Who is the highest level of care?

[spenac]

On the other hand, there are services west of us and to the south that are competent, kind, grateful to ground folks and always humble. In this service, even the pilots show respect to others. There exists no desire for hero worship and they actually care about the patients rather that feeding their ego's.

Thankfully those I deal with are cool. We all work together.

[akroeze]

That's why I like Ontario's system. Except for neonatal transfers, all our choppers and planes are staffed by Paramedics. Therefore it is easy to tell who is the "highest" level of care.

Primary Care Paramedic crew and Advanced Care Paramedic flight? They are

Advanced Care Paramedic crew and Advanced Care Paramedic flight? First on scene except when it comes to flight safety stuff

Advanced Care Paramedic crew and Critical Care Paramedic flight? They are

[captainstandup]

I'm happy to learn Canada staffs flight crews with Paramedics. There exists, in the US anyway, what seems to be a veiled attempt to eliminate Paramedics from rotorwing services. Many now utilize RN / Respiratory Therapist crews and as I understand it, this may become the norm.

[ERDoc]

The main flight service where I am at uses an MD/RN crew.

[captainstandup]

I suppose there is little confusion regarding patient care authority there?

[spenac]

The main flight service where I am at uses an MD/RN crew.

Now theres a pair that need to stay in the comforts of the hospital and let paramedics do what needs done. :wink:

[Doczilla]

remember the big R in the front of RN = Registered , the RN is a health professional with their own scope of practice rather than certified staff who rely on being employed by a service and having a medical director

On this side of the pond, the RN's independent scope of practice does not include many of the medications and procedures necessary for the prehospital environment. Our flight service (all RN) has a medical director and protocols and requires online medical direction.

'zilla

[VentMedic]

I'm happy to learn Canada staffs flight crews with Paramedics. There exists, in the US anyway, what seems to be a veiled attempt to eliminate Paramedics from rotorwing services. Many now utilize RN / Respiratory Therapist crews and as I understand it, this may become the norm.

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.

[chbare]

Where I fly, I have more freedom than I do working in the hospital; however, I still work under guidelines and a medical director. I do not know of any flight services where RN's are independent practitioners. My scope of practice is dictated by my medical director. What service uses RN's that do not work under the guidance of medical direction?

On to the original topic? I have never experienced this problem and I an unaware of this being a problem with other crews I know. We have had situations were flight crews thought flying was inappropriate, but the ground wanted the patient flown. Not the other way around. :-k

Take care,

chbare.

[VentMedic]

Where I fly, I have more freedom than I do working in the hospital; however, I still work under guidelines and a medical director. I do not know of any flight services where RN's are independent practitioners. My scope of practice is dictated by my medical director. What service uses RN's that do not work under the guidance of medical direction?

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.

I have had on three occasions to transfer to the flight crew and passed on it due to my personal dislike for the system as it is and the organizational culture.

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.