CCEMT-P??? What is this?

[lexfd5]

Saw CCEMT-P on some posters closings and was wondering what this is? I checked our state ems site and it had steps for certification (paperwork for giving the state money.) What does the class include? Is there testing?

Thanks in advance from Hicksville, KY.

[LEMSBLS]

not sure about testing or requirements or anything all i no is it means Critical Care EMT-P

[NFR22785]

not sure about testing or requirements or anything all i no is it means Critical Care EMT-P

If you have taken the CCEMTP course and passed, you are considered a critical care paramedic...The acronym stands for Critical Care Emergency Transport Program...As I am one, I can tell you that if you are interested in taking the course, you should google CCEMTP and click on the link to UMBC's Emergency Health Education department...hope this was helpful...

[montet202]

What additional skills, etc. do these new initials allow?

There is no such thing in Washington, but I am looking to move elsewhere and am also curious about this strange new level I can achieve.

Or...are these skills I already have and can get reciprocity for them?

[CoolDre]

RSI, chest tube insertion, hanging blood, starting insulin drips, initating thrombolytics, surgical cricothyrotomies, monitoring art. lines, monitoring ICP, foley cath insertion, etc...

[croaker260]

Lex,

In addition to the above core content, I would also add Balloon Pumps, lab values, and advanced ventilator managment. I think there is a touch of escorotomy and advanced burn management too. Most have some form of skills labs ( I would tell you more about mine, but PETA would have a cow) and limited ICU rotations.
Just like paramedic school, the course gives you a foundation, but its continued exposure, OJT, and pt contact that makes you truely qualified. For example: Due to the medical demographics of my state, I have'nt done a balloon pump transfer since 1997 (when I was in tennessee). Therefore although I am responsible for the knowledge, I am smart enough to realize that I need to really bone up on that before I do one again. This is why most critical care programs use the CCEMTP course as a starting point, not as a credentialing process.
Just like a good EMS program would not send anyone with a EMT-P card on the street with out additional training.

Regardless, Keep in mind that like a traditional paramedic your scope of practice is as broad or as limited as your medical director and state regs allow. A growing number of organizations are requiring this either in pre-employment or as a condition of continued employment. The majority of these are traditional flight services that, as the needs of the area evolve, do both ground and air transport..although there are some ground EMS that do this too.

My area for example has some non specific regulations regarding the critical care level of care, but has not defined anything that exceeds what we do now. In otherwords....They have laid the framework for a future level but have not pursued it further. Even with out a true CC level, my state for over a decade has allowed paramedics to do central lines, chest tubes, RSI, thrombolytics, high end med drips (NTG, etc) both in the field or in interfacility care. So in my state...and many others, at face value it does not seem a huge improvement.

That said I absolutely support the course. Having taken the UMBC one and an earlier "pre-UMBC" one from UT, I can say that each time has been one of the tougher challanges in my medical career...and have ALWAYS learned something new. FOr example, I have done RSI for years, but hearing from anesthesia and other "airway gurus" definitly improved my critical thinking skills.

The course is an 80 hour course, "supervised" but not always sponsered by UMBC, with the final exam administered by UMBC. The recert requires 24 hours of cont ed specifically related to the core material. There is also a pediatric critical care course add on as well, but I dont know much about that. There are also a high risk OB/neonate add on in the works according to rumors...but that is speculative at best.

The course appeals mostly to paramedics, but is also open to RN's and RT's. As mentioned above, it is a pre-requisit tothe FP-C cert, and a big feather for those looking at flight medicine.

If I remember correctly, it requires 3 years experiance in the field as a medic (or RN/RT in critical care enviroment), with a current ACLS, a current trauma course (TNCC, BTLS/ITLS/PHTLS, or ATLS), and probably some other minor requiremnts. Cost was over a thousand dollars when I took it last.

I hope these random comments are usefull.

