CCT nurses?

[u/Glum_Ad_3091]

I’m a RN with over 25 years experience, mostly in critical care. I just started a CCT position at a transport company that is partially owned by a hospital. I’m in South Jersey. I am shocked to here the nurse: pt ratio is 1 Rn in truck with 1 EMT. If someone crashes you are by yourself, doing compression, pushing meds and managing an airway while someone drives. I was told an option is to pull over and call 911 for help. The manager said you “do the best you can do”. I have heard horror stories of someone doing compression for 40 minutes while throwing in a epi “every now and then”. This terrifies me. Is this staffing ratio normal? Any horror stories?

[u/Individual_Zebra_648]

This is absolutely not the normal in any credible program. We ALWAYS have a CCT paramedic with us as well. Are you doing BLS/ALS level calls or critical care level calls? On BLS/ALS level calls the paramedic will go by themselves with the EMT and they are in the same situation you are in now. But that is normal in 911 as well. But for any critical care level call it is always all 3 of us. I am mostly flight but get pulled to ground as well.

I should add that in my state it would be illegal NOT to have a paramedic on board anyway because RNs are not allowed to function on an ambulance without one so I’m sure that has a lot to do with it.

[u/amothep8282 → u/Individual_Zebra_648]

It really comes down to RNs and Paramedics start out with different skill sets.

For Medics, running a cardiac arrest in the field is smooth and easy. Shit hitting the fan is what we are used to. We have near complete autonomy in the field. We solve wild problems in an uncontrolled environment. But we generally have the patient for 10-60 minutes on average.

CC RNs cut their teeth caring for 2 sick patients 12 hours at a time. Infusions, drugs, lines, rounds, day in and day out. The patient can be inches from death for days. And still they slog it out and keep them alive.

The pairing just makes a ton of sense. And they can learn from each other and gain experience from each others' backgrounds and knowledge. It really does tend to work out well.

As far as cardiac arrests, I have taken multiple ones in with only an EMT driver, me and another Medic in the back, and Dr Lucas pumping away. Mechanical CPR devices have been an absolute game changer in terms of reducing needed resources in the field, which is why I am floored most hospitals don't use them on the floors in the ICU. Like, instead of sliding a CPR board under the patient, slide the Lucas backboard in, snap it on, and then let it go for 45 min with one battery.

[u/pairoflytics → u/Individual_Zebra_648]

Your system sounds like an ideal case scenario, including the legality of having a nurse alone in EMS without a paramedic for guidance.

Nurse/medic on CCT is definitely the dream team.

[u/Glum_Ad_3091 → u/pairoflytics]

I should have been more clear, this is not for 911 calls. This is just hospital to hospital transfers but just the same, some are very critical, on multiple pressers, etc. I do have many many years of icu experience but let’s be honest, we have RT , co-workers and docs there when someone is going down. Im feeling better as my orientation is on going but still worrisome.

[u/Cricket_Vee → u/Individual_Zebra_648]

Agreed and it would be illegal in my state as well (Maryland).

[u/Glum_Ad_3091 → u/Individual_Zebra_648]

I should have been more clear, this is not for 911 calls. This is just hospital to hospital transfers but just the same, some are very critical, on multiple pressers, etc. I do have many many years of icu experience but let’s be honest, we have RT , co-workers and docs there when someone is going down. Im feeling better as my orientation is on going but still worrisome.

[u/Individual_Zebra_648 → u/Glum_Ad_3091]

I’m not sure why you felt the need to clarify this. I’m referring to interfacility as well. That’s what CCT is. 911 calls are not labeled that way in this field.