Scope of Practice

SeeNoMore

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I'd be curious to hear about the scope of practice of CCT providers who post on EMT life and how this breaks down among crew members. If you fly RN/Paramedic , do you have an equal scope of practice? Are you carrying blood, placing chest tubes , arterial lines, using an Istat etc?
 

VentMonkey

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I'd be curious to hear about the scope of practice of CCT providers who post on EMT life and how this breaks down among crew members. If you fly RN/Paramedic , do you have an equal scope of practice? Are you carrying blood, placing chest tubes , arterial lines, using an Istat etc?
RN/ paramedic. We work under the nurses scope (yaaay, California), which is NOT a dig at them by any means.

Sadly, no to blood, chest tube placement, iStat (I would take this over blood products), or art line placement (just monitor them). Our helicopter is somewhat limited in terms of what kind of extra pieces of equipment we can carry, so most of the IABP/ LVAD type patients are taken by our ground unit.

We do perform RSI, and the RN's scope is basically whatever the paramedic can, with additional medications, and procedures.

I do know for a fact that there are ground paramedics in other parts of the country that are given more tools, and trust in their respective systems without even being considered CCT/ SCT. Again, kinda disheartening, but I don't want to keep beating the California stigma into the ground.

I'd love to hear others input, and program scopes as well.
 
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SeeNoMore

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It seems like many rural states have options for Paramedics to become equal or primary providers. I know Lifeflight of Maine has the same scope of practice for both Nurses and Paramedics, I believe the same is true of DHART in NH.

I also work in a program that officially has an expanded scope of practice for RNs and not paramedics. I am happy to say the program focuses on equal education and shared clinical decision making. We are busy and do IABP, ECMO, RSI and have a very broad set of clinical guidelines. Sadly we don't carry our own blood , place chest tubes or carry an Istat. .
 

VentMonkey

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It seems like many rural states have options for Paramedics to become equal or primary providers. I know Lifeflight of Maine has the same scope of practice for both Nurses and Paramedics, I believe the same is true of DHART in NH.

I also work in a program that officially has an expanded scope of practice for RNs and not paramedics. I am happy to say the program focuses on equal education and shared clinical decision making. We are busy and do IABP, ECMO, RSI and have a very broad set of clinical guidelines. Sadly we don't carry our own blood , place chest tubes or carry an Istat. .
LifeFlight of Maine seems like a legitimately interesting program.

I will say for the most part, we share clinical decision making at our program as well. Is your particular program a twin-engine, at least for IABP transfers?
 
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SeeNoMore

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We have multiple airframes in use - both twin engine and single. We do IABP transfers in both.
 

VentMonkey

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We have multiple airframes in use - both twin engine and single. We do IABP transfers in both.
Are you guys taking perfusionists to assist in running the IABP patients, or are all of you guys pretty much stand alone when it comes to operating the balloon pumps? Does your service have its own IABP?
 

TXmed

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We dont take perfusionist on our IABP and i really dont see a need to (unless you have an extended transport time of 3+hrs). The transport crew shouldnt really be messing with any of the settings,(augmentation should just be 1:1 or 1:2) if you think something is wrong just turn the device off, its an assist device their lives dont depend on it.
 

Akulahawk

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VFlutter

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Some folks are very IABP dependent.

Those fun patients that crash just by going 1:2 or pausing the pump for a CXR.

just turn the device off, its an assist device their lives dont depend on it.

Are you going to manually cycle the balloon during the transport after you turn off the pump? Trying to surgically explant a clotted IABP is mess.
 

CANMAN

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Just turn the balloon pump off huh.. :eek:

Anyways, Nurse/Medic program, completely equal scope of practice and expected to practice as such. We rotate rolls every other call. Usually have one person as the "patient care provider" and one person as the "report person" who also handles the paperwork etc. We typically get report together at the bedside for IFT, but normally that's how we define the roles. We both always hit the room together and determine sick vs. not sick and if we both have to jump in directly for care then we do so and worry about the other stuff after we have stabilized the situation out a bit.

Protocols are completely the same. Fly all twin engine airframes in our system, either 135 or 145's. 3 sets NVG for all crew members. IABP at each base, company owned, no perfusionist for those missions. Only pickup perfusionist for ECMO missions. Also have an isolette at almost every base.

Carry 2 units of blood on every aircraft in the system, with certain bases also carrying plasma. Looks like we will be adding A-line placement within the next year, but no chest tube placement or central venous line placement. No istat's or EPOC's. Have worked in programs which use them and it just ends up delaying transport. If I need an ABG I can have the sending facility spin one down with relative ease. We do carry lactate meters and most of our fluid administration and shock protocols are guided by lactate levels. Also do remote ischemic conditioning which is something unique to our program I believe.
 

VentMonkey

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Also do remote ischemic conditioning which is something unique to our program I believe.
Really legit sounding program, CANMAN. Can you elaborate a bit more on this particular procedure? I don't know much about it...
 

CANMAN

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Really legit sounding program, CANMAN. Can you elaborate a bit more on this particular procedure? I don't know much about it...

Sure, I am short on time but will give some quick insight.

Based off a research study that was proven with beneficial outcome to patients in reducing end myocardial damage in then setting of acute MI.

Basically put a blood pressure cuff on and inflate the cuff to 200mmHg and leave inflated for a period of 5 minutes, deflate, short rest period, then same procedure to attempt to complete 3 total cycles. The ischemic caused by the blood pressure cuff allows for the release of free radicials which during the rest cycle migrate to the myocardium and decrease the re-perfusion injury. If the patient has excessive pain during the procedure we will treat per our pain protocol with fentanyl. Most patients tolerate it quite well, and this is in addition to the rest of the agents we are getting on board for our STEMI transports.

I will have to dig up the study but I remember the numbers being fairly impressive. I am not a big research guy but it was put out as a trial in or program and later implemented, a lot like our prehospital lactate level measuring was.
 

STXmedic

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My FT gig is doing an open trial on remote ischemic conditioning right now. Apparently we're having a hell of a time getting enrollment though. We're a large and busy system, but apparently a disproportionately large amount of people like to have their MIs on even-numbered days...

I'll have more input about our flight services protocols once I get more familiar with them. What I do know: Medics and RNs have the same scopes and function equally. Occasionally IABPs, but not all that common. We're getting blood very soon. In the middle of a TXA trial (as well as a couple other trials I believe).

Central lines, chest tubes, all new ReVels as of a couple weeks ago, and iStats.

Fly 407s and 430s, but I believe the 407s are getting replaced fairly soon. About 50/50 scene vs IFT.

I should be a little more informed in a couple weeks.
 
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