-Steve

[mitllesmertz1]

foley cath insertion, etc...
ROFL; OK, I let ya guys get all giddy about wanting to have every skill under the sun open to you, to make ya feel more useful, but for god's sake
FOLEY INSERTION IN AN AMBULANCE??????
Have you just gone overboard?
Are ya maybe losing touch with what's really important?
Go ahead, give me some valid, pertinant reasons for havingto insert a Foley in the field ( what, no urinals?).
Are there really that many pt's with inability to void in your area?
Do you carry bladder scanners for pre/post void residuals?

I can hardly wait to hear why this is an important skill....

[AKflightmedic]

Are ambulances the only place we as paramedics work? I dont think so.
I have done foleys in the ER and in flight medicine. However, you asked for an example in the back of an ambulance, so here you go...

Had roughly an hour transport by ground, no flight service avaliable, transporting a severe head injury. RSI'd the guy and hung a mannitol drip. His BP started to rise...was it the injury, the drugs, or a full bladder? A little palaption of the abdomen lead me to think it was the latter. Insertion of foley, major output and guess what...his BP came down.

I hope this answered your question...

[croaker260]

Mittle,

Step back please and look at the course and its scope in context. It is meant to better prepare the medic for inter-facility critical care transport, so the use of the term "in the field" has a slightly different impact.. Remember that in many areas this is a 2-10 hour flight by fixed or rotor wing, or even by ground. Since many of these patients may be sedated, intubated, or otherwise incapacitated, I think a foley is a reasonable skill to have for this enviroment.
Also recall that in some areas (like my own) it involves going to small rural clinics/hospitals there may be patients who do not have this done and the crew will do one on scene or in route to monitor output, like in critical burn or CHF patients.
Finally in order to trouble shoot a foley you should know how to place one. Rapid changes in altitude can result in changes in balloon pressures...and therefore may require some trouble shooting, same with your ETT cuffs. (and while I know that the majority of fixed wing transports are in pressurized aircraft, there are some that are not. Also most rotor wing transports are not pressurized either.)
Finally, one final note, whether you really think that a foley placement appropriate, the CCEMTP course is not a "skill driven" course as much as it is a knowledge driven course, and discussion of foley catheter placement takes up very very little of the course content, while discussion on the evaluation of renal function through output measurement and lab values; and the impact of the renal system on patient survival; takes up a considerable bit more.

Not trying to bust your balls, I know where your coming from mittle. Just commenting that maybe your frustration is misplaced here.

-Steve

P.S. Oh yes mittle, a reason why foley cath insertion and troubleshooting is important to the street level medic? Two words:

Autonomic Dysreflexia
:)

[mitllesmertz1]

Mittle,

Step back please and look at the course and its scope in context. It is meant to better prepare the medic for inter-facility critical care transport, so the use of the term "in the field" has a slightly different impact.. Remember that in many areas this is a 2-10 hour flight by fixed or rotor wing, or even by ground. Since many of these patients may be sedated, intubated, or otherwise incapacitated, I think a foley is a reasonable skill to have for this enviroment.
Exactly my point, Croake, you said it yourself: inter-facility transport.
People being taken from facility A to facility B should not have their foley placed in the back of an ambulance.
If that's the standard of care at your area facilities, well, that's another issue.


Also recall that in some areas (like my own) it involves going to small rural clinics/hospitals there may be patients who do not have this done and the crew will do one on scene or in route to monitor output, like in critical burn or CHF patients.
Any crew that is doing a foley on scene of a burn or CHF pt, as you just posted, should be shot.
We are, again, losing track of what emergency medicine is about. Monitoring the output of a critical burn pt is far down the road from what a medic IN THE FIELD should be worrying about.

Finally in order to trouble shoot a foley you should know how to place one. I value your opinion alot, but that was the worst excuse ever :)
Under that theory, the same medics should be able to place ICP probes.
Good luck with that one, although I have the feeling many here think they should ("Ya gotta be know why they're acting funny, right?")


