I'm interviewing for a Critical Care Transport position that is starting at my facility. Since we are the guinea pigs, we can shape it a lot....
From what I can tell, they're thinking of 12 hour shifts, and when not on a call, we are the critical care resource nurse for the department. They're still trying to work out out scope (from what I can tell, I'll ask more in the interview).
Since we are taking on more liability, some of us interviewing believe we should be paid more than our ED counterparts.
Thoughts? Do you know of facilities that pay more? Ideas for arguments for an increase in pay? Also, for GROUND ambulance, what typically do you see for scope of practice?
Here is the Colorado EMS description of scope if you want to familiarize yourself with what a Paramedic and EMT are capable of "IF" their medical director approves and writes their p&p.
This starts at page 30. Ch 15 and 16 are specific to CCT.
I hope you don't feel like I'm busting your chops. I'm really not. You asked some great questions and provided some really good information.
This is Colorado and not California. Other states usually will have RN/RN or RN/Paramedic teams taking care of the patient with an EMT driver. Only California has RN/EMT/EMT and they have to call 911 for intubations in transport.
In some places, their truck, their rules. Since you seem to be quoting the California system, you should know both the CCT RN and Paramedic fall under the county guidelines. More counties are changing to a more modern system which will utilize Paramedics to the fullest extent possible.
It also depends on whether the hospital will be just calling for any truck to take them or if there is a dedicated transport ambulance and team from that private ambulance. Many times you might see the name of a hospital painted on the side of the truck but it might actually belong to the ambulance company. Essentially it will depend if the contract is written as a partnership or a vendor providing transport.
You stated no turf but a "team" yet you have essentially down played the roles of both EMTs and Paramedics in your posts.
This link gives a great overview of how CCT teams are set up and the requirements.
You don't really think providers can do more at risk and invasive procedures without contacting their insurance carrier? Even in the hospital, if a nurse or RT is added to the intubation provider list, the insurance is contacted to cover those providers. This is one of the reasons why it is not common for either group to intubate in hospitals. This is also why if an ambulance has a Paramedic who intubates, it is silly to also have a nurse from the hospital intubate if they are a "team". If they are both from the same employer, then the coverage will be for both under the policy. Many providers may also want their own insurance to cover them for events where the hospital will not cover such as issues for discipline with the board.
This is Colorado and not California. Other states usually will have RN/RN or RN/Paramedic teams taking care of the patient with an EMT driver. Only California has RN/EMT/EMT and they have to call 911 for intubations in transport.
In some places, their truck, their rules. Since you seem to be quoting the California system, you should know both the CCT RN and Paramedic fall under the county guidelines. More counties are changing to a more modern system which will utilize Paramedics to the fullest extent possible.
You stated no turf but a "team" yet you have essentially down played the roles of both EMTs and Paramedics in your posts.
Nope not quoting California's system at all. Not even close. It seems their system is the outlier (and a strange one at that) when compared to the rest of the US. When I spoke of a contracted ambulance service sending EMTs not Paramedics I meant a singular EMT as the driver of the vehicle with the hospital's RN/RN or RN/Paramedic team to provide patient care which, in my experience, is the norm. And for the record I AM a paramedic so please stop with the "downplaying" garbage. That was NOT what I was saying at all and I will not let you convey an intent that WAS NOT THERE. It appears you missed the part about collaboration with the team on decisions regarding patient care.
As a former CCT nurse I am well-versed in different team configurations and how they work. I really didn't need to be educated on how the system works since I've been doing it since 1987 but thanks for the link . I have worked with several staffing configurations including working with paramedics that were not also nurses and RRTs. We switched off skills and whoever got to do the skill was the person who was up next for it whether it was intubations, IV.s or what have you. This kept the entire team on a a level field and provided the best patient care. Please explain to me what makes a paramedic better than a nurse for intubations and why it isn't a good thing to have both team members equally trained. Or why it's more "modern" to use paramedics which, BTW, is not a new thing at all. We were using them to "their fullest extent" way back in the 80s. Personally I think both RNs and Paramedics are equally capable and am mystified as to what special juju is conferred on a person once they pass their PM exam. Hopefully none of the patients who get an RN/RN team need intubated because it seems you think if they do they're screwed. As for RN-led teams. That's just how some are set up but it doesn't really mean much more than if something goes wrong it's the RN's head that will roll. Not sure how any paramedic would have a problem with that. One more question. What exactly is the role of the EMT in your CCT system?
