MICP - Introduction into CCT
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MICP - Introduction into CCT



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Focus Statement: This module will introduce the participant to the History of Critical Care Medicine, the roles and function of CCT, and basic differences between CCT and pre-hospital EMS.



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MICP - Introduction into CCT MICP - Introduction into CCT Presentation Transcript

  • Overview of Critical Care/Specialty Care transport Mobile Intensive Care Paramedic Series
  • Focus Statement
    • Focus Statement: This module will introduce the participant to the History of Critical Care Medicine, the roles and function of CCT, and basic differences between CCT and pre-hospital EMS.
    • This lecture meets Section 1 of the Idaho EMS Critical Care Curricula Guide
  • Presentation Information
    • Last revised 04/20/08
    • For more information contact the education department
      • 208-287-2972
  • Terminology
    • CCEMTP: Critical Care Emergency Medical Transport Program
      • Not Critical Care EMT-P
    • SCT: Specialty Care transport
      • AKA CCT: Critical Care transport
    • IFT: Inter-facility Transport
  • Role of the Critical Care Paramedic
    • Various Models
      • Standard EMS with critical care role, if needed
      • Dedicated critical care ground transport
      • Rotor transport
      • Fixed-wing transport
  • Ground Transport
    • PROS
    • Larger patient compartment
    • Lower cost
    • Relative immunity to changing weather
    • Safer
    • Less severe environmental factors
      • Oxygen levels
      • Acceleration/deceleration forces
      • Gas volume changes with altitude
      • Cabin pressurization
      • Humidity
      • Noise
      • Vibration
    • Specialty UNITS
    • CONS
    • Slower response
    • Needs a designated Driver
  • Rotor Wing
    • PROS
    • Can land almost anywhere
      • Scene
      • Direct to ER/OR
    • Quick to launch
    • Flying Billboards
    • CONS
    • Least Safe
    • Most expensive
    • Weight Restrictions
      • Affected by temperature
    • Tiny Patient compartment
    • Affected by weather
    • Not pressurized
    • IFR/VFR
    • Cant Fly “above the weather”
    • Noise and vibration
  • Fixed Wing
    • PROS
    • Larger patient compartment than Rotor
    • Lower cost than Rotor
    • Better Operating parameters than Rotor
    • Safer than Rotor
    • Faster than Rotor
    • Less severe environmental factors
      • Oxygen levels (pressurized)
      • Humidity
      • Noise
      • Vibration
    • CONS
    • Need a runway
    • More expensive up front?
    • More lead time to launch
  • TEAM Configuration
    • Team configuration ( Four Common Variations)
      • RN/ Paramedic
      • RN/ RN
      • Paramedic/ Paramedic
      • RN/ RT
      • May or may not include a third crew member (EMT) as a driver on ground operations
    • Some specialize in the transport of patients classified as
      • Pediatric
      • Neonatal /Maternal
      • Burns
    • THE RN/Paramedic configuration is the most common.
      • Different view, perspectives, and training
      • Ideally, equal responsibilities
        • State legislation and Nursing Lobbies may affect this
    • RN/RT more common on specialty teams and inter-hospital focused programs.
      • Neonatal
    • Certification
      • Currently in state of flux
      • Certified Flight Paramedic (FP-C) certification
        • Offered by Board of Critical Care Transport Paramedic Certification (BCCTPC)
        • Affiliate of the International Flight Paramedics Association (IFPA)
      • Certified Critical Care Paramedic
        • Certification not certified or standardized
        • Most widely accepted program
        • Course completion not certification
  • Scope of Practice?
    • MAY Include:
      • Advanced airway techniques
        • RSI
        • Surgical airway
      • Ventilator management
      • Pulse oximetry and capnogram interpretation
      • Chest tube placement and monitoring
      • Thoracic escharotomies
      • Transvenous pacing
      • Intra-aortic balloon pump
      • 12-Lead ECGCentral venous catheter maintenance/placement/ interpretation
      • Intracranial pressure monitoring
      • Venous cutdown
      • Blood/blood product administration and monitoring
      • Infusion pumps
      • Advanced pharmacological intervention
  • Scope of Practice??
    • Lots of Talk, Lots of variability
    • No federal Minimal Standard
  • Certification?
    • “Advanced Practice Paramedic”
      • Dropped from the National Scope of Practice due to pressure from fire service and affiliated lobbies.
      • Has garnered new support from unlikely sources….
        • NAEMT
        • AEMS
        • NREMT
  • NREMT and the Future of Critical Care Paramedic
    • NREMT has taken a stance for the “APP” (Advanced Practice Paramedic) in 2008.
    • “ This level wouldn't require unique licensure. It would be a specialty certification—earned through continuing education, advanced competencies and clinical requirements. It would require paramedic experience and endorsements as part of the certification process.”
    • William Brown of the NREMT
  • Idaho and Critical Care Paramedic
  • Medical Control
    • Similar to Pre-Hospital Systems, Critical Care Paramedics are directed by licensed physicians
      • Care guided by protocols, standing orders
    • Unlike Pre-Hospital systems, use of Specific Written , Verbal, and Telephonic Orders (On line medical Control) for specific patients are far more common
  • Patient Care Focus
    • More continuation of level of care, less initiation of emergency care
      • Unless needed!
    • Comprehensive formulary
      • Allows for greater continuation of care instead of improvising
      • May use drugs not carried/stocked
      • Increased responsibility
    • More complex tools
      • Temporary Pacers, Ventilators, Pumps
  • Who Needs CCT/SCT?
  • Who Needs CCT/SCT?
    • Patients who:
      • Have critical injuries or illnesses resulting in unstable vital signs AND need transport by transport teams with the appropriate levels of care capabilities to centers able to provide definitive care
      • OR
      • Need high-level care during transport (but lack time-critical illness or injury)
  • So why CCT Now? (Nationally)
    • $$$$$$$$$$$$$$$$
      • More upfront costs, bigger long term reward
      • Different (better) reimbursement schedule
    • Federal EMTLA and COBRA statues
      • Transfer requirement with appropriate staffing
    • Liability
      • Sending crews without appropriate training
    • Staffing
      • No longer cost effective to pull staff from floors.
  • Thoughts on Professionalism
  • In Hospital Culture
    • Must be able to adapt to hospital environment
      • Remember that you represent the entire prehospital profession
      • “ You never get a second chance to make a first impression”
      • Use common sense and respect when interacting with hospital staff, patients, and their families
      • Be nonjudgmental when completing assessment and care
      • Ask before using hospital equipment, viewing patient charts
      • Thank transferring facility staff, and offer feedback
  • Culture
    • “ Scene Calls with Walls”
      • Use common sense and respect when interacting with hospital staff, patients, and their families
      • Be nonjudgmental when completing assessment and care
    • Be prepared for staffing and equipment differences than what we normally use
  • Remember:
    • No matter how different or poor the care, patient care will NOT be served by pissing off the staff!
    • If they are pissed off, they wont call you for the next patient, who might need you help even more!
  • Professional Attributes
    • Professional
    • Put patient care first
    • Practice skills to the point of mastery
    • Understand the importance of rapid response
    • Take continuing medical education seriously
    • Set high standards for self, crew, agency, and system
    • Review own performance critically
    • Check equipment before it’s needed
    • Nonprofessional
    • Put ego first
    • See no reason to improve
    • Get to a scene when convenient
    • Feel no need for continued education
    • Aim for minimum standards
    • Protect self, hide inadequacies, blame others
    • Hope that equipment will work when needed
  • Political Influence on Critical Care Paramedics
    • Knowledge is power
    • Critical care paramedics should know the entities opposing their presence in CCT
      • Understanding opposing forces better prepares critical care paramedics to interface with those forces at work
      • Helps to bridge the divide between health care team members
    • Role of critical care paramedic in hospital is not to replace other health care team members
      • Goals are integration and enhancement
  • Nursing’s Longstanding Issues with Critical Care transport
    • Medics Perspective
      • “ Get er done” mentality
      • Broad scope seems to be a good fit. Areas of Expertise
    • Nursing’s perspective
      • Holistic mentality
      • Critical care paramedic is unlicensed provider concerned with skill provision, allegedly lacks breadth of knowledge offered in nursing school
        • Sedom distinguishes between an EMT, a paramedic, and a Critical Care Paramedic.
      • This is reinforced by nursing labor organizations fearing loss of nursing jobs.
    • RECOMMENDATION: Walk softly, do the job!
  • Remember: When crisis strikes, we don’t “rise to the occasion”, we “sink to the level of our training”. From “On Combat” Lt Col David Grossman (ret)
    • National Association of Critical Care Paramedics (NACCP)
    • International Flight Paramedics Association (IFPA)
    • National Flight Paramedics Association (NFPA)
    • National Association of EMS Physicians (NAEMSP)
    • National Association of EMTs (NAEMTs)
    • Society of Critical Care Medicine (SCCM)
    Professional Organizations
  • Remember….. You must always strive to earn your status as a health care professional!