End of CCT Nurses in California?

[TraumaSurfer]

It looks like the California EMSA is advancing its proposal for the Critical Care Paramedic in California. This provides for an expanded scope of practice which may surpass that of the RN even without the Associates degree.

http://www.emsa.ca.gov/paramedic/default.asp

I know the effects will be felt in both Flight and ground CCT. It will also extend into Maternal/OB and Neonatal Specialty transports. Some counties have already been watching this and are ready to make the transition from RNs to Paramedics on flight and CCT. This has already been heavily discussed in Orange county. It has both pros and cons. I am still a firm believer in education and that one should actually have worked in a critical care environment for at least a couple of years before transporting an ICU patient. But, that also may now become a reality for the Paramedic as the CCP is moving into the hospitals in Kansas, Oklahoma and Colorado. A few hospitals are using Paramedics to replace Respiratory Therapists for nightshifts and in the ERs. Some smaller hospitals in California are considering this also since the Paramedics will now have point of care devices and mechanical ventilators as part of their scope of practice. This could serve many purposes.

[DramaMomma]

I just have got to reply to this.

See, in Orange County, there didnt used to be any private, IFT medics. What that means is, if youre transferring a child to a PICU, and you need em on a monitor, you are waiting for a CCT RN. It takes a looong time.

Now, there are private ALS providers throughout the county.

Having explained that..

No possibility exists for a Paramedic to replace a CCT RN. At this time, a flight nurse works with a Paramedic on helicopters, RNs in this position have an expanded scope of practice. Ground transport nurses have the ability to transport critical care drips, vents, blood transfusions, chest tubes, literally ANYTHING with a doctors order, which is received at the point of pick up.

In Southern Ca, being the litigious society that we are, the county ems will never agree to send these critical care pts with a medic, due to the lack of clinical experience and or education a medic lacks, which an RN has. Its simply not feasible. Taking nothing away from a medic here, but realizing they have never monitored a blood transfusion for reaction, known when to recognize one, how to autotransfuse from a chest tube, titrate propofol to sedation etc etc.

In other parts of the country, there may be things happening, but it absolutely is NOT happening in Orange County, or Los Angeles County.

On a side note, MOST people have no clue what the different levels of transportation are EMT vs ALS vs CCT. Maybe that should be taught across the board

[akulahawkRN, ADN, RN, EMT-P]

On a side note, MOST people have no clue what the different levels of transportation are EMT vs ALS vs CCT. Maybe that should be taught across the board

Most people have no clue exactly what the scope of practice is for EMT, AEMT, Paramedic, or CCT-P. I've worked as a Paramedic for quite a while and in my experience, most nurses don't know that EMT and Paramedic are two different levels with very different scopes of practice for transport. All they know is that the "Ambulance Drivers" are here for the patient. I have had to refuse to accept a patient for transport because the patient required monitoring that was out of my scope of practice and it could be something as simple as having a patient on a potassium drip. Depending upon my Paramedic scope of practice for a given EMS system, I'm either not allowed to monitor any potassium drips and PIV only, OR I can monitor potassium drips up to 40 mEq/L through a central line.

Sure we can teach the basics of what each scope of practice is for each level of EMS provider but to go beyond the very basics, you'd have to be able to explain the scope of practice for all the different EMT/Paramedic personnel in all the different EMS systems in existence. What's driven into the heads of every EMT, AEMT, and Paramedic student is they must know their scope of practice because nobody else will and that they're not to exceed that scope. Ever.

Incidentally, this thread is about 5 years old and since the thread began, CCT-RN work hasn't decreased... even with the use of the CCT-P. The CCT-RN isn't going away any time soon.

[heinz57]

Most people have no clue exactly what the scope of practice is for EMT, AEMT, Paramedic, or CCT-P.

This is an old discussion but some attitudes don't change.

In all fairness, most EMTs and Paramedics have no clue about the many different specialties of nursing or any other hospital or clinic health care professional either. Many in EMS are clueless about the scope of practice of a flight or critical care nurse and assume all nurses must call a doctor to hold their hand for every order and procedure.

EMS has also changed some of its titles or has so many titles you need a continuously updating app to keep up with the "EMT-I is now EMTA (sort of) although it is more of an EMT-B, which is now EMT, with some of EMT-I but not quite. Some use the NREMT and some still don't. The Paramedic varies from State to State, county to county, city to city and company to company. Privates hate the fire department EMS. Fire department Paramedics think the privates are stupid and only good to transport BLS even if they have a Paramedic patch. Don't put this all on nurses for not knowing every little detail of your scope of practice for you patch. When contracts are negotiated, a cheap sheet should be given to the hospital to avoid confusion. It is really not that difficult. I will say the hospitals which have their own CCT teams with CC trained RNs are the easiest to deal with so I hope they stay or even expand more into transport.