As it stands you've made a lot of assumptions about me, most are incorrect, and some are downright insulting. Not exactly sure what your agenda is. I really tried to play nice with you but have gotten mostly condescension and snark back so I'm done playing. You win!
Nope not quoting California's system at all. Not even close. It seems their system is the outlier (and a strange one at that) when compared to the rest of the US. When I spoke of a contracted ambulance service sending EMTs not Paramedics I meant a singular EMT as the driver of the vehicle with the hospital's RN/RN or RN/Paramedic team to provide patient care which, in my experience, is the norm. And for the record I AM a paramedic so please stop with the "downplaying" garbage. That was NOT what I was saying at all and I will not let you convey an intent that WAS NOT THERE. It appears you missed the part about collaboration with the team on decisions regarding patient care.
As a former CCT nurse I am well-versed in different team configurations and how they work. I really didn't need to be educated on how the system works since I've been doing it since 1987 but thanks for the link . I have worked with several staffing configurations including working with paramedics that were not also nurses and RRTs. We switched off skills and whoever got to do the skill was the person who was up next for it whether it was intubations, IV.s or what have you. This kept the entire team on a a level field and provided the best patient care. Please explain to me what makes a paramedic better than a nurse for intubations and why it isn't a good thing to have both team members equally trained. Or why it's more "modern" to use paramedics which, BTW, is not a new thing at all. We were using them to "their fullest extent" way back in the 80s. Personally I think both RNs and Paramedics are equally capable and am mystified as to what special juju is conferred on a person once they pass their PM exam. Hopefully none of the patients who get an RN/RN team need intubated because it seems you think if they do they're screwed. As for RN-led teams. That's just how some are set up but it doesn't really mean much more than if something goes wrong it's the RN's head that will roll. Not sure how any paramedic would have a problem with that. One more question. What exactly is the role of the EMT in your CCT system?
As it stands you've made a lot of assumptions about me, most are incorrect, and some are downright insulting. Not exactly sure what your agenda is. I really tried to play nice with you but have gotten mostly condescension and snark back so I'm done playing. You win!
At no time did I say an RN can not intubate so drop the attitude. RNs are just as capable of learning a skill as a Paramedic. But, if the contracted truck already has CCPs who can intubate, why waste time teaching that skill if the chances of them doing it is very slim. The RN would be more valuable managing the IABP, ventilator, nitric oxide and the multiple IV pumps. Not intubating does not make you any less of a CCT team member especially when there are so many more things to do.
All of our CCT RNs also have their Paramedic cert so what is your point? That satisfies a state requirement for who makes up an ambulance team as if there was any doubt per state definition even if Specialty. Not all states are like that but some are.
We don't know the configuration of this newly forming CCT team.
Not all teams are the same.
Not all state out of hospital regulations are the same.
No all medical directors are the same when it comes to form policies and protocols even if it is in the scope of practice.
I already told you the EMT is usually the driver. They rarely have any direct patient care on CCT unless it is in California. Then, since there is only one RN, the EMT sets up the ventilators, does the vitals and helps switch whatever monitoring equipment over to their own. Some places allow them to start IVs. Since more states are going to AEMT (Advanced EMT), their scope is expanding.
BTW, Paramedics have been transporting critical patients between hospitals long before you came along in 1987.
At no time did I say an RN can not intubate so drop the attitude. RNs are just as capable of learning a skill as a Paramedic. But, if the contracted truck already has CCPs who can intubate, why waste time teaching that skill if the chances of them doing it is very slim.
Because SOME CCT teams routinely intubate which is why I asked the OP what area they will be covering. It's always better to have both people capable of a skill if one of the providers is having an off day and just can't get the job done. It does happen. Also, I never displayed an attitude I'm just trying to figure out why you think any skill should soley be in the scope of only one of the providers. Intubation just happens to be the chosen skill.
All of our CCT RNs also have their Paramedic cert so what is your point?
My point was you accused me of denigrating Paramedics and EMTs which, being one, I did not do.
We don't know the configuration of this newly forming CCT team.
You're right and the configuration changes a lot of things which is why I have repeatedly asked the OP to explain how their system is going to work because it is apparently going to mirror one that is already in place.
I already told you the EMT is usually the driver. They rarely have any direct patient care on CCT unless it is in California.
Again, you accused me of denigrating them by saying that they are usually the driver which is exactly what you said so how was I "minimizing" their role?
BTW, Paramedics have been transporting critical patients between hospitals long before you came along in 1987.
I'm fully aware of this. I was speaking to your use of the term "modern" when it came to the use of paramedics currently. What I was saying is that medics have been used to their "fullest extent" for a very long time. This isn't a "modern" phenomena. Go back and read what you said.
