Just having a Paramedic cert does not guarantee competency in endotracheal intubation. There are some Paramedics who may not have placed a tube for several years. Their Paramedic program may not have been able to hook up with an OR or ED that allows Paramedic students to get live intubations and the field clinicals may be a hit or miss for a chance to intubate. There may be some Paramedic students who graduate never having seen a live intubation except on a video. Some employers
will not monitor the intubations by having lax QA/QI nor will there be an opportunity for the Paramedic to perfect some of their skills. In some areas all the FFs and/or EMS personnel are Paramedics which dilutes the chance to perform skills or even very much patient contact. Paramedics on an ALS ambulance that does transport for an ALS FD may be little more than ambulance attendants unfortunately. There are Paramedics who work a routine ALS truck who have not utilized either their intubation, IV insertion skills or have not led a code or emergent situation in several years. Some agencies will have flycars with Paramedics who are trained to do DAI and RSI for the field Paramedics. There are also many EMS agencies that are no longer emphasizing endotracheal intubation and are going to alternative airways such as the King especially in code situations.
A Flight employer may ask a Paramedic candidate "Can you intubate?" The answer may be "yes" for adults, peds and babies but the Paramedic may be referring more to their state scope of practice than if they actually are proficient with intubation. A good Flight program should go through the competencies of any new hire and work on the weaknesses as well as introducing new material and skills.
There are many Flight programs that utilize RN/RN crew configuration. The RN, in some situations, may even have the advantage of obtaining intubations in the hospital setting more than a Paramedic or Paramedic student. Some RNs who have gone through a Paramedic program have been disappointed. The program may state they teach intubation but that does not guarantee they will get an opportunity to do one as each program may vary in their set up or connections. Some RNs are also led to believe central lines and chest tubes are standard material in the Paramedic curriculum with an opportunity to perform these skills. However, it is a rare class if either is actually allowed in a clinical and some programs just skim over them or do not even cover them at all since they have fallen out of favor and may no longer be in a state's scope of practice for Paramedics. However, a Flight program may do their own training of these skills for both the RN and Paramedic. The RN would have the advantage here since CLs and chest tubes are part of their ICU responsibilities for set up and maintenance. Even if they haven't done the actual skill they may have seen many procedures in their 5 years of ICU/ED experience. The 12-lead may also not be taught in all Paramedic programs since only half of the EMS agencies in the U.S. utilize 12-leads. Some that do also rely on machine interpretation or transmit to the hospital for the physician to read.
If you are looking into any Paramedic program whether it is a bridge or traditional, find out what and how each skill set is taught. Find out the credentials of the instructors and their teaching experience or special certs in education. Find out if there will an opportunity to obtain live intubations and how many are expected. Find out what EMS agencies you will will be doing ride time with and a little about their protocols and reputation. Make sure the Paramedic program is accredited by CoAEMSP/CAAHEP. This will be a requirement to take the NREMT in a couple of years. Not all states utilize the NREMT and are essentially ignoring the push for accreditation right now. If you want to move to an NREMT state later, you may be at a disadvantage.
Below is a link to a questionaire sent out to the state EMS boards in 2008 to determine if other professionals are allowed to challenge the Paramedic test or work on an ambulance with their own credential. California is not listed but I posted that info earlier.