Critical Care Paramedic

Craig Alan Evans

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I was just shown this slide during a critical care paramedic course. Thought it was worth sharing.
 
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Veneficus

Forum Chief
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Somebody has to carry the gear and drive.

Otherwise it wouldn't be "transport." :)
 

VFlutter

Flight Nurse
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Eh I agree to an extent. It really depends what you define as a "Critical Care Patient". I think the major issue would be IFT of critical care patients. How many "street" medics would truly feel comfortable transporting an IABP patient maxed out on 3 different pressors or a SAH patient with a ventriculostomy, etc.

That is where the CCEMTP makes the most sense. Familiarizing medics with those types of patients and equipment. Is there a real benefit of a CCEMTP in normal 911?

And yes, In an CCT environment the Basic would pretty much do just that. How many CCT teams even use basics? Most are Medic/Medic or Medic/RN/RRT
 
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Veneficus

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I have a question.

Since we know that response times play almost no role in outcome, do not save significant time during transport, driving lights and sirens increases the chance of a MVA, and generally the equipment and patient are not conducive to bouncing down degraded roads at 60 mph, why do critical care transport ambulances even have lights and sirens?
 

VFlutter

Flight Nurse
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Appearance and tradition. Why even use ambulances for CCT? Just fly them all
 

Veneficus

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Appearance and tradition. Why even use ambulances for CCT? Just fly them all

But what if it is raining?

"If there is a cloud in the sky airmed don't fly."
 

Aidey

Community Leader Emeritus
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Lol Vene. One of our HEMS once refused a flight because the dew point was too high.*

Our main local CCT agency does heilo, fixed wing and ground. Flight doesn't always make sense due to pt condition, size or location.




*It may have been super bowl Sunday... But I'm sure that is just coincidence.
 

NomadicMedic

I know a guy who knows a guy.
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Our joke is, aviation doesn't fly if there is a cloud in a 200 mile radius.

Then they :censored::censored::censored::censored::censored: when we don't call them.

I might or might not have had this exchange over the radio...

"Dispatch, can I have the status on aviation?"

"they state available, would you like them to respond?"

"negative, just checking. I need an incident number for a patient refusal."
 

abckidsmom

Dances with Patients
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Our joke is, aviation doesn't fly if there is a cloud in a 200 mile radius.

Then they :censored::censored::censored::censored::censored: when we don't call them.

I might or might not have had this exchange over the radio...

"Dispatch, can I have the status on aviation?"

"they state available, would you like them to respond?"

"negative, just checking. I need an incident number for a patient refusal."

Lol. I think I am gonna try that one. Awesome.
 

abckidsmom

Dances with Patients
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I was just shown this slide during a critical care paramedic course. Thought it was worth sharing.

Craig, I think I'm right there. If a patient is critically ill AND needs transport between hospitals, the odds that the patient has been mismanaged up to that point are high.

People who arrive, assess a patient and the go to take full responsibility for them need to have a 100% understanding a d comfort with what's going on. Thats less than 5% of medics in general, if not less.

Entertaining because UMBC is so full of themselves that they don't realize how many people they are marginalizing by writing the slide that way, but whatever.
 

usalsfyre

You have my stapler
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Eh I agree to an extent. It really depends what you define as a "Critical Care Patient". I think the major issue would be IFT of critical care patients. How many "street" medics would truly feel comfortable transporting an IABP patient maxed out on 3 different pressors or a SAH patient with a ventriculostomy, etc.
The majority of "street" and for that matter "CCT" paramedics would not. Certain programs (NCTI in particular in this area) have done a lot of people a disservice in giving them "critical care" classes that leave much to be desired at the end of the day.

That is where the CCEMTP makes the most sense. Familiarizing medics with those types of patients and equipment. Is there a real benefit of a CCEMTP in normal 911?
In theory, a CCT medic SHOULD be thinking further down the road, be more familiar with more medical conditions and bring a higher level of practice to the game. In reality...it depends.

And yes, In an CCT environment the Basic would pretty much do just that. How many CCT teams even use basics? Most are Medic/Medic or Medic/RN/RRT
Due to staffing shortages we just dropped from CCT/EMT-P to CCT/EMT-B. They do a bit more than that, but the workload is still quite a bit higher in this config than it was.

Appearance and tradition. Why even use ambulances for CCT? Just fly them all

Probably because flying a non-time critical patient is ungodly more expensive and somewhat more dangerous.
 
