Flight Nurse vs Flight Paramedic

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OK 1st off......new grads do not have expertise in anything. Secondly, when people say things like this, it tends to lead to disaster or a near miss. C'mon....you're only 24 years old how 'many years' experience can you really have? First rule of emergency service - NO COWBOYIN'!!! Have you ever heard the saying "Beware the (whoever) that knows it all"? This will apply to your healthcare career as well. I have 12 years as a FF in a busy urban dept, 10 as an EMT-B in same dept, and almost 10 as an RRT in a 1200 bed tertiary care, level 1 medical center. I then relocated to a 25 bed rural hospital where I faced different challanges that I never even thought I would, or ever had before. So the REAL bottom line is no matter where you do your training, what experiences you've had, there will always be a learning curve. If you don't respect that, you're headed for trouble. Also, I suggest you get typed and crossed at your first job, because if you don't change that attitude you'll eventually be pimped so hardcore that you will need to be transfused. Around here D.H.A.R.T. (Dartmouth) is the primary air transport. For interfacility transport its either RN / EMT-P / RT or RN / EMT-P and for scene response it most often RN / EMT-P / RT.

There is no "attitude" here. Im not sure how you are getting attitude out of my posts. I was simply stating facts and my opinion. And I happen to be at the top of my class. As far as experience, sure, I dont have 20 years under my belt, but I have been an EMT for 6 years now.

Also, if you read the rest of the conversation/posts, you will see where I clarified some things in my previous posts.

Unfortunately, some of your comments could be interpreted as attitude. However, I would like to believe it is more ignorance. I was ~ your age when I started nursing school, and I had about 5 years of EMS and military medic experience under my belt. Additionally, I absolutely thought I knew as much as a medic and had a big advantage over my classmates. My first semester of nursing school was quite painful unfortunately.

The old saying "you don't know what you don't know" really does apply. When you make statements saying you will be equivalent to a paramedic with nursing school and 5 years of EMT experience, I hope this is simple ignorance. Core paramedic modalities are not even covered in nursing school. In fact, nurses and paramedics receive a very different education. The fact that you seem to have little knowledge of what you really learn in nursing school adds evidence to my hypothesis.

You sound like a sincere person who is pushing foreword with your medical education and experience; however, try to understand that there is still much you do not understand. Even with my flight experience, I am constantly surprised by how much I do not know, and by how much I have to learn. It is truly a life long process. Additionally, a concept that seems simple initially may in fact be far more complex. As a new provider I honestly thought ventilator management was easy because my experience was limited and I simply had no idea. I started using an Autovent 2000 where I really thought all it involved was setting a tidal volume and rate. Then, I started flying and learned about patient ventilator interaction, modes of ventilation, monitoring pressures, lung protective strategies, inspiratory holds and static compliance, ABG's, and waveform capnography. Now, I am learning about gas physics such as transition from laminar to turbulent airflow, concepts such as pressure support, and additional modalities such as oscillatory ventilation strategies.

This is but one example of how additional learning and experience will change the way you think and understand. You must realize that your comprehension and general opinion are dynamic concepts. Otherwise, you will be like old Gila, learning the hard way and suffering through the entire process.

I knew I shouldn't come here tonight...

My esteemed friend Gila already said much of it. But he left out that suffering right along with you will be your patient and their family. Every time. Even when you don't see them there. My dear friend Chel Finn (a VERY smart lady and great paramedic) used to tell her students, "patients have to die for you to learn to be a good medic. And they will keep dying for you to learn to be a great medic." She knows of what she speaks. That burden will be on your shoulders every day. Overconfidence will make it worse, rather than better.

I think I'm the oldest dog on this thread, so I will repeat what Gila said, "YOU DON'T KNOW WHAT YOU DON'T KNOW." You haven't a clue. I am still humbled every shift by some patient or situation or question from another nurse or medic that I can't answer. That is no exaggeration.

Your short experience as an EMT-B (6 years isn't much from where I sit) will positively contribute to your nursing; but no where near as much as you think. And new grad nurses don't know a damn thing about any sort of sophisticated patient care. The real learning starts the first day on the job. Same for medics. Your patients will be paying your tuition so that you can learn at their expense. And they won't know it. No informed consent on that one. They'll be paying in suffering or less good outcomes. The only thing in my UNhumble opinion (I'm allowed at my advanced age ) that will reduce or shorten their suffering on your behalf will be your humility. That quality will allow you to learn more and faster.

For now, YOU DON'T KNOW WHAT YOU DON'T KNOW. But you will, maybe, one day. Hopefully not at too high a price for your patients or you.

Actually you are incorrect. First of all since nurses practice nursing and are under the BON they can never be "the medical authority". There are two areas where nursing interacts with Paramedics in the California paramedic act found here:
http://www.emsa.ca.gov/laws/files/ch4_emtp%20.pdf

The first is here:
100145. Scope of Practice of Paramedic.
(a) A paramedic may perform any activity identified in the scope of practice of an EMT-I
in Chapter 2 of this Division, or any activity identified in the scope of practice of an
EMT-II in Chapter 3 of this Division.
(b) A paramedic shall be affiliated with an approved paramedic service provider in order
to perform the scope of practice specified in this Chapter.
(c) A paramedic student or a licensed paramedic, as part of an organized EMS system,
while caring for patients in a hospital as part of his/her training or continuing education
under the direct supervision of a physician, registered nurse, or physician assistant, or
while at the scene of a medical emergency or during transport, or during interfacility
transfer, or while working in a small and rural hospital pursuant to Section 1797.195 of
the Health and Safety Code, may perform the following procedures or administer the
following medications when such are approved by the medical director of the local EMS
agency and are included in the written policies and procedures of the local EMS
agency.

The second is here:
100168. Paramedic Base Hospital.
(7) Assure that nurses giving medical direction to paramedic personnel are trained and
authorized as mobile intensive care nurses by the medical director of the local EMS
agency.
(9) Identify a mobile intensive care nurse, if utilized by the local EMS system, with
experience in and knowledge of base hospital radio operations and local EMS agency
policies and procedures as a prehospital liaison to assist the base hospital medical
director in the medical direction and supervision of the paramedics.

The first exist because California like most states limits the Paramedic to the prehospital
environment. This authorizes training in the hospital. There is a separate section 1797.195
that allows a EMT or Paramedic to work in the ER of small rural hospitals.

The second exists to allow MICNs to function as liasons between the physician and the
Paramedic. It clearly establishes them as liasons who do not give medical direction but
instead ensure that the paramedics follow policies and procedures as outlined. Historically
it exists because the physicians don't want to be tied to the radio while in the ER.

A paramedic works under delegated practice in California (as in most states). This is
medical delegation from the medical director. The roles of nurses in this are to act as
a liason (in the case of the MICN) and to work as supervisors (among other medical
professionals) in Paramedic training. The only medical authority over Paramedics
is the medical director.

David Carpenter, PA-C

yes, very different!

in order to become a flight nurse do you have to do any ER or hospital work first?

You should look through the other threads on this forum for your answer. Short answer being, yes. You will need at least 3-5 years of solid experience.