Strictly Drivers!

[Mateo_1387]

PAs and Dentists can also challenge the Paramedic exam in Florida. So there are ways to find the loopholes.

There are a lot of overlapping training and education in other professions that meet or exceed the EMT-B and EMT-P but don't get recognized as such.

Now that is surprising. A dentist can challenge the EMT-P exam.

I am curious about the overlapping of education that exceeds and EMT-P Training that should allow them to challenge the paramedic exam. The only ones I could really think of would be certain MD's, Certain PA's, and certain RN's. I say certain meaning that they would be working with acutely ill patient such as an SICU, or maybe ED.

[VentMedic]

Most of the specialty transport RNs and RRTs have the same plus many more skills and much more education than a Paramedic. They work from protocols on calls that can take several hours. The things missing would involve extrication and scene safety although they do get survival, vehicle and helicopter training. They are also well versed in immobilization and restraints within their specialty.

[Mateo_1387]

Most of the specialty transport RNs and RRTs have the same plus many more skills and much more education than a Paramedic. They work from protocols on calls that can take several hours. The things missing would involve extrication and scene safety although they do get survival, vehicle and helicopter training. They are also well versed in immobilization and restraints within their specialty.

What can RRT's do skill wise?

So pretty much my list was accurate? I have met level IV RN's (this may just be a NC thing, I am not sure) who have an extensive scope of practice, and are usually the ones working on Helicopters or critical care transports. On the other hand I have definitely met some RN's, who just do ER nursing, who do a great job, but would not be suited to working in an ambulance. Of course, there are plenty of people already in EMS not suited for the job either.

I always thought of EMS and Paramedics as a beast of their own. I know some training overlaps, but that should not mean every RN, MD, and PA should be able to be a paramedic by just passing a test. Just certain ones. I really have a problem with a Dentist working on my grandparents, or a Dermatologist working on my Father. Now a level IV Critical Care RN who has ICU experience and years of acute nursing experience, I would rather see them working on my family than a lot of career medics.

I would like to see EMS one day get their own and be able to hold their own, the way other health care professions have.

Thanks for the quick reply VentMedic.

[VentMedic]

I always thought of EMS and Paramedics as a beast of their own. I know some training overlaps, but that should not mean every RN, MD, and PA should be able to be a paramedic by just passing a test.

The same could be said for some Paramedics that try to pass themselves off as "Critical Care" after just a short Critical care course. RRTs and RNs will spend easily 2x the number of total hours covered in a CCEMT-P course on each of the topics in just their Intro to Critical Care orientation. RRTs cover hemodynamics (and balloon pumps) over several college semesters.

What can RRT's do skill wise?

My scope of practice as an RRT is open ended to which the state allows my medical director to determine what I can do in the hospital and outside. My scope as a Paramedic is determined and limited by the state as well as the medical director.

Skills:

IVs

ECGs

Hemodynamic monitoring

A-line placement

UAC/UVC placement

Intubation

Rapid Sequence Intubation

Needle and surgical cricothyrotomies

Femoral and external jugular IV insertion

Needle chest decompression

External pacing and monitoring of Internal pacing

Intraosseous placement

Monitoring of Intra Aortic Balloon Counterpulsation

and of course ventilators as well as all the basic nursing and RT stuff which paramedics rarely ever see.

ECMO can also be included for the few facilities that do it.

On transport we can do all meds that a nurse can do as well as those specific to RT. Many of these meds a Paramedic will not be exposed to at all. (You should also consider yourself, as a Paramedic, very lucky on that part.)

A Paramedic would not be wise to challenge other professionals solely based on skills. Even the med-surg RN would never be able to list all of their "skills" very easily. All a paramedic may have to do is look at their school check off list or their skills practical exam. Most Paramedic state statutes also, embarrassingly, list the skills like "BVM" and nasal airway. I could also put those under my RT list. Those just come with the RRT title with the accredited education and don't have to be listed in the RT statutes.

As so many threads have stated, the paramedic program comes down to "hours" of training. It is very easy to take well educated individuals and expand their knowledge base and "skills". RNs and RRTs work in the hospital with access to many patients and doctors. If their medical director wants to broaden their scope into a CCT, how long do you think it would take them to get 10 - 20 intubations? I can get 3 - 5 intubations as an RRT in one shift when carrying the code and ED beeper. Rarely must we go to the OR for intubations unless we need serious remedial training. RRTs' medical directors are usually Pulmonologists, Intensivists or Anesthesiologists.

There are practicing Paramedics who barely get 10 intubations/year. Some that are on the CCT trucks that may not get any if they are private.

Transport RNs and RRTs will also usually have a minimum of a Bachelors degree in their professions. Many of these professionals will spend 100 - 200 hours/yrs just maintaining their specialty certificates and mandatory CEUs. Even a 700 hour Paramedic class would not be a stretch. If you take out the 10th grade A&P and pharmacology as well as the IV and ECG stuff...what or how many "hours of training" is left?

The basics of education and training have similarities, the application is very different.

Not all Paramedics, RRTs and RNs choose to do the "exciting stuff". Thank goodness for those that do want to do med-surg, industrial safety, asthma clinics, routine ALS interfacility etc.

Also, just like EMS, RN and RRTs will have their skills and responsibilities varied greatly from hospital to hospital.

Example of one of Florida's Flight teams although this team only does adults. They have separate teams for Peds and NICU which are also RN/RRT.

http://www.flhosp.org/services/floridaflight1/index.htm

I don't agree with the challenge either but if EMS would take note of the other professions that closed the loophole by education minimums, it wouldn't keep happening.

BTW, the Canadian RRTs by far out shine the U.S. RRTs also. Their educational standards have been much higher for years.

[JPINFV]

I believe in California, CCT is EMT-B and RN in some areas. The EMT-B has an expanded scope of "advanced equipment setting up".

Either I'm grossly misusing the term CCT or something else. At the company that I worked for, if the patient was on a vent, an RT was sent (transfer to/from sub acute, hospital transfers, even in one case a vent patient being taken care of at home) in addition to the two EMT-Bs. The decision to involve one of the RTs on a call was completely independent of if a transport required a RN for other reasons.

[Don1977]

PA one EMT and one has to be at least CPR certified, but a person w/ CPR and medic together is illegal

[VentMedic]

Some Northern California private ambulance companies utilize RN and EMTs. Usually there are two since it is rare to have just a driver. I have on rare occasions seen a Paramedic patch but they do the same as the EMTs which is setting up equipment. The RN does the rest. One hospital system is now starting their own ambulance service for their interfacility. I believe the configuration will remain RN/EMT(s) since the RNs are already CCT trained. Only if the patient is difficult to manage or requires special ventilation or respiratory meds will an RT accompany on those. They run their RTs lean in that part of the country.

REACH uses RRTs or used to. Some have found their way back to the ICUs on the "ground".

[copamedic1]

The two services I work for , here in mississippi, each truck is staffed with a medic and most of the time, an EMS-D. only requirement for ems-d , is to have passed a ambulance driving course. one service is hospital based, and the other is county owned.

[iMac]

Interesting. You have 2 EMS crews here. Regardless of the level of care that crew can give, he/she is a registered and licenced member. You require a special driver's licence here. Regardless of it being an EMT or FF you have someone who is licenced driving.

[WestSideBorderPatrol]

The private service I work for also operates in Delaware. To be a driver in DE, all you need to have is CPR. However in Maryland you need to be to be a FF or EMT and have EVOC.