Who is the highest level of care?

[Mateo_1387]

This same ambulance medic is not concerned with flight weather, as he wants to ground the patient and believes there is no problem with this. The flight RN, wants to fly the patient, and disagrees with the assessment of the Medic. Who gets to make the final transport decision??? I believe its the RN, but I just don't know for sure. Can someone provide me with some valid basis as to whether I am right or wrong?

Think of it this way. If you can't figure out who gets the patient based on each one's assessment (which should be the same) then put it on a doctor's shoulders. You both answer to one, so present the picture to them and let them decide. Should you not be in Contact with Medical Control then I say the decision rests on the First patient contact crew. I don't care if it’s the RN or the MEDIC. You both have the training to identify and deal with injuries, and the if the MEDIC got onscene and cancelled the helicopter, then there is no difference than if he cancelled him before he landed or after he arrives on scene. I say let the first onscene decide if yo can't reach medical control.

[VentMedic]

With this said, only a fool would squander the additional knowledge, tools, equipment, supplies and therapies the flight crew can offer. One of the reasons this sometimes occurs is that a history of arrogance and criticism of EMS and Fire by the flight crews. This is especially true in our area where virtually without fail they are arrogant, ungrateful and exude an omnipotent persona that offends pretty much all of the "less lofty" terra firma bound providers. These folks are hated and every attempt is made to call other flight services when possible. Problem is they are virtually the only game in town. .

Is this envy or jealousy talking? Emotions such as these can skew any professional assessment or "doing what's right" for the patient.

Beyond this we carry the same critical care medications, same therapies, and have the same critical care training as the flight crews. In this situation the CCEMTP on scene retains patient care authority until transferred to the flight crew..

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.

I mentioned relatively faster transport times because if calling for the chopper is delayed until the EMS unit reaches the scene there are many instances where ground transport is faster if the patient is treated as a "load and go" We must also remember the risk of helicopter evacuation. Unfamiliar terrain, overhead obstructions, scene debris that may become airborne and threaten the aircraft and bystanders are but a few considerations. These risks must be weighed against the actual benefit of minutes saved. In very rural area such as where spenac works helicopter evac of even mildly serious medical emergency patients may be warranted..

The initial post concerned both HEMS and gound EMS at scene with a 2 hour ground transport time.

Turf battles are inherent in highly emotional situations such as EMS. These are worsened by people of poor character who have been lucky enough to be selected for highly honored flight positions. Hopefully the old guard of the hateful, arrogant fools will “die out” or leave these services sooner rather than later.

Finally, I would caution providers against the assumption that just because someone flew into your scene on a helicopter and has RN or CCEMTP on their name badge doesn’t make them uniquely qualified to deliver better care. I have witnessed egregious errors on the part of flight nurses, potentially life ending errors for the patient that was never pursued by the powers that be. We are all human, in spite of the flightsuit and arrogant attitude, they are too.

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.

[n0ssb]

I love Flight Crews, Though What I do is different than anyone else in the City( Work Search and Rescue), We have used Civilians flights as needed, but usually use Miliary (MAST) crews for med help/assistance on Searches..

We salute all the Flight Paragods and Nurses and of course the Pilots of the Choppers

[spenac]

Until I turn care over I am the highest level. I am the patients advocate. Once I turn care over they are in charge. No egos, just the facts.

[VentMedic]

Until I turn care over I am the highest level. I am the patients advocate. Once I turn care over they are in charge. No egos, just the facts.

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.

[Scaramedic]

Wow, in all my years I have never had a problem with flight crews. No ego trips, no fights over care, nothing.

In fact the only time I have ever seen a problem was between a fire crew and a flight crew when I was third riding for my Medic. Fire Paramedic didn't feel an unresponsive trauma needed a tube. Flight crew arrived and went to intubate and found the patients trachea was completely severed from hitting the steering wheel, no seatbelt. Patient arrested soon after while a cric was being set up.

Flight crew was understandably pissed at the FD who was bagging the patient and not noticing the air was just going into the neck (SQ emphysema). Screaming and cursing ensued. We were finished with helping out with the other pts and watched the hilarity.

Oh, in case your wondering it was a call outside our district and in Fire's territory so we were not involved except for helping with other patients. Fire wanted the really cool trauma. :roll:

It was cool to see SQ emphysema though. Snap crackle pop.

[Scaramedic]

One further thought as far as safety goes. I do my report in the back of my rig, help the crew move the patient to their stretcher and then let them have the patient. Homey don't do hot loads. I am 6'3" those blades are just a little close to my head for comfort. :shock:

[zippyRN]

The Flight RN. EMS is ultimately not a democracy.

'zilla

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

[spenac]

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.

The flight crew is in charge when they take over care. I always invite them into my truck to see what they have, rather than rushing patient over to them. If they need/want to do anything to the patient in my ambulance, I assist or get out of the way, their preference. I understand they have a tighter area to work so I offer as much help as I can. But again I am in charge until they take patient care over.

[captainstandup]

There was no attempt on my part to hide my disdain for SOME flight crews. You may join others in helicopter worship if you wish. The point I was trying to make is that just because an RN arrived via helicopter doesn't make him / her the final authority on proper treatment of every patient. The greatest percentage of flight calls in our region are interfacility transfer. Probably 90% of the time they are called all critical skills have been completed and all the patient requires is a ride to the hospital with ongoing support

Your inference that these folks possess higher training or experience is, at least in this instance, inaccurate. I went through Paramedic School with three of them and later to Critical Care School. We have exactly the same clinical background, difference is that I actually use my skills because we, the ground transport team, aren't always grounded for maintainance or fog or lack of interest. 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.

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.

I spent way too long hacking on helicopter folks and didn't mean to. The point I was trying to make is a nurse is a nurse is a nurse and there will be those incredibly competent providers that bring to the table an excellent ability to care for sick and injured folks, On the other hand there are the gorgeous, blue eyed big boobed, striking appearance nurses that were hired for PR and personal reasons rather than clinical ability.

Take care of the patients regardless of who or how many alphabet acronyms they possess. Until you relinquish care they are merely an additional tool on scene