VentMedic

You may still have control of the patient but may not necessarily be the highest level of care. If the HEMS crew is flying Paramedics that do not have the ability to perform any additional procedures or protocols or if you actually have more advanced protocols , then yes the level of your care may be equal or greater. There are some services that actually just place ground paramedics on a helicopter without any additional education or training. EDIT: deleted reference to the new service in Kingman, AZ to give them a chance to prove themselves before forming an opinion.

I didn't type "feeding ice chips". However, I do believe your post gives us a clue that whatever education you received did nothing for your knowledge about healthcare professionals or the field of medicine. Paramedics make up the majority of students attempting Excelsior. RRTs usually take the traditional route if they wish to be dually credentialed. They already have a solid educational foundation so only some of the nursing core is required. Many RRTs that do get their RN rarely leave the RT field but use the education to expand their knowledge of the nursing process to compliment their professional goals. RRTs at least have been past the ED and do have an understanding and respect for nursing as a profession before they enter into it. The reason RT is no longer an attractive option for Paramedics is it requires 76 semester hours at a college without the option of a mail order program. Event the lowest or entry level credential, CRT, requires a minimum of a two year degree. Late addition: I chose to get another healthcare credential, RRT, in 1986. I was among the many degreed Paramedics graduating in the late 1970s and early 1980s. Nursing had just achieved their professional status with the 2 year degree and it looked like the Paramedic would be next. Then, the medic mills started flooding the market with 3 month wonders who were making the same money with less education, clinical time and knowledge as a degreed Paramedic. It cheapened the profession and many really good Paramedics left for other occupations. In my RT class of 24 students, there were 10 Paramedics. There are several other healthcare professions that may actually pay more than RN which some Paramedics would be better suited for. These are rarely considered because of the time required to obtain the education needed. It seems like Paramedics have also narrowed the options for alternative career considerations because the RN is the only other healthcare professional they "think they know" when in actuality very few know what a nurse is or does.

I had to cross the state line many years ago to get the NR. donedeal, you list yourself as a paramedic student in Florida. Are you taking the Florida exam first?

http://www-personal.umich.edu/~mshlafer/Le...ebsli3_4rgb.pdf http://www.oqp.med.va.gov/cpg/MDD/MDD_cpg/...mdd_app5_fr.htm A couple more links for one's viewing pleasure. This was a good review because I don't always keep up with how many MAOIs and TCAs there are on the market and how many combinations they are used in. note: Albuterol is a direct acting sympathomimetic and beta-2 agonist. Also, don't be mislead by levalbuterol. The use of levalbuterol over the more traditionally used racemic albuterol is still controversial. A solid college education in the sciences (chemistry and pharmacology) is definitely helpful when evaluating new and/or improved meds objectively.

COMPARISON OF INHALED SYMPATHOMIMETIC BRONCHODILATORS http://www.medpin.org/education/monodocs/B...lators-0506.pdf The Treatment of Acute Asthma: Role of Short-Acting ß-Agonists in Acute and Emergency Department Treatment http://www.cmecorner.com/macmcm/accpchest/accp2003_02.htm After reading all the cautions, it's a wonder we give any meds at all. I had been very cautious in the past when oral and IV Xanthines were popular. I do get concerned and monitor closely if the patient is also taking OTC cold meds with pseudoephedrine and MAOIs and/or TCAs. Most of the COPD pts will already be on bronchodilators and MAOIs and/or TCAs and beta blockers. The receptor sites will just have to compete for a drug. Oral meds do free up the sites at varying times. In the field, the delivered dose of a 2.5 mg Albuterol neb is less than 20% especially if a face mask is used. For the MDI without an aerochamber, it can be less. There are a lot of new meds on the market but they are still in the same family with the same cautions.

Kyle, you are student still learning about EMS. Lose the term "BS". It should not be in your vocabulary while you are learning patient care. It also makes your posts read like a burnt out and frustrated EMT we see way too often in the field and lessens the professionalism you may be wanting to present. How old was "the old lady"? I'm asking this just as a reference for what young people consider "old". I promise I won't lecture you on the etiquette of age.