Not trying to bust your balls, I know where your coming from mittle. Just commenting that maybe your frustration is misplaced here.
Steve, I always value your opinion. My sense of frustration is twofold,really.
-First, I think alot of skills/procedures are being allowed in the field that have no true need in the field, but can be justified by some far-reaching reasoning (ie AKFlightMedic's example of "why is the BP going up? oh, I'll place a foley, that'll tell me".
-Also, and perhaps more saddening, what we are seeing is medics doing procedures/skills/meds that have traditionally been done by RN's, or MD's even.
While a medic may get all excited about doing a new procedure that used to be forbidden, all that has happened is a shift in the job market.
A company/agency/hospital can now have a lower-payed medic, with less education (typically), perform the procedure.
They can replace a BSN with a high school degree carrying medic.
And this is better for pt care?
But, because the medics get to do something new, they see this as a good thing!
Why not become better educated, why not raise the standards for paramedicine, instead of being the dumping ground for Administrators looking to cut costs?

All of these nifty skills listed under CCEMT-P sum up one thing: they don't have to pay an RN to do it. Congratulations on your new skills :rolleyes:
Just because we can do something doesn't mean we should be doing it.



P.S. Oh yes mittle, a reason why foley cath insertion and troubleshooting is important to the street level medic? Two words:
Steve Steve Steve, is this really a common illness?
As an experienced medic, which I believe you are, how many cases of Automic dyreflexia have you seen in the field, and what is the cost/benefit ratio for spending the money to equip medics with foleys,and have proper training/QI, to treat this malady?

Of course, I guess your cheaper than having an RN do it. :(

[croaker260]

Steve Steve Steve, is this really a common illness?
As an experienced medic, which I believe you are, how many cases of Automic dyreflexia have you seen in the field, and what is the cost/benefit ratio for spending the money to equip medics with foleys,and have proper training/QI, to treat this malady?

Of course, I guess your cheaper than having an RN do it. :(

Mittle, I will comment on the rest of the post later (baby is waking up)
I will however jot down a quick reply on AD...but I personally see about 2 cases of this a year in the 911 arena, and substantially more when I did contract fixed wing VA transports (more chronically cord injured patients). Since I dont think Boise is the dumping ground for cord injuries, I think this is not far out of line incidence wise. Granted I, and the rest of the department, tend to see the same two or three patients over and over again...but that is neither here nor there. Which , BTW, is more than the cases of life threatening post partum bleeding I have seen in my entire career, but we still cary pitocin. There is an argument for both sides of this.
In our protocol for this (yes we have one for our 911 service) , before we do pharmacologic therapy, we rule out causes including flushing the catheter (or straight cathing them). I dont think thats over aggressive, I think thats quite reasonable and in the patients best interest. Not the hospital/companies administrators, but the patient.

There is a fair number of these cases in any sizable community, I dont have the stats infront of me, but I seem to recall that 80% of injuries above T-6 will develop this malady in the first year. One patient told me he has episodes about twice a month...but usually he can self tx and he is OK. UAnd that is typically the case, which is why we seldome hear about it. Usually the patient can self resolve it when it occurs and its no big deal. When the patient cant, sometimes due to other issues....it becomes a big deal...and then it becomes a true emergency (HTN crisis, stroke, etc). Therefore the benifit can be sustantial.

