Flight Nurse vs Flight Paramedic

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Until the other day, I had no idea there was a such thing as a flight paramedic. I thought all of them were flight nurses. What are the differences in pay and training of a flight nurse vs a flight paramedic? They both have the same job - to stabilize the patient for transport to a hospital, so how different can the training really be?

Thanks for the input!

Jeremy

beejfrance said:
Wow, how "ridonculous", quite arguing and wasting time in life. Go save lives both of you! Cheese-n-rice! LOL

Nobody is arguing, yet. Relax mate...

What does this community think will happen when the paramedic position evolves into an advanced practice role as has been seen in europe, australia, and new zealand. Is it possible the flight companies will do away with flight nurses in favor of these "ditch doctors" ?

954_racer said:
What does this community suppose will happen when the paramedic postion evolves into an advance practice role as has been seen in europe, australia, and new zealand. Is it possible the flight companies will do away with flight nurses in favor of these "ditch doctors" ?

What do you mean by "advanced practice?" Nurses are still involved in transport throughout the world. If anything, evolving the paramedic and requiring additional education can only ensure a better educated provider is providing patient care. Also, what exactly do you mean by "ditch doctors?" I've worked with Australian critical care medics and South African B-Tech medics. My old boss overseas was an OZ Critical care medic. Their scope of practice was roughly comparable to many US flight paramedics with the exception that the OZ and SA medics typically had degrees and much more formal education. Clearly, the scope of practice and medical control issues were different, but they roughly operated at the same level as their US counterparts.

954_racer said:
What does this community suppose will happen when the paramedic postion evolves into an advance practice role as has been seen in europe, australia, and new zealand. Is it possible the flight companies will do away with flight nurses in favor of these "ditch doctors" ?

Advanced practice? No, the Paramedics in other countries just have the appropriate education to perform what many U.S. Paramedics do. The Paramedics in other countries have a better understanding of what they are doing and can function under different guidelines with more autonomy. If they want advanced practice at scene, there may be a physician that responds. The protocols in the U.S. EMS system are usually written for the minimum education standard. For flight, a Paramedic may have additional training and/or an RN can be partnered with them. Some Paramedic flight teams have essentially the same protocols as the ground crews with the only difference being the mode of transportation.

In Europe, several countries have Physician or nurse led EMS. The nurse led EMS countries include the Netherlands, Spain and parts of Italy which have ALS. The ECP in the U.K. can also be a nurse.

In the U.S., since flight programs may also do critical care IFT, there is a need to have a provider who is educated and experienced in critical care. Right now that happens to be a nurse.

I don't see many changes for EMS in the U.S. except for more accountability in the various systems for the way they use resources to justify funding. I don't see this country even requiring an Associates degree for many years so the education will not catch up with the other countries. Some are even against the changes in the NREMT like calling the Intermediate an Advanced EMT which is a more appropriate description or requiring Paramedic programs to be accredited.

Depending upon where you practice , your state's scope of practice will be different for a Flight Nurse and a Flight Medic. Both have their own area of expertise and comfort level. Our program does approx 60-70% interfacility transports and 30-40% scene responses. In my experience the Medics tend to take the lead at scenes and the Nurses more so on the interfacility transports (especially the complicated ICU patients with multiple drips being titrated) but we ALWAYS work as a team and utilize each other's strengths. Sometimes it's as simple as where you are located in the aircraft or ground unit in relation to the patient that determines whether you do the intubation or push the drugs. We have the same protocols to follow as a team and we both need to know them as well as each other. We also validate our observations/assessments with each other all the time. As a Flight Nurse I know that our Medics are woefully underpaid in respect to their skills and duties. However our AirMedical program is a non-traditional one in that our pilots and medics are employees of a free standing ground and HEMS service and the nurses are employed by the associated hospital in a joint venture service. A little out of the norm , but the set-up serves us well.

Specializes in Critical Care, Trauma.

I believe medics are underpaid... whether its air or ground... they are pretty much the doctor in the field here in central, pa and they get paid around what I get paid as a nursing assistant in the hospital were I don't have to worry about being shot or weather... kudos to medics and nurses who run in the field...

steve emt-b said:

I believe medics are underpaid... whether its air or ground... they are pretty much the doctor in the field here in central, pa and they get paid around what I get paid as a nursing assistant in the hospital were I don't have to worry about being shot or weather... kudos to medics and nurses who run in the field...

Every time I read a post like yours i realize just how much education needs to be done in ems.

No, paramedics (not medics) are not doctors. They function under protocols which sometimes are very limiting. They do not write prescriptions and they do not have an unlimited scope of practice. The education for a paramedic is between 4 months (with emt-b) and two years. The education for a physician extends past 12 years.

If you and others had a more realistic idea about what the difference between a doctor and a paramedic, ems might be able to move on to the next level instead of believing you have more than enough education to be the doctor in the field. You might also check out the countries and a few places here in the us that do utilize physicians in the field for some enlightenment.

For your pay, an emt-b usually requires only 110 hours of training in most places and you have only one patient at a time. A cna is required to have no less than 75 hours of training by a federal regulation, may have over 400 hours or more if advanced to pct and may be responsible for over 30 patients at one time for the entire shift without a chance to nap.

Health care workers in the hospitals are also killed while on duty and there have unfortunately been some very disheartening headlines with violence within the walls of the hospital which has also included death of professionals. The majority of emt-bs in this country do routine transfer and not 911 ems unless they are first responders with a fire department. You might also want to take a look at the new levels that will be out in a couple of years to see exactly where the emt-b will be in the line up.

Specializes in Critical Care, Trauma.