I was going to write something about cellulitis, infection and sepsis. But, then I thought about it a little and to a 16 y/o, at 47, I could be "the old lady".

*Sigh* I guess that answers my question.

Unless you are working in the town of Pleasantville, there are dangers to the job. We have adults that don't understand the basics of infection control. Sixteen is an early age to get exposed to Hep C, TB and MRSA on a regular basis. Are they mature enough to handle the dynamics of a domestic? Child abuse? Rape? Miscarriage? Console a family of a SIDS baby? What will their view of the world be if they are exposed regularly to drug addicts' vomit and foul language while demanding a fix? Yes, that sends a message, but is it the right one? Even the 2 years between 16 and 18 make a difference in maturity or "growing up". We also have movie ratings to keep 16 y/o kids from seeing things that they can be exposed to in EMS. Again, there are those in EMS that is still looking at the profession as just a "few skills" with a little training and not knowledge, education or maturity. At 16, you are already judging calls as BS? What have you learned about patient care?

I did get ruffled by your other post, but I must agree with you on some of this post. I am not naming any service but making a general statement for a few services (ground or air) that just hire people to fill vacancies. Nor am I fond of the Excelsior RN graduate. My service as I stated before, does not give a paramedic/RN the Flight RN position until the he/she has done the required years in ICU. I also have not heard of any of our NICU or PICU nurses being graduates of Excelsior. There were a couple Excelsior RNs in the ED. There are the exceptions out there that make great nurses after Excelsior. But, there are those that don't want to do the clinicals on the med-surg floors which I think provides reality fundamentals in patient care that goes beyond the "medic skills". It is also harder now to find qualified paramedic applicants even though we may get 100 applications for each opening. We saw more degreed paramedics in the 1980s than now. Very few do any prep classes to boost their resume. Very few have even researched what the job is about beyond the nice uniform and the helicopter. Yee Gads! You still have to do patient care??! So now, if you do get picked to be on a flight team and are told you were chosen out of a stack of 100 applicants, can you really consider that a compliment anymore?

RRT, EMT-P HEMS and some interfacility - Paramedic (RSI, central lines - rare, IABP -rare, blood, vent) Another hospital helicopter service does the intense ICU transports. This is my job for the pension plan which I'll have my 20 years with the retirement system very soon. Hospital - NICU/PICU Transport (This is the job I love)- all modes of transport- RSI, NO2, N2, HeO2, all ICU drugs including sedation and paralytic maintenance if necessary, UAC/UVC, PAL, needle and surgical cricothyrotomies, femoral IV insertion, needle chest decompression, IOs, nebulized prostacyclin Chest tube maintenance is part of an RT's job in many places as are IABP, A-lines etc (in Florida)

Professionalism at its finest. :roll:

The only advantage would be to have a baseline EKG when the actual Chest Pain was occurring. Many times the pain and the EKG changes are transient and it is difficult to get good documentation until they are stress tested. I have spent countless hours in the hospital trying to catch an elusive arrythmia, especially for pacemaker qualification, or capture the moment of CP in print. Other than that, ALS or BLS, all EKGs are usually repeated as soon the ER can get set up in most hospitals for serial comparisons.

But the education stuff will give you enough clues about the patient's disease process to know what I meant by broad generalization. No one expects a Paramedic to know all the devices out there, but there are some basic clues to tell how much patency there is by understanding more about anatomy and disease processes. The reason we have ongoing inservices is to provide education to go with some of the mechanical generalizations made in EMT and Paramedic school which sometimes are less than adequate in a technologically changing medical world. Without a solid foundation, it is more difficult to build on. Ever see the results when someone yanked and twisted on a Montgomery Tube because was they thought it was a regular trach tube? It ain't pretty. Education is needed for understanding when to yank, when not to, why and the alternatives. The education will compliment your assessment to determine which way the patency of the airway flows. http://www.bosmed.com/trachbronch/safettube.html Now as far as NHs, between the government cuts and a few greedy NH owners, there is little left in the budget for training or education. And, just like all of the threads here from EMTs who hate doing the NH trucks, nursing has a stigma for some jobs also. Even if they love geriatric medicine, the right RNs will burn out soon in the wrong facilities. Their replacements aren't always the best suited for that job and should be working in facility where there is more supervision of their education and training. The same can be said for some EMTs and Paramedics. The skills paramedics do now might not be in such controversy such as intubation. EMTs and Paramedics get into it because "they can" with little or no requirements and little class time. Sort of an"instant career" as it is advertised by some PDQ Marts.