I mentioned the "RN-led" team because I though that might have rubbed you the wrong way and I was trying to clarify that I didn't mean the RN was in charge but that in a bad situation that comes into question and the poo flies it's going to hit the RN not the paramedic in an RN/PM team. Yes, I've seen this on several occasions and it's happened to me. I was pulling meds for a trip and the medic was supposed to be grabbing the monitor (we were using a back up vehicle that did not have one on board). He forgot it. I was the one who got suspended. He got nothing!
I'm not entirely sure what I said to put you on the defensive. I thought we were having a good discussion and I pointed out the very good information you provided. You responded with a great deal of condescension towards me in your schooling of me on all thing CCT. If that was not your intent then just say so and quit with the attacks. Otherwise, we both need to step back and stop this ridiculousness as it is derailing the thread and isn't fair to the OP.
I'm not entirely sure what I said to put you on the defensive. I thought we were having a good discussion and I pointed out the very good information you provided. You responded with a great deal of condescension towards me in your schooling of me on all thing CCT. If that was not your intent then just say so and quit with the attacks. Otherwise, we both need to step back and stop this ridiculousness as it is derailing the thread and isn't fair to the OP.
Schooling you? The discussion and links were directed at the OP to help better understand all the things which go into a CCT.
As a new team and if they are using a contracted ambulance with a Paramedic, they will have time to develop more skills as the team grows. They might have removed intubation from their 911 EMS Paramedics in favor of supraglottic devices but their CCPs may still have intubation and RSI.
Too many get caught up in the cool skills like intubation and fail to see the rest of the forest. Even doctors might have a tech intubate so they can oversee the resuscitation team from all angles.
I don't know the configuration. They haven't said much, just asked whose interested, and I said me.
I WILL ask all these questions. And I have time today to look up the stuff hopefully for the other facilities in the system. I will get back to you when I can.
Sorry, on my phone, I might be missing some other questions.
Schooling you? The discussion and links were directed at the OP to help better understand all the things which go into a CCT.
I'm not talking about those which, if you recall, I pointed out as being really good information. I'm talking about the one in the post directed solely at me.
As a new team and if they are using a contracted ambulance with a Paramedic, they will have time to develop more skills as the team grows. They might have removed intubation from their 911 EMS Paramedics in favor of supraglottic devices but their CCPs may still have intubation and RSI.
I agree. But are you speaking of a contracted ambulance that has their own dedicated CCT team or a contracted ambulance that only provides the vehicle and the driver? That's where I think our conversation fell off the rails. My experience and that of the many people I'm acquainted with from all over the country do not get a paramedic as a driver they get an EMT and the vehicle.
Too many get caught up in the cool skills like intubation and fail to see the rest of the forest. Even doctors might have a tech intubate so they can oversee the resuscitation team from all angles.
Also agree but depending on the area that will be covered and the quality of the referral hospitals this is an important skill that they need to have.
Listen. I'm trying to extend an olive branch quit lighting it on fire.
I tried posting this earlier, but I don't see it...
From what the other facilities have posted its RN/Paramedic/EMT. And some things (including RSI, and airway management) can be delegated to the medic. Unsure what that means for my facility though. Thanks for all the wonderful questions to have, and to determine if I want to take this position or not. I will definitely be asking what kinds of skills and patients they expect us to know, and then the training they are providing! I've definitely learned to advocate for myself in the way of training.
. I have worked with several staffing configurations including working with paramedics that were not also nurses and RRTs. We switched off skills and whoever got to do the skill was the person who was up next for it whether it was intubations, IV.s or what have you. This kept the entire team on a a level field and provided the best patient care. Please explain to me what makes a paramedic better than a nurse for intubations and why it isn't a good thing to have both team members equally trained. Or why it's more "modern" to use paramedics which, BTW, is not a new thing at all. We were using them to "their fullest extent" way back in the 80s. Personally I think both RNs and Paramedics are equally capable and am mystified as to what special juju is conferred on a person once they pass their PM exam. Hopefully none of the patients who get an RN/RN team need intubated because it seems you think if they do they're screwed. As for RN-led teams. That's just how some are set up but it doesn't really mean much more than if something goes wrong it's the RN's head that will roll. Not sure how any paramedic would have a problem with that. One more question. What exactly is the role of the EMT in your CCT system? 
heinz57
168 Posts
I guess it would help to post the link.
https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=5808&fileName=6%20CCR%201015-3