Who is the highest level of care?

[Scaramedic]

My post was towards Paraloco Vent, I have no doubts about your qualifications.

[ERDoc]

a helicopter is an ambulance. If I have to call one, I call them for a specific patient. They are not going to land, then re-triage. I called you here to take this guy. Load him and leave. the only thing you have to offer is speed. so offer it. I actually had this problem with flight crews from a prominent service in the Houston area. we corrected the problem.

To which the flight crew should respond, "You called us to turn over pt care to someone of equal or higher training. We are assuming care for this pt. It is our responsibility to do our own assessment to properly care for the pt and fix the things that you missed. Thanks for thinking you are able to tell us how to do our job."

[paraloco]

Early in my career, the helicopters were usually staffed by 2 rn's, sometimes an rn and a medic. The RN's were BSRN's with years of experience prior to their flight jobs. The medics were handpicked, underwent vigorous training. When they landed, you knew you were handing a patient over to a homerun hitter. Those folks are gone, they moved on to other things. The flight crews now are mostly field medics who got tired of the grind on the street, or medics who got their Excelsior RN and didn't like working in the hospital. They attend the same CE's, have the same or very similar protocols. WHere I work, we very rarely need a helicopter, due to short transport times. The only time we do anymore is for critical burns. We send those straight to a burn center. The incidents I alluded to in my post were from about 10 years ago, in a town about 30 minutes by ground from a large medical center in a very large city. In my area, we don't look up to the crews like we did 20 years ago. Cuz they are us. In your area, it may be different. If I offended anyone, I apologize. If you want particulars about why I posted what I did, PM me.

[captainstandup]

Although I work for a ground critical care service, It's is inconceivable that anyone with even rudimentary understanding of patient care would expect the flight crew to simply load and leave. Its important to remember once the flight crew accepts care of the patient, they are accepting the total package. There is no way in hell I would accept responsibility for a patient based soley on a report from someone else.

I have tremendous respect for fellow EMS folks but there are a few things I'm taking a look at, such as, but not limited to: Airway patency and status, based on my criteria for intervention, work of breathing, circulatory status and need for intervention, Initial neuro status and disability, breath sounds and ETT placement if intubated, appropriatness of immobilization, IV patency, Monitoring data, SpO2, EtCO2, EKG, BP and Pulse

[flight-lp]

Early in my career, the helicopters were usually staffed by 2 rn's, sometimes an rn and a medic. The RN's were BSRN's with years of experience prior to their flight jobs. The medics were handpicked, underwent vigorous training. When they landed, you knew you were handing a patient over to a homerun hitter. Those folks are gone, they moved on to other things. The flight crews now are mostly field medics who got tired of the grind on the street, or medics who got their Excelsior RN and didn't like working in the hospital. They attend the same CE's, have the same or very similar protocols. WHere I work, we very rarely need a helicopter, due to short transport times. The only time we do anymore is for critical burns. We send those straight to a burn center. The incidents I alluded to in my post were from about 10 years ago, in a town about 30 minutes by ground from a large medical center in a very large city. In my area, we don't look up to the crews like we did 20 years ago. Cuz they are us. In your area, it may be different. If I offended anyone, I apologize. If you want particulars about why I posted what I did, PM me.

I'd be interested in knowing what your beef with Hermann Life Flight is. Shoot me a PM.......

[VentMedic]

Early in my career, the helicopters were usually staffed by 2 rn's, sometimes an rn and a medic. The RN's were BSRN's with years of experience prior to their flight jobs. The medics were handpicked, underwent vigorous training. When they landed, you knew you were handing a patient over to a homerun hitter. Those folks are gone, they moved on to other things. The flight crews now are mostly field medics who got tired of the grind on the street, or medics who got their Excelsior RN and didn't like working in the hospital. They attend the same CE's, have the same or very similar protocols. WHere I work, we very rarely need a helicopter, due to short transport times. The only time we do anymore is for critical burns. We send those straight to a burn center. The incidents I alluded to in my post were from about 10 years ago, in a town about 30 minutes by ground from a large medical center in a very large city. In my area, we don't look up to the crews like we did 20 years ago. Cuz they are us. In your area, it may be different. If I offended anyone, I apologize. If you want particulars about why I posted what I did, PM me.

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?

[captainstandup]

I had considered the Excelsior RN program just as a way off the ambulance. Nursing schools here are so politically charged and "anti-male" that its really difficult to gain admission regardless of my previous education and honors society status. Add this to the fact that greater nursing has a vested interest in perpetuating the "nursing shortage farce" In NC the board of nursing has been fairly successful in keeping paramedics out of the ER's in order to protect their turf.

Before the nurses jump on me (like a pack of wolves) about quality of education crap or selecting the best candidates, give me a break! I can match "pedigrees" with pretty much anyone with less than a Masters Degree and have almost 16 years of caring for the sick and injured, and doing so without a net. Regardless of your education or ability, unless we kiss the "ring" of the nursing powers that be, paramedics aren't invited nor are they welcome.

[Richard B the EMT]

I had mentioned that, in the "Do You Take Vitals" string, that I got into trouble because the extended medical facility RN complained that I was taking vital signs, which seemed to them to be an affront to their "authority".

As far as I am concerned, if I am turning a patient over to anyone, from my agency, from another agency, a flight crew, paramedics, flight nurse, or the occasional in-the-flesh Flight

Surgeon, if they don't do even a quick re-evaluation, something is wrong.

Figure it this way, even if it is only a moment apart: "This was the vital signs of the patient in the immediate past, from the other crew. From when I took over responsibility for this patient, has anything changed, for good or bad?"

We all know, or should know, a patient's condition can change in a very short time period, so, even when you are still unwrapping a BP Cuff from the patient, and start presenting to whoever assumes the responsibility for that patient, they will be starting their care as they relieve you.

It should NEVER be "This patient is mine until you close the doors between us and yourselves in your conveyance for the patient to the ED".

(PS: When a Certified First Responder-Defibrillation Engine company has made it to my scenes prior to my arrival, I make a point of telling them "I am going to take my own set of vitals, compare it to yours, and see if anything has changed from when you took them. Thanks for the baseline set of vitals.")

[zippyRN]

I had considered the Excelsior RN program just as a way off the ambulance. Nursing schools here are so politically charged and "anti-male" that its really difficult to gain admission regardless of my previous education and honors society status. Add this to the fact that greater nursing has a vested interest in perpetuating the "nursing shortage farce" In NC the board of nursing has been fairly successful in keeping paramedics out of the ER's in order to protect their turf.

<snip>

you are C.V Compton Shaw and i claim my 5 currency denomination note

[firefighter14emt]

It would be the Flight RN. In an ALS situation, you transfer authority of patient care to the higher trained individual on scene.