I appoligize...Where do I check the emt b levels?

Steve EMT-B said:
I appoligize...Where do I check the emt b levels?

No apologies needed. Just catch up on your reading for the future which is coming soon.

https://www.nhtsa.gov/people/injury/ems/EMSScope.pdf

More great info at this site:

http://www.ems.gov/

Another good site to visit

https://naemsp.org/

Specializes in RN-BC, CCRN, TCRN, CEN.

Steve,

I can understand and somewhat agree with what you are saying. EMS plays an important role in the outcome of the patient. Physicians and nurses rely on the pre-hospital assessment to prepare for their patients. A Trauma Code is very different than a finger amputation- Though they'll both likely be going to the OR, different specialists need to be called for each one. It is the pre-hospital report that prepares these resources. Even knowing the difference between a stable and unstable patient can make a world of difference at the hospital.

Our Medical Director for my Volunteer Collegiate EMS squad is from Germany. She said Doctors rode on ambulances there so they can start treatment right away. Since we don't have this in the US, it is the paramedic or EMT that is responsible for not only getting the pt to the hospital but starting what can be life-saving interventions on them

Just my 2c!!

Jeremy, you also bring up some interesting topics which are being discussed at local and national levels.

EMTJeremy said:

I can understand and somewhat agree with what you are saying. EMS plays an important role in the outcome of the patient. Physicians and nurses rely on the pre-hospital assessment to prepare for their patients. A Trauma Code is very different than a finger amputation- Though they'll both likely be going to the OR, different specialists need to be called for each one. It is the pre-hospital report that prepares these resources. Even knowing the difference between a stable and unstable patient can make a world of difference at the hospital.

Trauma Activation fees can range from $1000 to $25,000 per patient. Thus, criteria is very strict and usually it is someone inside the hospital who makes the actual decision to activate the alert which may get at least 12 health care professionals responding including a representative from the trauma surgeons.

Essentially, the report given to the hospital should follow the criteria that has been established by physicians to give those at the hospital the correct information. The guidelines include information such as BP parameters and level of consciousness which takes the mystery out of the determination for appropriate level of care at the hospital.

The costs and RISKS for activating a helicopter are also pretty extreme and when activated for a patient who is walking out of the trauma center before the helicopter gets back to base has brought a lot of scrutiny to when and who should activate the helicopter. This is an area that must be examined more closely to stop to over use of helicopter especially when a trauma center is just a few miles away. If an ambulance has to wait on scene for 20 minutes to fly to a hospital that could be driven to at a normal rate of speed in 15 minutes, the patient is not benefited.

STEMIs are another situation and some hospitals are more comfortable activating the cath lab if the ECG can be transmitted from EMS to a physician first.

In some areas EMS is limited to transporting to the nearest facility regardless of condition of the patient which then requires another transport either by helicopter or CCT.

Regardless, it is a physician or a group of several physicians that advise and make the protocols for EMTs and Paramedics to follow. Some protocols may seem more like guidelines with some degree of flexibility but that again is determined by a physician what is appropriate for the EMS in his or her area.

EMTJeremy said:

Our Medical Director for my Volunteer Collegiate EMS squad is from Germany. She said Doctors rode on ambulances there so they can start treatment right away. Since we don't have this in the US, it is the paramedic or EMT that is responsible for not only getting the pt to the hospital but starting what can be life-saving interventions on them

Just my 2c!!

How about the cost effectiveness and level of care comparison between the systems. Physicians have much more assessment and treatment abilities than EMTs or Paramedics (especially in the US). In other countries you may have only one responder to a patient and that patient may be treated and not transported. There might only be a doctor, nurse and a driver for calls. Some countries have Emergency Care Practitioners which may be a nurse or a Paramedic with several years of education and experience. The US is a long way off from that. Some systems will use 2 nurses who are the equivalent of nurse practitioners in training. Here in the US we send 3 expensive vehicles with 4 - 6 Paramedics to every calls and then may a BLS ambulance will transport while the FD vehicle follows to retrieve their Paramedics. Often the treatment is just a ride to the hospital since only the obvious symptoms for broad diagnoses can be determined with treatment initiated in the field. For cost, each FF/Paramedic may make $60k - $100k depending on location. At another $20k - $40k per year for each towards their benefit package. Now consider the contract with the ambulance and maintenance of all the responding EMS/FD vehicles including gas and insurance. EMS in even the smallest cities is very costly. How is the tax base and what allocations for the different regions determined? Let's also consider the cost to the patients. Do you understand how a patient is billed, what part insurances will cover and how your EMS agency is funded even if it is volunteer?

There are also more controversies such as BLS vs ALS, scoop and run or stay and play as well as if advanced procedures by Paramedics are necessary or even detrimental when proficiency levels are not maintained. We are now seeing more extraglottic devices used instead of ETI in field EMS. What about lights and sirens for every call both to and from?

EMS systems, which include the hospitals, have many factors to consider so the responsiblity is not solely based on the opinion of the EMT or Paramedic. Yes, you can pat yourself on the back if you get a patient who still has a pulse to the hospital but you can not ignor all the professionals, both medical and non, that make up the entire EMS and healthcare system. If you want to be successful in EMS (definitely for Flight or CCT) you have to consider a broader picture and one that involves patient/provider safety as well as outcomes.

Hi,

I was reading this article but I was doing research on to what's the steps of becoming a paramedic or just a paramedic ,I seen that some of the people who replies to this artice ,where or are currently medics. Is there any advice you can give me as in what you did to get to that postition ,what classes you took? did you voluunteer anywhere? and etc.

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