Expensive indeed. Saw their recent article in the Washington Post. http://www.washingtonpost.com/wp-dyn/conte...7111701025.html

Broad generalized statement that is not always true. There are many different trachs now in the nursing homes especially if they are not on a ventilator that allow more "normal" functions to facilitate weaning. If you see a trach patient wearing a nasal cannula, it does not necessarily mean somebody doesn't know what they are doing. However, it may not have been true for the situation you mentioned, but it is good to ask or know a little be more about recognizing different trachs, various speaking valves and prostetic airways. There are about 300 different airways out there. We try to give frequent inservices to the paramedics that service the area NHs but it always ends up being the paramedic who blew off the inservice that gets the call and mucks up the stoma. If a trach patient accidentally decannulates, a BVM will still work when the stoma is sealed manually until recannulation unless it is a laryngectomy with a tie-off.

There are alot of people on these forums. Most never post. Occasionally something familiar will cause you to check the profile of someone. Company officers and supervisors get interesting email all the time from employees or concerned citizens who have found an employee's profile or posts on the net especially if something about the company is posted. FireGuard69, I'm sure your company already has seen alot of your postings on the net. You are an open book now and have already provided alot of information for anyone to do almost anything with. Although, I did Google "VentMedic" and that is definitely not me, except in the EMS forums. I don't go near snow. And, of course, I would not give my true birthday and age.

I wasn't too sure after rereading the post if zippy was referring to a scope of practice designated by license or a scope that must be confirmed by the medical director. Examples of this would be a medical director of an EMT-B in Texas allowing ETI which is not normally under their certified scope of practice or the paramedics that must call for orders when doing certain procedures.

Just about every profession, both inside and out, of the hospital work under the guidelines of a medical director. However, the RN functioning outside of the hospital can still operate with protocols, including those in their expanded scope, provided by the medical director. This is were I have an issue with ground crews calling shots based on a personality confict and not patient care. We had a county in Florida that went through this. It was pathetic to hear the residents of that county at the meeting begging for a flight service while some members of the local EMS and FD were bad mouthing it. The nearest trauma center for these residents was 170 miles away with a couple of 30 bed hospitals in the area 50 miles apart. Luckily that has now been settled and a good air service has been selected.

For specialty crews such as Neonatal, Pediatric and specialty cardiac centers such as Florida Hospital in Orlando, yes, RRT and RN are common. RRTs do staff a few HEMS services that are usually hospital based such as in North Carolina and a couple on the West coast. However, it is still more cost effective to use the paramedic since their wages are still much lower due to lower education standards and variations in licenses. There is usually no shortage of paramedic applicants for any specialty transports. There is, however, a shortage of qualified applicants. For some, just keeping the basic certifications and passing the background check can be a problem. I do HEMS as a paramedic and Neo/Peds specialty transport as an RRT. My scope is broader on the Neo/Peds specialty team but that is due to the technology and RT meds/gases. As a paramedic, there is little way I could ever have functioned adequately on a high level neonatal team. Just "skills" such as "tubing the baby" are definitely enough. There is a broad educational and knowledge base there as well as years of hands on experience. Many RRTs from the 1980s are/were also paramedics. Those of us early paramedics who got our 2 year degrees in the 1970s or early 1980s, because that was supposed to be the future, were disqusted when then medic mills started spitting out 3 month wonders that were making the same as those who put some interest in learning more than just skills. It also takes 76 more college credits for the EMT-P to RRT transition at the 2 year degree programs. RRT to EMT-P, about 16 - 24 credits, including EMT-B, if the college route is taken. The RRT is 2 year with 4 year preferred. New legislation and bills are now pending to make 4 year the norm for more RRT opportunities. As far as the RRT replacing the paramedic in HEMS, no. Not because of the skills and knowledge but because as every profession, their focus is different. Yes, it would be nice to start our VAP protocol in the field but the ED will suffice. If the RRT has to reintubate with one of the specialty tubes, no problem. For the RRT, just like the paramedic, to maintain proficiency in their field, they must work at it. The technology and protocols change almost weekly in the ICU as we are constantly trying new things to shorten the ICU vent days. For the amount of advanced airway/ventilation stuff in the field as compared to the hospitals, an RRT is better utilized in the hospital. The RRT skills/knowledge would atrophy quickly if based solely outside of the hospital. Can an RRT or RN be trained for HEMS? Of course. We take people with no medical background, push them through a few months of school and call them paramedics. Many of these graduates are then put on an ambulance with little or no additional training. For flight, MD/RN is not a bad idea for some areas and it can work well. For a paramedic to make a statement about any other profession negatively and sometimes including their own, "you don't know what you don't know". Doczilla, You're generalizing all RNs for those specific to your area. RNs that do HEMS and other outside of the hospital transports have an expanded scope in many states. Let me clarify my statement, not independent from a medical director but with protocols designed by the medical director. Independent in that they do not have to call for every order.