OMG don't get me started on the "Ambulance Driver" bullpoop! "The "ambulance driver" got a ticket" or "Tell the Ambulance Driver to move their rig" and you get holy heck raining on you even if it does not pertain to anything medical. Who cares what their medical certification is if they were doing a 100 mph in a school zone going back to the station? The person driving the ambulance (Ambulance Driver) probably has the most responsibility of all getting everyone where they should be safely in a timely manner regardless of which EMS title they hold. This includes the routine medical transport rigs which have to keep on schedule to get patients to their schedules appointments.

[PeeWeeQ, ADN, RN, EMT-B]

It's never NOT going to be about the money. EVER. Like it, hate it, or indifferent, SOMEONE has to watch the bottom line--it DOES matter. And, the person or people doing it, are going to have to make unpopular decisions and no matter what, there will always be those who disagree. I wouldn't want to have that job/jobs, would you?

[PMHNP2023, RN]

5 years from the original post and CCT RNs are still here in So Cal!

[drewseph92]

@CSUSM10, Yep! And there are definitely still CCT RN's up here in Nor Cal!

[LG1137]

Hospital based? EMS based? Private or government?

[akulahawkRN, ADN, RN, EMT-P]

Most people have no clue exactly what the scope of practice is for EMT, AEMT, Paramedic, or CCT-P. I've worked as a Paramedic for quite a while and in my experience, most nurses don't know that EMT and Paramedic are two different levels with very different scopes of practice for transport. All they know is that the "Ambulance Drivers" are here for the patient. I have had to refuse to accept a patient for transport because the patient required monitoring that was out of my scope of practice and it could be something as simple as having a patient on a potassium drip. Depending upon my Paramedic scope of practice for a given EMS system, I'm either not allowed to monitor any potassium drips and PIV only, OR I can monitor potassium drips up to 40 mEq/L through a central line.

Sure we can teach the basics of what each scope of practice is for each level of EMS provider but to go beyond the very basics, you'd have to be able to explain the scope of practice for all the different EMT/Paramedic personnel in all the different EMS systems in existence. What's driven into the heads of every EMT, AEMT, and Paramedic student is they must know their scope of practice because nobody else will and that they're not to exceed that scope. Ever.

Incidentally, this thread is about 5 years old and since the thread began, CCT-RN work hasn't decreased... even with the use of the CCT-P. The CCT-RN isn't going away any time soon.

This is an old discussion but some attitudes don't change.

In all fairness, most EMTs and Paramedics have no clue about the many different specialties of nursing or any other hospital or clinic health care professional either. Many in EMS are clueless about the scope of practice of a flight or critical care nurse and assume all nurses must call a doctor to hold their hand for every order and procedure.

While it is true that most EMT's and Paramedics have no clue about the many specialties of nursing or much of whatever else happens in hospital, they do know one thing about Flight/CCT nurses: their scope of practice is incredibly wide and they are expected to function nearly independently, relying primarily on standardized procedures/protocols and only calling for specific orders when necessary... just like the Paramedics do.

EMS has also changed some of its titles or has so many titles you need a continuously updating app to keep up with the "EMT-I is now EMTA (sort of) although it is more of an EMT-B, which is now EMT, with some of EMT-I but not quite. Some use the NREMT and some still don't. The Paramedic varies from State to State, county to county, city to city and company to company. Privates hate the fire department EMS. Fire department Paramedics think the privates are stupid and only good to transport BLS even if they have a Paramedic patch. Don't put this all on nurses for not knowing every little detail of your scope of practice for you patch. When contracts are negotiated, a cheap sheet should be given to the hospital to avoid confusion. It is really not that difficult. I will say the hospitals which have their own CCT teams with CC trained RNs are the easiest to deal with so I hope they stay or even expand more into transport.

If it's difficult for to keep track of all the capabilities of transport personnel, it's going to be difficult to keep track of all the non-transport personnel. I didn't put anything on the nurses for knowing all details about what I can do as a Paramedic. The easiest way to find out if a given provider is OK to transport a certain patient is to ask. It's not a difficult thing to ask whoever is coordinating transport, "hey, this patient has 3 drips, is on a vent and has a chest tube, can you take this?" Where I currently live, that's a CCT-RN thing. In other states, a Paramedic can do it without batting an eye.

