CCP in a 911 Setting

[NPO]

Does anyone have examples of agencies that recognize Critical Care Paramedics, and but they function in a primarily 911 setting? How does it work? What extra functions are they given?

My agency does not recognize anything above Paramedic, but I'd like to pitch to them to make Critical Care Paramedic another step, but I don't know what to say to make that step unique.

One obvious thing would be RSI. Currently all ambulances carry Ketamine and Etomidate, but only supervisors carry paralytics. Perhaps certified CCP-Cs could be permitted to carry paralytics too.

(The argument for all medics carrying paralytics is going to be harder to make).

 

[RocketMedic]

We officially call our supervisors '"critical care medics" but its effectively the same as everyone else's normal medic. Only exception is blood, which is still protocol-driven.

 

[Tigger]

We have two but are currently do not have expanded guidelines for them to follow. The idea is that they will be able to take more transfers out of the local hospital that usually go by flight, with the use of the hospital's medications and our guidelines. Currently there is no push for expanded scope for them in the 911 setting, through waivers we have chosen to get all of our paramedics CCT level interventions that are felt to be crucial for our area (RSI, tPA transports, etc).

 

[StCEMT]

Being a critical care medic here simply expands the hospital transfers you can do. There is no official carry over into 911, although I believe I have heard mention that it has in the past in a pinch. Otherwise no, although I was talking about it the other night. I'd be interested to see it potentially do so, the few here I am friends with and talk to regularly are incredibly smart people.

 

[DesertMedic66]

Have you determined the need for a CCP position? If you are looking into a couple of additional skills or medications it will probably be more simple to try to get those added to the current scope instead of creating an entirely new position.

As others have already stated the majority of CCPs are used for IFTs because it allows them to take a greater number of medications/vents/IABP/art lines/PA caths/impellas/chest tubes/vent/EVDs/etc which are items you don’t usually need to worry about in the 911 setting (aside from vents)

 

[NPO]

Have you determined the need for a CCP position? If you are looking into a couple of additional skills or medications it will probably be more simple to try to get those added to the current scope instead of creating an entirely new position.

As others have already stated the majority of CCPs are used for IFTs because it allows them to take a greater number of medications/vents/IABP/art lines/PA caths/impellas/chest tubes/vent/EVDs/etc which are items you don’t usually need to worry about in the 911 setting (aside from vents)

We are free to add any medication or skill to our scope that we choose.

Additionally, we can already take any medication on transfer. The reason I'd like to see CCP be recognized is to encourage more of my coworkers down the path of higher education.

 

[DrParasite]

in NJ, all providers can RSI, provided your medical directors approves its use.
in NC, the majority can't, as most medical directors don't allow it (at least to the best of my knowledge). But it is still taught in the paramedic curriculum.

I guess the question I would ask is why become a CCP in a 911 settings? I have no problem with the education, provided it is applicable to the job. Using @DesertMedic66's list of medications/vents/IABP/art lines/PA caths/impellas/chest tubes/vent/EVDs/etc , I'm assuming that is all maintaining existing items right? not starting new ones in a patient who needs them.

education is rarely a bad thing, provided it is directly beneficial to the job that is being done (meaning, you can go to medical school, or PA school, which gives you a lot of knowledge, but when you are working as a paramedic, you are just a really well educated paramedic, and need to act and function as a paramedic, including all the limitations that come with it, despite your advanced education)

Wake County EMS has their Advance Practice Paramedics, which have some more leeway in terms of patient destinations, and perform community paramedicine, but their scope of practice is the same as a regular paramedic within the system.

Helicopter flight medics might be a good comparison. take what they can do, and apply it to a ground medic (to be honest, i don't know what more they can do, but i thought their scope was more than just a standard paramedic). Take whatever they can do for a scene job, and let the CCP medic do it.

I guess my other question would be, what 911 calls would a CCP be better suited than a regular 911 paramedic? are their any?

 

[NPO]

I guess my other question would be, what 911 calls would a CCP be better suited than a regular 911 paramedic? are their any?