Where/when do you give care over to the flight team? Even with extensive education we have EMS crews trying to come in on us as a hot load. This is basically a dump and run from them. Others take total offense when we leave the helicopter to offer suggestions about packaging for safety. Others don't understand why we want to sedate and intubate a combative head trauma before flight. When it is a long distance flight, we don't like to bicker very long about safety protocols for flight. Our response is usually because we are summoned by someone at scene. Most of the time we have no problem with the ground teams. If we have to get our MD involved to talk to their medical control, no problem. In some services that are distant transports, both flight and ground services are dispatched simultaneously. The flight team still will be concerned about safety and that includes the safety of ground EMS. That is why when you live in the boonies, know your local protocols. Who calls and for what, who cancels, when and why. Long distance ground coverage has a slightly different set of rules for reasons I mentioned earlier.

Is this envy or jealousy talking? Emotions such as these can skew any professional assessment or "doing what's right" for the patient. You have CCEMTPs on every ambulance? And no, the paramedic does not get 3 -5 years of hands on working experience in the ICU except for possibly in another country other than the U.S. The initial post concerned both HEMS and gound EMS at scene with a 2 hour ground transport time. It has been a while since I have read such a blatant hate post for flight teams. Usually they are written by one of the applicants that didn't have what it takes to become part of a team, ground or flight. This could be things like education, experience, ambition and the ability to deal with issues without prejudious. Any advice given here could contradict the policies and procedures of his area and HEMS agreement. Bashing flight services just because you don't like where you are, either by area or emotionally, is not a professional attitude to decipher a valid question that was asked. As far as the author of the initial post is concerned you are giving him what he wants to read so he can stroke his paramedic partner's ego later. I am sure there are clear guidelines for this if he was to ask his own superiors or check the county EMS and HEMS agreement. Helicopters don't just fly around looking for a ground EMS crew to pick on. Since this involves long transport time for the patient, maybe it would be appropriate to do what is right for the patient and not the egos. Just check the local protocols and don't make any more of this pissing match between the services.

I got a chance to look at EMS from the other side this past year. I actually had no complaints with the hospital, SNF/convalescent center or the hospice center. The ambulance company on the other hand left me baffled as to where the pride in one's profession has gone. My mother had to endure 5 ambulance rides (1 ALS and 4 BLS) during the month prior to her death. I have considered forming an advocacy group for nursing home patients who have had to be transported by "bored" and/or burnt out EMTs and Paramedics. Dialysis patients would be welcome to join also. I think the final act of inconsideration was when I had to pluck the iPod earphones from the EMTs who where "jammin" out while trying to put my mother on the stretcher and not hearing a word about her pain or discomfort. If she had not been in pain from a recent surgery I would have called a taxi because there are many taxi drivers who offer much more consideration when transporting the elderly especially in Florida. I have offered my services to that ambulance company to teach a couple of their EMT recert courses. I may use the day room at a local nursing home for classes and let the residents do the grading when it comes to assessment skills. Also, you could not pay me enough to be an RN in a nursing home. The patient load and understaffing are bad enough. But, if the RN tries calling the physician for transfer orders and then gets chewed by BLS crew for waiting too long. However, if the RN recognizes early sepsis or AMS and something is not right, bypasses the physician and calls 911 for ALS EMS, he/she will get chewed by the ALS crew for a "BS - BLS" call. There is no winning for the staff at the nursing home. Eventually the RNs that loved geriatric medicine and wanted to make a difference leave and you will find less qualified people willing to work under those circumstances. For those of you that do care about the patients and recognize other professionals as team mates, don't stop.

