could we make this very quote the coverpage of all EMS texts?
What does it take to fly as a medic?
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could we make this very quote the coverpage of all EMS texts?
Sasha
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Perhaps because nurses are not so much first aid providers, but a participant of definitive care?
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8jimi8
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I definitely appreciate the importance of this statement. I think the confidence derived from "skills," is having a platform from which to operate in the face of crisis. My first two semesters I was on a telemetry med / surg floor and I was very scared that someone would code on me. Why? Because I didn't have a basis from which to react, other than my knowledge of "hit the button, call the code, and start cpr." It wasn't until I took an ACLS class that I understood what would happen in a code. What did I do on my first code? Chest compressions. But having the knowledge of what was about to be going on around me and then the understanding of what was going on around me, while i did my compressions, gave me a sense of relief. A sense of knowing which direction things were going, and ultimately that I was doing everything I should be.
***edited for punctuation***
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Ridryder911
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One has to recognize, the drama and glamorous life of a flight nurse/medic is really over exaggerated. If you do not like the ground areas of ER, Field, ICU then you will hate the air. The only difference between the ground units and air is speed.
Having RT's must be a regional thing. I have not seen an RT on a neonate or flight team in over a decade. Most of our Neonate team is Neonate Nurse Practitioner with a RN/Paramedic or CCP speciality trained in neonate. The Paramedic being more of an assistant. As well, very few flights are now with neonate as it is hard to justify a helicopter with a scene time >1hr and then rapid transport? Most around here have also included a ground transport unit.
I believe we see will a major reduction of HEMS within as little as 2-3 years. Economics will determine that it is foolish in the majority of cases of calling a helicopter and awaiting then to transport when if the patient was properly diverted or immediately transported the patient would had been at the appropriate facility to begin with.
Our HEMS is only making it because of trauma funding associated with tag tax at this time. Even now, this week there is meetings to cut that pie open and share with more with others. Interfacility transfers per HEMS is beginning to decline, justifying a $10,000+ trip is hard to do and insurance companies are exploring these justifications even more. I am seeing more and more abuse of HEMS services as well. Barely justification and definitely not "time" warranted. The reason it is one of the most competitive medical areas known. Also with the safety record being as it is, it will be under more of a microscope.
In reality many of the HEMS have lost their appeal in my area. The truthfulness that there is not or any difference in treatment regime and also many flight services have lost their "attraction" as the pay is many times no different nor the personal on them any better than ground units have. Many have returned back to the streets or units for better working conditions and schedules.
If one is really serious about aviation medicine, then one has to be very comfortable on the ground in the unit, field. Obtain as much experience for autonomy and being to perform needed clinical skills in adverse conditions. Hence the reason for the required experience.
R/r 911
Having RT's must be a regional thing. I have not seen an RT on a neonate or flight team in over a decade. Most of our Neonate team is Neonate Nurse Practitioner with a RN/Paramedic or CCP speciality trained in neonate. The Paramedic being more of an assistant. As well, very few flights are now with neonate as it is hard to justify a helicopter with a scene time >1hr and then rapid transport? Most around here have also included a ground transport unit.
I believe we see will a major reduction of HEMS within as little as 2-3 years. Economics will determine that it is foolish in the majority of cases of calling a helicopter and awaiting then to transport when if the patient was properly diverted or immediately transported the patient would had been at the appropriate facility to begin with.
Our HEMS is only making it because of trauma funding associated with tag tax at this time. Even now, this week there is meetings to cut that pie open and share with more with others. Interfacility transfers per HEMS is beginning to decline, justifying a $10,000+ trip is hard to do and insurance companies are exploring these justifications even more. I am seeing more and more abuse of HEMS services as well. Barely justification and definitely not "time" warranted. The reason it is one of the most competitive medical areas known. Also with the safety record being as it is, it will be under more of a microscope.
In reality many of the HEMS have lost their appeal in my area. The truthfulness that there is not or any difference in treatment regime and also many flight services have lost their "attraction" as the pay is many times no different nor the personal on them any better than ground units have. Many have returned back to the streets or units for better working conditions and schedules.
If one is really serious about aviation medicine, then one has to be very comfortable on the ground in the unit, field. Obtain as much experience for autonomy and being to perform needed clinical skills in adverse conditions. Hence the reason for the required experience.
R/r 911
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8jimi8
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While Air transport is my stated goal, I think I would be equally happy doing ground ICU. The flight nurses that I have talked to, also have other jobs "so they can afford to fly." There is a rumor that, Acadian, a private company that operates in the surrounding areas of Austin has a mobile ICU that rolls with an RN. Like i said in my first post... I WISH I WENT TO PARAMEDIC SCHOOL INSTEAD! I don't know why my brain is so drawn to pre-hospital. Believe me, i'm not going to waste the two years I've spent to get where I am. I'm going to take my education and alot of advice from those who came before and do what I know is right, advocate for the patients. There is no telling where my final destination will be, the least that I know is that I'll be studying hard to get there.
This seriously must be limited to Oklahoma. Read the American Academy of Pediatrics for recommendations for Pedi teams.
The majority of Neo specialty teams do include an RRT. The other teams are RN/RN or RN/NP.
Honestly, would you want a Paramedic who does not have the ability to work inside of an NICU caring for your newborn on transport or an RRT or RN with a minimum of 5 years of experience exclusively in neonates with several hundred intubations, line placement and education of the latest technology and meds?
There are now 5 established HEMS services with RRTs.
How did Oklahoma not get the memo that RRTs have moved on? Maybe that is why they are so poorly represented at the nationals. No interest but they still must meet the national level of education to take the boards whether they like it or not in that state.
Flight nurses can not afford not to work somewhere else because they must maintain their expertise in critical care. They must continuously stay on top of the latest technology and protocols in the ICUs. If they rely only on the experience from flight, they will eventually become ineffective as a Flight Nurse with critical interfacility transports.
If you are not up to the challenges of being a nurse, then by all means go on to be a Paramedic. Which ever one you choose, stick with it and don't be constantly saying I wish I had done the other. That will not gain any points with your co-workers and your supervisors will not be impressed with your lack of dedication or enthusiasm for the job.
Ridryder911
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Vent I believe you will see more and more working somewhere else. I know of five flight services in neighboring states that requires flight teams to work in the ED, clinics, and even the two neonate teams works in either the clinics or NICU in between flights. There are more flight nurses in many parts of this area that work in between flights than just performing flights alone. Even our state teaching facility has contracted out the NICU flight team and has been controversial as they are only PRN assigned.
Many do not work in the ICU areas as being assigned a patient and leaving, many are assigned in the ED's as the Paramedics are as well. Twenty four hour shifts are becoming less and less popular, and when that occurs many feel the downtime one should be productive.
In fact interfacility transports per flights have decreased remarkably being able to justify a $10-25K bill over a $800 is difficult to do. Insurance companies are becoming more savvy and know many of these teams are more for PR for hospitals than any real change in outcome as studies showing any difference between ground teams and having a flight team is minimal to none.
That is why many of our HEMS are no longer speciality teams but are primarily scene flights. Trauma funds are now the support as they recieve a guarenteed payment but alas even this will be changing. Along with the obvious safety issue, I believe with economic issues many HEMS will be soon a thing of the past. Having a 3-10 million dollar helo sitting in front of the hospital one will still have to justify and I don't believe many will be able to do it. Speciality teams yes.. but; not always per helicopters.
R/r 911
Many do not work in the ICU areas as being assigned a patient and leaving, many are assigned in the ED's as the Paramedics are as well. Twenty four hour shifts are becoming less and less popular, and when that occurs many feel the downtime one should be productive.
In fact interfacility transports per flights have decreased remarkably being able to justify a $10-25K bill over a $800 is difficult to do. Insurance companies are becoming more savvy and know many of these teams are more for PR for hospitals than any real change in outcome as studies showing any difference between ground teams and having a flight team is minimal to none.
That is why many of our HEMS are no longer speciality teams but are primarily scene flights. Trauma funds are now the support as they recieve a guarenteed payment but alas even this will be changing. Along with the obvious safety issue, I believe with economic issues many HEMS will be soon a thing of the past. Having a 3-10 million dollar helo sitting in front of the hospital one will still have to justify and I don't believe many will be able to do it. Speciality teams yes.. but; not always per helicopters.
R/r 911
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8jimi8
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The flight nurse that taught my advanced EKG class told me that she was working 3 jobs. The flight team, in ICU and in the ER. She is the one that told me that she held these other positions so that she could afford to fly. But she also remarked that she was going to stop working in the ICU because being there PRN, she was losing touch with the floor and she had "had enough of wiping butts." Please don't misunderstand my exclamations about paramedic school. I am VERY excited about working as a nurse, I just know in my bones that I cannot take a regular "floor nursing" job. I know that many people feel that one should take a med/surg position to get their feet under them, but this is not the type of job that I could handle doing. I would definitely be willing to take a stepdown IMC floor, but I've got an ER job lined up. The issue is that I don't even want to be in the ER. Now that I have found that the ICU is where i need to get my experience my mind is set on that. I'm not an 18 year old out of high school. I am confident in my skills, organization and assessments and I'm ready. Now then, I'm not ready to jump into a bird, but that is the destination.
AJ Hidell
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I'm sure it's for the same reason it is drawn to the air. You have some craving for a sense of sexy excitement that you think exists in both fields that you don't think is in the hospital. Well trust me; that all wears out very quickly, in less much than a year in the field. Then you're just stuck with all the mundane, boring, low paid nonsense that everyone else doing the job hates. Yeah, I know you have to get it out of your system for yourself, but it wil happen quickly.
You absolutely made the intelligent choice by going to nursing school first. To do otherwise is contrary to every intelligent concept of education. Education is just like building a house. You do not specialize in something before establishing a foundation. And if you try to pour a foundation on top of an already established specialization, it collapses. I know that you feel ripped off right now, missing out on the sound of the siren and the rotor blades, but get over it. It's done. Recognize the fact that you made the right choice and focus on capitalizing on that, rather than trying to think of ways to undo it.
Rid,
Specialty teams such as NICU or PICU are usually dedicated and from the ICUs. Sometimes they can be on call and sometimes they can be floaters in the units.
I believe that are at least 2 or 3 dedicated NICU teams in Oklahoma that use RN/RRT. One I know is in Tulsa, St. Francis. You can check the AAP database to see which hospitals have dedicated teams.
That being said, not all babies need a level 3 NICU or a pedi ICU. A state level 1 baby will probably be fine with a Paramedic even with limited knowledge or training. A low acuity child will also be okay most of the time. However, if you are running HFV, nitric oxide, nitrogen, CO2 or ECMO, it would probably be wise to how those actually work with this equipment everyday and not a "once in a blue moon saw that" type flight team or CCT. I do not see where it is PR to dispatch a Level 3 NICU team to a child that requires any of that equipment. These teams are usually busy enough with just 2 or 3 transports in 24 hours since each transport may take 8 hours. They do not go out for room air baby from a hospital that doesn't admit children. Nor will they go out for a baby until it is determined to be viable. So no, I do not see Level 3 NICU Specialty teams as being just a PR stunt.
Specialty teams don't always own their own helicopter. Sometimes they share with other Specialty teams within a hospital or contract a helicopter service with a pilot on call. Sometimes they drive and sometimes it is fixed wing. Occasionally we'll even go commercial with a medical fixed wing for the return. It all depends on where we are going since we travel to several states and countries. Flight is only on part of Specialty Team's transit system.
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Ridryder911
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I'll even ask this; have you ever been in helicopter before? Seriously, I had a lot of wanna bee's but when I placed them in the back with vibration, noise, see & sawing, majority washed out. Yes, they had all the qualifications but was the understanding that it would be alike inside a hospital and medics were no different.
Nothing like trying to re-establish an IV in a cramped moving quarters. Unlike what most presume.. it is just a job. Yes, I like flying but I know many that washed out after a few missions because it was nothing alike they presumed.
I usually describe flight teams either get two types of patients. Those that are B.S. that can walk out to the aircraft (yes, I have seen some) and those that have one foot in the grave and the ER/Unit is pushing you out the door before they die on them.
Realistically, there is nothing more you can do in the air than in a unit or ground; in fact usually less.
Let me assure you the "glamorous" side leaves when you soon discover that safety is your first priorty and patient care is second. Also those sexy flight suits get pretty dang hot in the summer and we won't go into altitude and mexican food in a small aircraft.
Other than the flying part, I really do not know what the "attraction" is to it? Personally more medics are drawn to it than nurses. Nurses appear to be more patient advocates than upon their own egos and adrenaline rushes. I know of many places that have considered flight nursing similar to those that work in a clinic or nursing home (not really nursing).
The prestige usually comes with the self acknowledgement that you are working with other qualified, experienced peers. Hoping that your combination of education and experience will deliver the best care within that period of time to the patient. ........
Other than that.. it's just an ambulance with rotors...
R/r911
Nothing like trying to re-establish an IV in a cramped moving quarters. Unlike what most presume.. it is just a job. Yes, I like flying but I know many that washed out after a few missions because it was nothing alike they presumed.
I usually describe flight teams either get two types of patients. Those that are B.S. that can walk out to the aircraft (yes, I have seen some) and those that have one foot in the grave and the ER/Unit is pushing you out the door before they die on them.
Realistically, there is nothing more you can do in the air than in a unit or ground; in fact usually less.
Let me assure you the "glamorous" side leaves when you soon discover that safety is your first priorty and patient care is second. Also those sexy flight suits get pretty dang hot in the summer and we won't go into altitude and mexican food in a small aircraft.
Other than the flying part, I really do not know what the "attraction" is to it? Personally more medics are drawn to it than nurses. Nurses appear to be more patient advocates than upon their own egos and adrenaline rushes. I know of many places that have considered flight nursing similar to those that work in a clinic or nursing home (not really nursing).
The prestige usually comes with the self acknowledgement that you are working with other qualified, experienced peers. Hoping that your combination of education and experience will deliver the best care within that period of time to the patient. ........
Other than that.. it's just an ambulance with rotors...
R/r911
AJ Hidell
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Much less. Heck, the one thing that medics are always sitting around and wishing for is a full arrest, and we don't even do those in the air, so that eliminates most of the "excitement" that even ground crews get.
Of course, if you want to work full arrests in the air, you can always go to Iraq or Afghanistan. We still worked them there, although the helicopters were a LOT bigger than anything flying outside of LA or SBD counties.
If there were HEMS flying around in Blackhawks after school I'd definately try to find a p/t gig there. No way would I get on some of the smaller ones I have seen recently. Even as a patient, I'll go by truck thanks.
Foxbat
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My impression was that helicopter crews transport the most challenging patients, so to say.
I did ride-along (or should I say fly-along?) 3 times. No calls. Well, there was one, but we were cancelled before we lift off. I am the whitest white cloud. I will try another time, if that won't work, maybe it's hint for me to stay on the ground
MSDeltaFlt
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That's where I beg to differ, my friend. Depending on your state and local protocols, you will not be able to do the same job in the back of the truck.
You may not have the equipment. You may not have the protocols. You may not have the QA/QI. You may not have the quality of on/off line Med Control. Hell, you may not even have local protocols to even allow you to touch that stuff on the ground.
The only place where I can do this job is as a flight medic. That being said, it's what I do, not where I do it that's important - meaning as a flight medic doing a ground transfer for weather.
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medic417
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Actually there is no real difference anymore between air and ground. I am aware of some air services now flying with Paramedic/Basic crew. In fact my ground protocols are as aggressive as many air providers. The day and age of I'm a flight medic meaning you are more educated and better than most ground providers is gone. Perhaps this will change as they make it harder to fly patients which will lead to many of the get rich flight services that have sprung up on every street corner the past few years shutting their doors.
AJ Hidell
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Not so much. Well over half of the scene responses are not justified by anything more than MOI. No truly serious injuries. Even those with truly serious injuries generally do not have any condition that the flight crew can address with anything more than IV and airway, which was usually started by the ground crew before you arrived. In some areas, half of your flights are for IFTs, where again, your patient had all the stabilizing treatment done before your arrival. If you're lucky, you're in some area like PA, MD, or VA, where everyone on the ground is an EMT vollywhacker, so no real patient care is done before your arrival, and you get to shoot your wad occasionally. That is not usually the case though, especial in metropolitan urban and suburban areas. Again, there is this popular perception of the sexy thrill aspect of flight medicine that is not at all accurate.
If you are talking about the programs that are strictly HEMS, you may be right. Although, there are several that do allow for the use of ventilators, RSI, chest tubes and central lines where the ground crew may not have the capability. Some still hire for more than a warm body for their helicopters.
If you are talking about a service that also does interfacility, you can be trained to transport IABP, VADs, ventilators other than the ATV, manage (not just stare at) several medicated drips as well as initiating them and monitor a variety of hemodynamics by pressure lines.
The helicopter services that can provide more than a speedy taxi ride will do be than the others.
MSDeltaFlt
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Maybe you should reread my post, medic417. I told Rid "depending on your state and local protocols". Also, Vent is dead-on accurate with what she said. There's a lot more to it than just skills. Helicopters are not flying ER's. They are ambulances that are flying ER/ICU's. That's not really taught much in paramedic school.