None, really. We are a primarily 911 agency, but as the exclusive area provider we do our share of IFT.

As I alluded to before, we have almost no restrictions on us for IFTs. Every ambulance has a vent and we can take any medication on IFT. We don't often see advanced equipment, although we have the occasion balloon pump. Our local hospital is more of a regional hospital with a Cath Lab.

Because we have so few restrictions I think we should have a CCP program. Also, as a smaller agency, we have an issue with opportunities for advancement and I think if given the opportunity, several medics would take the CCP route.

Fundamentally, probably not a lot would change (other than like I said, RSI) but I think the education would be good, and to be honest, I am seeking my CCP-C and would like recognition of earning it.

 

[DesertMedic66]

It really doesn’t sound like there would be any benefit of creating a CCP position because you guys don’t have any restrictions currently. Since a CCP position wouldn’t expand what you can do so there is no real incentive for employees to get CCP or for your company to pay extra for it.

The CCP-C and FP-C certificate only means you can pass a test and nothing more than that. It has no bearing or prove that you have the educational standards/critical thinking to do critical care transports. I passed the FP-C (same exact test as CCP just with flight operations mixed in) as a ground 911 in a restrictive system in SoCal with no critical care experience and only a review course and self study.

 

[RocketMedic]

None, really. We are a primarily 911 agency, but as the exclusive area provider we do our share of IFT.

As I alluded to before, we have almost no restrictions on us for IFTs. Every ambulance has a vent and we can take any medication on IFT. We don't often see advanced equipment, although we have the occasion balloon pump. Our local hospital is more of a regional hospital with a Cath Lab.

Because we have so few restrictions I think we should have a CCP program. Also, as a smaller agency, we have an issue with opportunities for advancement and I think if given the opportunity, several medics would take the CCP route.

Fundamentally, probably not a lot would change (other than like I said, RSI) but I think the education would be good, and to be honest, I am seeking my CCP-C and would like recognition of earning it.

Where you at?

 

[NPO]

Where you at?

Missouri

 

[Jim37F]

Just peanut gallery here, but maybe a CCP medic program could include not just vents and super advanced meds and whatnot over a regular medic, but things like (due to more education) take ETOH Pts directly to sobering centers and/or Psych Pts directly to mental health facilities vs the ER? Or suture small minor wounds on scene and prevent a transport in the first place? Or at least low acuity Pts to an Urgent Care Center?

If your agency has (at least a perceived) problem with lots of low acuity "sub BLS" calls, maybe they could handle that until the 1 of a handful calls a year where they can go and do an advanced Vent or blood or meds or whatever the "normal" medics don't carry that you want to add?

I know there's a handful of places that use NPs or PAs on this concept, but maybe you can convince the powers that be to add in a CCP medic to fill that ambulance based role instead?

 

[DesertMedic66]

Just peanut gallery here, but maybe a CCP medic program could include not just vents and super advanced meds and whatnot over a regular medic, but things like (due to more education) take ETOH Pts directly to sobering centers and/or Psych Pts directly to mental health facilities vs the ER? Or suture small minor wounds on scene and prevent a transport in the first place? Or at least low acuity Pts to an Urgent Care Center?

If your agency has (at least a perceived) problem with lots of low acuity "sub BLS" calls, maybe they could handle that until the 1 of a handful calls a year where they can go and do an advanced Vent or blood or meds or whatever the "normal" medics don't carry that you want to add?

I know there's a handful of places that use NPs or PAs on this concept, but maybe you can convince the powers that be to add in a CCP medic to fill that ambulance based role instead?

That would be a very easy way to keep people from becoming critical care paramedics. The critical care providers that I know have all gone that route because of the greater patient acuity, critical thinking, enhanced formulatory, and additional skills. Tasking them with the calls that a lot of them are trying to avoid will not lead to good things.

Those are all functions that could easily be added to a traditional medic scope as none of them require critical thinking.

If I went from being a 911 provider dealing with psychs, drunks, and other low acuity patient to a critical care provider and being tasked with dealing primarily with those patients, I would be out faster than a Democrat at the Trump hotel.

 

[Tigger]

Just peanut gallery here, but maybe a CCP medic program could include not just vents and super advanced meds and whatnot over a regular medic, but things like (due to more education) take ETOH Pts directly to sobering centers and/or Psych Pts directly to mental health facilities vs the ER? Or suture small minor wounds on scene and prevent a transport in the first place? Or at least low acuity Pts to an Urgent Care Center?

If your agency has (at least a perceived) problem with lots of low acuity "sub BLS" calls, maybe they could handle that until the 1 of a handful calls a year where they can go and do an advanced Vent or blood or meds or whatever the "normal" medics don't carry that you want to add?

I know there's a handful of places that use NPs or PAs on this concept, but maybe you can convince the powers that be to add in a CCP medic to fill that ambulance based role instead?

The same testing body that provides the FP-C test also now does a CP-C (community paramedic). Those knowledge paths are very, very divergent.

 

[NPO]

Just peanut gallery here, but maybe a CCP medic program could include not just vents and super advanced meds and whatnot over a regular medic, but things like (due to more education) take ETOH Pts directly to sobering centers and/or Psych Pts directly to mental health facilities vs the ER? Or suture small minor wounds on scene and prevent a transport in the first place? Or at least low acuity Pts to an Urgent Care Center?

If your agency has (at least a perceived) problem with lots of low acuity "sub BLS" calls, maybe they could handle that until the 1 of a handful calls a year where they can go and do an advanced Vent or blood or meds or whatever the "normal" medics don't carry that you want to add?

I know there's a handful of places that use NPs or PAs on this concept, but maybe you can convince the powers that be to add in a CCP medic to fill that ambulance based role instead?

What you're describing is much more in line with the role of a community paramedic. We are actually exploring that too. We have one medic in a community paramedic class so that we can start up a program soon.

Unfortunately, we don't have any alternative destinations in county, except perhaps urgent care. All of our psych patients get transferred out of county (by a process we call MHT mental health transport, usually just an EMT or Paramedic solo in a Dodge Charger with a prisoner cage in the back seat, for lack of better terminology).

I'm not sure how we are going to deploy our community paramedic, probably aiming at reducing the use for non-emergent use of 911, but exactly how I'm not sure.

As I kind of figured, it seems like there's not a lot of room for a CCP at my agency since we already have few restrictions. I was just curious to see how other places are using them to see if it would spark any ideas.

 

[Tigger]

As I kind of figured, it seems like there's not a lot of room for a CCP at my agency since we already have few restrictions. I was just curious to see how other places are using them to see if it would spark any ideas.

It is reasonably helpful in states with limiting scopes of practice (which of course not all states even have). The baseline "acts allowed" in Colorado are what you'd probably call decent, but adding things to agency guidelines takes a long and rather difficult waiver process. Agencies that have state endorsed critical care providers have access to very broad "acts allowed" and provided that they have medical director approved guidelines for such interventions, can use most of all of them in a 911 setting.

As always, the lack of continuity between state EMS governorship is...difficult.

 

[StCEMT]

Saw on a UK documentary where psychs have a PD/Psych specialist (forget the title)/medic combo and they work in a similar fashion. That'd be a neat concept to test.

 

[Tigger]

Saw on a UK documentary where psychs have a PD/Psych specialist (forget the title)/medic combo and they work in a similar fashion. That'd be a neat concept to test.

We have several flavors of that regionally. Medic/Social Worker/Cop, Cop/Social Worker, and us Medic with some extra training meeting cops on scene. It's great, but there is no crossover between critical care and that.

 

[NPO]

Yeah, my state also just passed a law allowing Paramedics to get special training that'll allow us to place psychiatric holds so we don't have to wait on/rely on law enforcement.

 

[RocketMedic]

I have very little clinical interest in psychiatric care. Necessary, but not my cup of tea.