different geographical requirements...an Orlando unit could not be expected to know all the intricacies of an Anchorage unit, etc..
It is, as I'm sure you know, very frustrating to work your backside off in this field only to get looked at as a glorified ambulance driver, and I have the utmost respect for MANY paramedics out there who do just that. Please don't get the idea I'm beating up on RNs either - I'm actually working on mine - in part for the training, in part because of the previous sentence, and in part for making peanuts $$ as a medic.
Question: Are the CC trucks in your area controlled by a separate director / coordinator, or are they a beefed up version of a regular ALS unit under the same supervision as the other trucks? Just curious.
I don't know where anyone's getting a CCEMTP patch in 8 hours, but the programs are very closely monitored by UMBC (the actual CCEMTP, I can't speak for others) I know this because I've coordinated one - huge pain in the $#@. Alas, there are now bridge programs online for RN that can, and have been finished in 4-6 months - if you have the money. If ANY CC program - flight or ground - is only hiring warm bodies there's a problem. No argument there, I guess I'm fortunate to not work for one of those.
Just so we're comparing apples to apples, and oranges to oranges, know that I do agree with you - to a point - that there needs to be a more comprehensive standard nationwide for Paramedics. There are way too many out there (yes, I said "many") that gripe about not being treated as professionals, and yet do not consistently behave that way.
BUT - and I'm standing by this regardless of what any 'national standard' may someday say, I firmly believe that if any institution is going to slap a 'critical care transport' sticker on the side of a vehicle, they had better be able to back it up completely, with comprehensive credentials, regular testing, regular ICU rotations, etc.. I know of some companies that merely require a week's training to hop on and go - and again, I am fortunate to not work for a company like that (3+ months of full time clinical rotations are required for us ) These are requisites for any CAMTS service, and relying on a national standard is not enough to guarantee that, just as having alphabet soup behind your name doesn't automatically make you an ICU guru. I think a national standard would be inneffective in most CC programs; in part because of the differences in medical services (type / level) and in part because of different geographical requirements...an Orlando unit could not be expected to know all the intricacies of an Anchorage unit, etc..
It is, as I'm sure you know, very frustrating to work your backside off in this field only to get looked at as a glorified ambulance driver, and I have the utmost respect for MANY paramedics out there who do just that. Please don't get the idea I'm beating up on RNs either - I'm actually working on mine - in part for the training, in part because of the previous sentence, and in part for making peanuts $$ as a medic.
Question: Are the CC trucks in your area controlled by a separate director / coordinator, or are they a beefed up version of a regular ALS unit under the same supervision as the other trucks? Just curious.
Both.
I am also familiar with two different areas on opposite coasts.
In Florida, you may find private ambulance services as well as FD ALS attempting interfacility with various degrees of proficiencies.
In California, you may find 1 RN and two EMT-Bs doing interfacility CCT. The EMT-Bs "set-up" the ventilators "by the numbers" which is not always possible since ICU and transport ventilators are rarely similar. Many times there will be a hospital CCT RN on duty to be another licensed person on the transport.
The base education should have some standards regardless of the scope of practice for whatever state.
UMBC CCEMT-P is still just an introduction to Critical Care Medicine. Very few Paramedics with ground transport will have the opportunity to do a rotation of any length in an ICU. Right now some can not find hospitals that allow them to do intubation rotations. RNs with hospital based CCTs do not have any of these issues.
No FD or private CC services around here - one was tried in Kansas City area some time ago, but flopped for reasons I'm not aware of (maybe due to some of the reasons we've discussed perhaps?) The hosp. based units are usually made up of what I call 'the usual' crews - RN/RT/MD/Perfusionist/Medic/another RN (pick two), and an EMT-B who only drives...and definately doesn't set up vents! Not really sure why the EMT driver, most likely a state reg. There's only one 'ALS' provider (RN) on a CC unit? Don't think I'd want that job...
I whole-heartedly agree with you that even with the nice oval cc patch one's only scratched the surface of CCT, and it's unfortunate there's not more cooperation with the hospitals / anes. depts for intubations and other proceedures. That's gonna have to change as demand increases, no doubt. We have had to have some pretty big fights to get to the point where we have all the clinicals and labs we are privy to (cats, pigs, dogs, cadavers, live tubes in surg, all ICUs open to us, Neonatal and OB rotations...the list goes on and on...).
It would be an understatement to say the whole system nation-wide needs an overhaul, especially considering the whole 'boomer effect' on regular and CC EMS. I do remember reading over a draft of a new national 'scope of practice' standard a couple years ago, but it's late and I can't remember much of it, it did expand (and define) the roles for EMS - much clearer than what's out there now. Haven't heard anything on it lately tho...might do some digging around for that when I'm not cross-eyed.
I whole-heartedly agree with you that even with the nice oval cc patch one's only scratched the surface of CCT, and it's unfortunate there's not more cooperation with the hospitals / anes. depts for intubations and other proceedures. That's gonna have to change as demand increases, no doubt. We have had to have some pretty big fights to get to the point where we have all the clinicals and labs we are privy to (cats, pigs, dogs, cadavers, live tubes in surg, all ICUs open to us, Neonatal and OB rotations...the list goes on and on...).
It would be an understatement to say the whole system nation-wide needs an overhaul, especially considering the whole 'boomer effect' on regular and CC EMS. I do remember reading over a draft of a new national 'scope of practice' standard a couple years ago, but it's late and I can't remember much of it, it did expand (and define) the roles for EMS - much clearer than what's out there now. Haven't heard anything on it lately tho...might do some digging around for that when I'm not cross-eyed.
mycrofft
Still crazy but elsewhere
- 11,322
- 48
- 48
Stop trying to run a fledgling profession on "certificates".
Nationally mandated curricula to earn DEGREES.
Oh, and by the way, having once been tempted into babysitting a pt above my level of expertise, alone with a pilot to the Mayo clinic in a light fixed wing aircraft, it was the most ignorant, flattery-sucking and downright silly thing I have done in EMS ever. GD'ed lucky for everyone involved.:blush:
Nationally mandated curricula to earn DEGREES.
Oh, and by the way, having once been tempted into babysitting a pt above my level of expertise, alone with a pilot to the Mayo clinic in a light fixed wing aircraft, it was the most ignorant, flattery-sucking and downright silly thing I have done in EMS ever. GD'ed lucky for everyone involved.:blush: