Emergencies or Transport

DesertMedic66

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911 emergencies for me. I'm not a fan of transporting at all. My bread and butter is the on scene medical aid. I love working in changing environments and trouble shooting issues that we face out in the field.
 

NPO

Forum Deputy Chief
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911 emergencies for me. I'm not a fan of transporting at all. My bread and butter is the on scene medical aid. I love working in changing environments and trouble shooting issues that we face out in the field.

You could make the argument that dealing with Med/Surg nurses is more challenging ;)
 

DesertMedic66

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You could make the argument that dealing with Med/Surg nurses is more challenging ;)

I try not to deal with nurses in general. At least at our local hospitals the ER nurses always seem nicer to us than floor nurses (plus the 1-2 hours waiting for them to get paperwork for the transfer <_< )
 

NPO

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I love when you are there picking up a patient and they make up excuses why the patients bp is 186/98...

"The patient is just agitated and you know moving a lot to get on your gurney."

No.

I get that almost daily.
 

NomadicMedic

I know a guy who knows a guy.
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I'll be splitting the posts about PAs and med students into a different thread. Please try to stay on one topic... thank you
 

46Young

Level 25 EMS Wizard
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I love when you are there picking up a patient and they make up excuses why the patients bp is 186/98...

"The patient is just agitated and you know moving a lot to get on your gurney."

No.

I get that almost daily.

This is why I always tell my partners that they need to get a set of vitals on the floor before we move the pt, instead of being lazy and taking the nurse's last set, and only doing one set during txp.
 

Carlos Danger

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I love when you are there picking up a patient and they make up excuses why the patients bp is 186/98...

"The patient is just agitated and you know moving a lot to get on your gurney."

No.

I get that almost daily.

I love it when a basic EMT spends 30 seconds with a patient and think they know more about what is going on with them than the RN who has been caring for that patient for hours or days.
 

islandmedic

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What kind of things would an EMT assisting an RN do on a CCT rig?

FuMan, I just left my service after working the last 7 months on a CCT unit staffed with two EMT's and a CCT-RN. In my experience, this was the best kind of IFT unit to be on. I routinely saw critical patients and was able to use my brain rather than load and go with a dialysis patient or take a home S/P knee replacement. While I was never in charge of these patients per se, I happened to be lucky enough to work with the same two RN's for the entire 7 months and with time comes trust. If you can prove yourself to be a competent EMT you can expect to have a good working relationship. Here are some of the things I did as a basic on a regular basis.

-Almost all the CCT patients we transported, stable or not, are gonna be cardiac monitored at the least. You will get very familiar with your CCT monitor. Each run I was expected to apply ECG leads, limb leads or twelve lead depending on the call. Apply O2 saturation monitor and NIBP auto cuff. I don't know if you've ever used these monitors but they are all different and have a million different things they do and you will get very familiar with them. I have found them to be generally user friendly. Ask questions.

-O2 administration. Simple enough. Get good at applying a nasal cannula.

-Know which equipment you will need for different calls. Our nurses were also expected to be proficient using a ventilator and we routinely had vent calls. This will require special equipment. Obviously this is something you learn over time but like I said if you take the initiative and ask questions you have the opportunity to learn a lot.

-At our service we were required to complete a full run sheet to accompany the RN's PCR. This was helpful because we kept our paperwork skills fresh.

-Lastly, if you've been a basic already then you are probably already good at driving but the cargo you are hauling can be a bit more likely to need to be expeditiously transported. Not saying that every call is a code 3 emergency but I found that I needed to be more aware of possible diversion hospitals and being a little more mindful that there can be very complex things happening in the back, especially if you have a doctor on board. Talk about back seat drivers...;)

Anyway, being on a CCT unit was fun and definitely the best learning experience I've ever had. It opened my eyes to some medical conditions that I would probably never run into in the field as a 911 provider and helped me understand the pathophysiology behind it.

Good luck and have fun!
 

Clipper1

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I routinely saw critical patients and was able to use my brain rather than load and go with a dialysis patient or take a home S/P knee replacement.

Besides all of the equipment, these transports are an excellent way to gain more understanding of dialysis, the different types and how some ICU patients become the 3x/week transports. It often starts in the ICU where the treatments to save someone's life also gives them a lifelong sentence dependent on a dialysis machine and a "burden" to an EMT. These transports should make you aware of what these patients have gone through before they might eventually become one of those dreaded routine nursing home calls. Knowing a little about what they have been through might give you a better insight to respect the routine calls more. Even some of those take home knees may have had an extensive stay in the ICU due to complications.
 

NomadicMedic

I know a guy who knows a guy.
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I've moved the comments about PAs vs Med Students and all other off topic conversation.
 

FuManChu

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FuMan, I just left my service after working the last 7 months on a CCT unit staffed with two EMT's and a CCT-RN. In my experience, this was the best kind of IFT unit to be on. I routinely saw critical patients and was able to use my brain rather than load and go with a dialysis patient or take a home S/P knee replacement. While I was never in charge of these patients per se, I happened to be lucky enough to work with the same two RN's for the entire 7 months and with time comes trust. If you can prove yourself to be a competent EMT you can expect to have a good working relationship. Here are some of the things I did as a basic on a regular basis.