And of those times I have cathed someone in the field for this, the fortunate thing is that the patients tend to have their straight caths handy, or have a cath in place that simply needs to be flushed. When it is done (assuming that is the cause, wich it likely is but not always), then the s/s tend to promptly resolve.
There are no extra drugs for us to carry, since NTG is acceptable in this setting (although procardia and hydralizine (sp?)are used by patients themselves too)...
So the benifit is there, the need is there (how many cord injured patients live in the community), and there is not a real equipment issue. And since RN's are not usually in the field with us...its not a doing the job of RN's because we are cheaper issue.... and since this is an out of hospital setting (not interfacility...which is a whole other discussion of foleys)...and around here home health is habitually absent when a patient really needs them....its a question of my being in the right place at the right time to do something truely useful (rather than 70% of the calls we go on). Considering that...other than the critical thinking of knowing why you are doing it...it is a simple skill to do (most of the time), I dont see the problem.
So its a training and education issue. And I am all about training and education. And with that I will close and say that I am in 100% agreement that we need more education and higher standards for paramedics. BTW, I heard the other day that George washington University of modifying a doctorate program in public health administration to have an EMS emphsisis option.
A doctorate in EMS. Nice. Every step in the right direction helps....every step.

:)

P.S.

When I mentioned "on the scene" earlier for burn/CHF patients, I was refering to the ER for an interfacility transport...not a regular scene (911) call. My bad there for the misunderstanding. I agree in the initial phase of burn care/CHF care there are more pressing things to do than get a foley.

[wnwd00]

mitlle,

it is clear from you post that you have never worked for a ground transport EMS that has extended trasnport times. I have had the excellent expierence of having worked inner city ALS and rural ALS. Of course the city medics think the rural medics dont know a thing and vice versa however take these "trauma" city medics and give them a sick CHF, and they are 45-60 mins from a hospital and they will sh*t their pants. In these cases you would eventually put a folley in because the lasix will eventually start to work and the last thing you want your pt who cant breathe very well is worrying about having an accident.

I have never worked critical care and I only work non transport ALS in a chase vehicle and on a regular basis (well much more regularly than most places at least) I hang IV drips on pumps of everything from nitro, dopamine, cardizem, insulin, etc in addition to RSI, foley, NG tubes and other skills

so mitlle before you go and critize a procedure as being a nurse only thing or as someone being an idiot for doing it in the field maybe you should broaden your expierence and take a look at what other departments/agencies have to do due to their unique geography and situations.

[DrParasite]

Also, and perhaps more saddening, what we are seeing is medics doing procedures/skills/meds that have traditionally been done by RN's, or MD's even.
While a medic may get all excited about doing a new procedure that used to be forbidden, all that has happened is a shift in the job market.
A company/agency/hospital can now have a lower-payed medic, with less education (typically), perform the procedure.
They can replace a BSN with a high school degree carrying medic.
And this is better for pt care?
But, because the medics get to do something new, they see this as a good thing!
Why not become better educated, why not raise the standards for paramedicine, instead of being the dumping ground for Administrators looking to cut costs?

All of these nifty skills listed under CCEMT-P sum up one thing: they don't have to pay an RN to do it. Congratulations on your new skills :rolleyes:
Just because we can do something doesn't mean we should be doing it.A very interesting point of view. a similar response was made when the paramedic program was initially started, where all the RNs said that EMT-Ps would end up taking over the roles that were traditionally held by RNs. and last I checked, there was still a high demand for RNs.

as for new tools, well, how long ago was being able to defib someone a doctor only skill? and now MDs, BSNs, RNs, Medics, EMTs, and any bum off the street can do it. apples to oranges maybe? or a similar idea, being looked at a different way?

it's a little off topic, but just wanted to point that out.

[montet202]

Actually Mittle, I HAVE seen a foley placed in the field. The aid car was sent back to the ED for the kit and returned. The medic placed it and left the patient at home. He was a terminal cancer patient who had come home to die with his family and was in excruciating pain because he could not physicly urinate. The foley allowed him to empty his bladder and relieve the pressure on his diseased liver.

This actually occured in YOUR county and was done by one of the most respected Medics to come out of your system.

[RyanEMVFD]

Not very often do I see AD even brought up. Here CCEMT-Ps are slightly more skilled but they deal mostly with inter-facility transfers of patients on vents, drips and other stuff out of the ICU. To go to the college that teaches it in this county, you must have been a medic for at least 3 years.