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Jambi

Forum Deputy Chief
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Since the UMBC course has turned into a merit badge course what are all of your's opinion about the http://www.bcctpc.org/ CC and FP certs?

I think it's a step in the right direction and it's not making money off of courses.
 

shfd739

Forum Deputy Chief
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Craig, I think I'm right there. If a patient is critically ill AND needs transport between hospitals, the odds that the patient has been mismanaged up to that point are high.

Thankfully most of my critical care transports are being sent due to services not available (cardiac cath lab, CABG surgery, neurosurgery etc.. I dont do a lot of fixing/transporting mismanagement. Except for sedation- the ERs here suck at keeping vent patients properly sedated so I have to fix the lack of sleepy time.

usals nailed it with the other points.

We staff CCTmedic/basic..however my basic partner knows how to setup our vent and IV pump, I check the settings prior to moving the patient over though.
 

Summit

Critical Crazy
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Craig, I think I'm right there. If a patient is critically ill AND needs transport between hospitals, the odds that the patient has been mismanaged up to that point are high.

I don't agree in rural situations where the sending facility was used for stabilization or didn't have adequate capabilities whether treatment (cath) or experience (rarely have ICU patients).

Probably because flying a non-time critical patient is ungodly more expensive and somewhat more dangerous.

I agree with this in addition to weather issues.

i might or might not have had this exchange over the radio...

"dispatch, can i have the status on aviation?"

"they state available, would you like them to respond?"

"negative, just checking. I need an incident number for a patient refusal."

awesome
 
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Sublime

LP, RN
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And yes, In an CCT environment the Basic would pretty much do just that. How many CCT teams even use basics? Most are Medic/Medic or Medic/RN/RRT

The CCT at my service is CCEMTP / EMTP in the back and EMT-B driving.
They are apparently moving to 2 CCEMTP's in the back and the EMT-B up front.

That slide is correct from what I've heard. The Basic's only function is to drive and nothing else.
 

MSDeltaFlt

RRT/NRP
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I have a question.

Since we know that response times play almost no role in outcome, do not save significant time during transport, driving lights and sirens increases the chance of a MVA, and generally the equipment and patient are not conducive to bouncing down degraded roads at 60 mph, why do critical care transport ambulances even have lights and sirens?

Because lights and sirens only do two things. They tell everybody around the truck, "Don't crowd me", and they politely say at the stop lights, "Excuse me pardon me". Because if I'm hanging to the "oh @#$&" bar like a spider monkey and getting thrown in to the "&$#@" net, then I'm not taking care of the pt.
 

46Young

Level 25 EMS Wizard
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The CCT at my service is CCEMTP / EMTP in the back and EMT-B driving.
They are apparently moving to 2 CCEMTP's in the back and the EMT-B up front.

That slide is correct from what I've heard. The Basic's only function is to drive and nothing else.

When I worked at North Shore LIj, the basics were shown how to set up pumps, vents, and 12-leads. The medic just had to confirm that the equipment was set up properly. Some CCT's were routine and needed only one medic. Most CCT's used a second medic off another ambulance. They eventually went to just a CCM alone in the bus, and then using a road medic/EMT crew to do the call with the CCM. CCM's wre not used for routine ALS or any BLS IFT's, just legit CCT's.
 

VFlutter

Flight Nurse
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When I worked at North Shore LIj, the basics were shown how to set up pumps, vents, and 12-leads. The medic just had to confirm that the equipment was set up properly.

I am way to paranoid for that. I won't start a pump unless I set it up myself
 

Jon

Administrator
Community Leader
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Since the UMBC course has turned into a merit badge course what are all of your's opinion about the http://www.bcctpc.org/ CC and FP certs?

I think it's a step in the right direction and it's not making money off of courses.

It is very much a step in the right direction, and brings legitimacy to CCT.

FP-C is the hardest test I've ever taken. Usually I'm really good at standardized tests. I failed. Missed by 3 questions. (In my defense, the prep class was crappy, but in the end, I need to study more).
 

46Young

Level 25 EMS Wizard
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I am way to paranoid for that. I won't start a pump unless I set it up myself

The hospital and our ambulances used the same pumps, the Abbot Plum, so we just had to take out the cassette and plug it back in to our pump, and set it. The medic would always tell the basic what to set it at, and then confirm before txp. The basics do several days in classroom orientation just learning the pumps, the vents, etc. It's not a field pencil-whipping thing by no means. They were also tested yearly on their proficiency.
 
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