Who dispatches the helicopter? What are your policies for canceling the helicopter before it lands? What is the cost of a two hour ground transport? How many back up ambulances do you have to allow far a truck to be out of service for 4 hours minimum? How many calls per month over x years has your paramedic done? This sounds like a very rural area with a low call volume. Can your paramedic be absolutely positive the patient won't deteriorate in enroute? Remember, if the patient does deteriorate enroute via ground, the RN will make a great witness. Will this be a "speedy" L/S trip for two hours? What about patient comfort? An ambulance ride is not a lot of fun especially if you are the patient. Does your paramedic have the ability to provide adequate pain management for a two hour trip if necessary? What is your "plan B" if the patient becomes unstable from an unseen internal bleeder in transit with another hour to go? Drive faster? While I agree, helicopters are over used in some areas, but when there is a 2 hour transport involved, some justification can usually be found to fly especially if both services were dispatched simultaneously or by another authority at scene. Granted there are cases like you stated that might be just BLS. Many EMS systems consider the transport time as a criteria for using the helicopter. Some systems stipulate transport times over 30 minutes or 1 hour for calls that were initiated by 911 and require transport may need flight. I would take it that your traveling time to get to each scene is probably fairly long also. You would have to consult with your county and State policies. Many times flights to rural regions are also funded by other means and there is a contractual agreement with the county and state. You can also venture over to www.flightweb.com if you want a whole forum of flight people.

Are both ground and air dispatched by the same service at the same time? I can assure you that an RN who responds via Flight to a scene has advanced training including scene response and is not "just a hospital RN". He/she will probably have the same and more skills than the ground Paramedic as well as 3 - 5 years minimum in an ICU and ED. The skills include intubation including RSI, central lines, IOs and crics. These RNs also come with the whole alphabet soup and usually a BSN. In my area, if the flight team is on scene they call the shots for transport or not and additional sevices. Safety is a concern and many factors must be taken into consideration that the ground crew are not aware of. Weather may detour the crew to another hospital or force them to defer the transport to the ground crew. If the hospital is two hours away by ground, the ground paramedic may not know the specifics of weather and can not make that call even if he/she did. If the patient is in cardiac arrest, the flight team will probably not transport. The exception might be for a cold water drowning of a child. Weight of the patient for smaller aircraft may also have to be considered. We also understand if the ground crew wants to start moving if our ETA is extended. They must try to get another landing zone for the helicopter if they want us to meet up. Again, safety for everybody is a priorty. The Flight team is very aware of many safety factors that the ground crew may not be. (yes, I am repeating SAFETY again) The flight team also knows their advanced capabilities better. Since this is even being questioned by members of the ground team indicates that they are not familiar with the services and abilities of the flight crew. If might be time your ground EMS had an inservice by the Flight team. This would also be the best way to get a handle on the specifics of scene management. Each area has a few different quirks in their policies. Not knowing the specifics of your ground EMS, Flight team, local and state policies, it is difficult to give you any more specific information. Just starting the helicopter is expensive. We do not allow money influence our decision. Delay in definitive care may be way more costly in the long run. One must also understand the limitations of on scene diagnostics and lack of specific diagnostic equipment. Another interesting fact for many flight services; if a paramedic gets his/her RN license, he/she still can not apply for the Flight RN position until they have finished a minimum of 3-5 years in the ICU/ED. An RN in Florida can challenge the Paramedic exam.