As far as doing Interfacility transports, hospital-based teams are fantastic because they can either extend the care of a given hospital to the patient (retrieval teams) or they can continue care of a patient until the patient reaches the other facility. CCT programs that aren't hospital affiliated will usually have transport contracts with certain facilities and EMS systems and these contracts often delineate the scope of practice that is used. The "worst" part of those is usually Paramedics have to be accredited for each county and will have to follow those protocols whereas a flight nurse follows only a single set that the company says "if we're to play here, these are our rules for our nurses."

OMG don't get me started on the "Ambulance Driver" bullpoop! "The "ambulance driver" got a ticket" or "Tell the Ambulance Driver to move their rig" and you get holy heck raining on you even if it does not pertain to anything medical. Who cares what their medical certification is if they were doing a 100 mph in a school zone going back to the station? The person driving the ambulance (Ambulance Driver) probably has the most responsibility of all getting everyone where they should be safely in a timely manner regardless of which EMS title they hold. This includes the routine medical transport rigs which have to keep on schedule to get patients to their schedules appointments.

Oh, and the "ambulance driver" stuff isn't about the medical certificate. It's one thing to ask for the ambulance driver to move the ambulance and another thing to announce to staff, patient, etc that the "Ambulance Drivers" are here. It's better simply to announce that "transport for XXXX" is here. This is because you might actually have a CCT crew or a Paramedic crew, or an EMT crew picking up the patient. The term "Ambulance Driver" really needs to back to the 1970's and stay there.

Is that a bit of a "sore spot" for folks that work in EMS? Yes, it most certainly is. Where I work, we do work very well with EMS providers, public and private. This is because I work in the ED and we get a number of our patients by EMS and we do send a lot of patients out by EMS. This frequent contact means we also know their scope of practice and knowing this makes it easy for us to ask for the correct type of transport for a given patient.

Given the rate at which the State of California changes the scope of practice for EMS providers, it's going to be a very long time before CCT-RN disappears from the scene in this State. In order for that to happen, the State would have to allow CCT-Paramedics to have a scope of practice that would allow them to transport any patient from any ICU to any ICU anywhere. That's not going to happen for a number of reasons, not the least of which is the pushback from CCT nurses.

A good CCT-P program would, in theory, allow for better utilization of CCT-RN tranport resources. I've yet to hear of a very good CCT-P program in California that actually accomplishes this in a significant way. This is because the CCT-P in California is far behind what many standard Paramedic programs can do elsewhere in the US.

[heinz57]

@CSUSM10, Yep! And there are definitely still CCT RN's up here in Nor Cal!

After reading Akulahawk's post, I doubt if CCT RNs have anything to worry about.

Akulahawk, Stop worrying about being called an Ambulance Driver if it is in reference to the "one who drives the ambulance". I can see you getting out of your ambulance to scold the child who gets excited watching someone he thinks is cool driving an ambulance. Nurses have learned to accept the rude remarks and even laugh about it when Paramedics call them butt wipers and bed pan specialists. They know it is part of their job and not their entire identity as professionals. Work as a nurse and you'll be called a lot of things.

[Drew Congdon]

I just want to comment on this and dispel the misinformation that’s happening. I am a flight medic in California, this scope is essentially a push to allow us to work under the same protocols as the rn’s that we work with. The current model in California requires flight Paramedics to work under the ground ems protocols while also following our flight protocols. It makes for often confusing and conflicting patient care scenarios. It also forces flight medics in Ca to be accredited in many different counties all with different policies. This would unify flight scope. This proposal is ONLY for flight medics who hold either the FPC or CCp which is the same test as the CFRN or CCrn. This is not for ground medics. This also is in NO way a threat to flight nurses, the staffing will always be nurse medic or nurse nurse. This simply allows us to be in line with all other states where the scope for flight rn and medic are the same. I hold a degree in paramedicine and the FPc as well as being held to the same clinical knowledge standard as my nurse colleagues. The company requires most employees to have a degree and years of experience to be hired. Please support this move as it only benefits patients and allows the flight teams to more effectively do their jobs in California. Also bear in mind the entire country is way ahead of California in ems. Our company is nationwide and California is the only state where the scopes are not equal. In most stated ground ems have the same if not more expanded scope than we do in the air here. As medics and nurses who work in this capacity, we are trying to push the state forward and improve patient care. We are in no way a threat to any job for nurses.

[PeakRN]

On 10/7/2019 at 6:03 PM, Drew Congdon said:

This proposal is ONLY for flight medics who hold either the FPC or CCp which is the same test as the CFRN or CCrn.

Not the same tests.

[Drew Congdon]

2 hours ago, PeakRN said:

Not the same tests.

The training materials are the same. Most books and prep classes are for both. Tests may have varied questions, but topics covered and knowledge base are the very close.