-Almost all the CCT patients we transported, stable or not, are gonna be cardiac monitored at the least. You will get very familiar with your CCT monitor. Each run I was expected to apply ECG leads, limb leads or twelve lead depending on the call. Apply O2 saturation monitor and NIBP auto cuff. I don't know if you've ever used these monitors but they are all different and have a million different things they do and you will get very familiar with them. I have found them to be generally user friendly. Ask questions.

-O2 administration. Simple enough. Get good at applying a nasal cannula.

-Know which equipment you will need for different calls. Our nurses were also expected to be proficient using a ventilator and we routinely had vent calls. This will require special equipment. Obviously this is something you learn over time but like I said if you take the initiative and ask questions you have the opportunity to learn a lot.

-At our service we were required to complete a full run sheet to accompany the RN's PCR. This was helpful because we kept our paperwork skills fresh.

-Lastly, if you've been a basic already then you are probably already good at driving but the cargo you are hauling can be a bit more likely to need to be expeditiously transported. Not saying that every call is a code 3 emergency but I found that I needed to be more aware of possible diversion hospitals and being a little more mindful that there can be very complex things happening in the back, especially if you have a doctor on board. Talk about back seat drivers...;)

Anyway, being on a CCT unit was fun and definitely the best learning experience I've ever had. It opened my eyes to some medical conditions that I would probably never run into in the field as a 911 provider and helped me understand the pathophysiology behind it.

Good luck and have fun!


Thanks for all the info Island Medic!
I am on a BLS IFT rig right now, I have an interview with a CCT company soon. I won't be starting out on CCT, I will still be doing BLS IFT for a while, but I definitely would love to move into CCT once I have payed my dues on a BLS rig. Just wanted more info on what I might expect.

Thanks again!
 

islandmedic

Forum Probie
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Besides all of the equipment, these transports are an excellent way to gain more understanding of dialysis, the different types and how some ICU patients become the 3x/week transports. It often starts in the ICU where the treatments to save someone's life also gives them a lifelong sentence dependent on a dialysis machine and a "burden" to an EMT. These transports should make you aware of what these patients have gone through before they might eventually become one of those dreaded routine nursing home calls. Knowing a little about what they have been through might give you a better insight to respect the routine calls more. Even some of those take home knees may have had an extensive stay in the ICU due to complications.

Well said and very true. That's kind of what I meant when I said you get to learn and understand the pathophysiology behind these issues. As you said, this can make you more sympathetic to the more common and monotonous, if you will, BLS runs that happen. I didn't mean to take away any importance from those types of calls.
 

VFlutter

Flight Nurse
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Ya most people never see CRRT/CVVH before people get on scheduled HD. For those who have spent weeks in the ICU to get to that point it is a precious gift.

I just had a Peritoneal Dialysis patient with peritonitis and sepsis end up on CRRT for quite some time.
 

Jim37F

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What kind of things would an EMT assisting an RN do on a CCT rig?

Shadow the nurse getting the report so you know what's going on with the patient and whether its a stable transfer or not, when your nurse is ready disconnect hospital equipment (mostly EKG, NIBP and pulse Ox, we let the CCTRN deal with IV. lines and pumps and ventilator while we switch out o2 lines for basic stuff like cannulas and mask). Sheet the patient into the gurney if they're non ambulatory, hook up our monitors and equipment.

While transporting, basically keep an eye on the patient, fill out the paperwork, if they need any interventions enroute you can do anything in your scope (suction, airway adjunct and oxygen delivery, bleeding control etc) know where all the equipment is in the rig so if your nurse asks you to hand them something you can just grab instead of searching, etc

And of course at the destination sheet the patient into bed, switch out your equipment for the hospitals and get your signatures, decon, prep for next run, etc
 

medicsb

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This question is highly dependent on either location or company. I far preferred the prehospital/911 setting. I did more skill-wise and had to be on my toes in terms of management far more than on CCT. But, this is not to say that you can just coast through CCT, you do need a better understanding of in-hospital diagnostics and treatments and you need to know how to respond to adverse reactions or how to adjust the continuing treatments to meet the patients needs. If (BIG IF) things are done right by the sending facility, you really shouldn't have to do much during the transfer other than talk to the patient, monitor, and document.
 

Akulahawk

EMT-P/ED RN
Community Leader
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I think this discussion really highlights that IFT and 911 are just two different parts of EMS. These two ends of the spectrum just aren't that interchangeable. A medic that normally does one, and excels at it, might only barely be able to muddle through the other side...
 

Summit

Critical Crazy
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the patient is maxed out on pressors and every time the ICU nurse turns their level I off you lose the waveform on the a-line

Uh... so how did that one work out?
 

Carlos Danger

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Uh... so how did that one work out?

Not so good. It was a sad case. Young female, in a small rural but generally very good hospital, about 20 hours post-partum, with massive, intractable DIC and surgical bleeding that wouldn't stop after several trips back to the OR. We flushed huge amounts of products into her for a long time but eventually she died before we could leave.

It was years ago but its still one of the first transports that come to mind when I think about tough ones I've been on.
 
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