As for foleys, we don't do them and I don't really want to. Granted I imagine it will be something we do in a few years if the situation warrents it.

[medicmaster]

CCEMT-P is a great class to take...but now my disclaimer. If you are not in a system that is going to allow you to use it, it's a waste of time.

The scope of what is taught in the Critical Care Paramedic program is meant for use on interfacility transfers. If you don't routinely do these, it is impossible to actually stay current with the skills and knowledge you obtain from this course.

Another thing to consider is that this is not a certification. It is just like ACLS, PHTLS or any other class. It is meant to serve as proof that you have received enhanced training in the context of conducting a critical care transfer between hospitals. Right now, I believe Iowa is the only state that actually "certifies" an individual as a Critical Care Paramedic. It is tacked onto your Paramedic Specialist (NREMT-P) certfication as an endorsement. Also, the state scope of practice for the Critical Care Paramedic may only be utilized during an interfacility transfer...not on 911 calls.

While I did not take the UMBC course, I took the state approved course through the University of Iowa which mirrored the UMBC course. I have learned alot from it, and I am fortunate to work in a system that I am able to use the skill sets frequently. However, I rarely get to monitor an art. line, or ICP, or manage an LVAD patient. Most of what I see are multi-drip meds, and ventilator patients. (Of note, Iowa's Paramedic scope of practice includes foleys, blood administration, insulin drips, and thrombolytics)

In all, the course is worthwhile, but again, only if you are going to be able to actually use it. (Or you are going after a job where you will...i.e. a flight crew position.)

Because I am in fact "certified as a Critical Care Paramedic....note my signature, PS-CCP, Paramedic Specialist-Critical Care Paramedic.

[ditchdr1964]

CCEMT-Paramedics is the up and coming thing in South Carolina. IF you are intrested in critical Care transport, especially in the cardiac arena, it is a great certification to have. I'm trying to get all my paramedics certified in this.

[mitllesmertz1]

Of course the city medics think the rural medics dont know a thing and vice versa however take these "trauma" city medics and give them a sick CHF, and they are 45-60 mins from a hospital and they will sh*t their pants.
Why is it that because I see 15-20 pts a day,as opposed to 15 a month in the country, people think that I must have no ability to do anything other than pray the pt won't die?
I have a sneaking feeling that I just might be able to handle the overwhelming fear of transporting a sick pt for longer than an hour.
The boredom might kill me, but I doubt I would sh*# myself.

In these cases you would eventually put a folley in because the lasix will eventually start to work and the last thing you want your pt who cant breathe very well is worrying about having an accident.
As opposed to doing an invasive, contamination prone procedure, I might just let it go.
Urinal anyone?

I have never worked critical care and I only work non transport ALS in a chase vehicle and on a regular basis (well much more regularly than most places at least) I hang IV drips on pumps of everything from nitro, dopamine, cardizem, insulin, etc in addition to RSI, foley, NG tubes and other skills
So I guess I could comment on your total lack of critical care experience compared to myself?
Or that I transport more critical pts daily than you do in a month?
Naaah, that's besides the point.

so mitlle before you go and critize a procedure as being a nurse only thing or as someone being an idiot for doing it in the field maybe you should broaden your expierence and take a look at what other departments/agencies have to do due to their unique geography and situations.

Wow, ya got me- if a transport takes longer than an hour, yes, the pt may need a foley.
Since diuretics rarely start urine production for 20-30 minutes, we're really looking at 90 minute or longer transports.
So Yes, I agree, for this critical subset of pts, that are being transported for 90 minutes or longer, and have been given diuretics whilke being transported, and can't use a urinal or bedpan, then yes, they may need a foley catheter.
Congratulations, you found a justification for this skill.
Since they train Medical Assistants to do it, I'm sure youre a very proud individual for this valuable skill. :rolleyes:
http://www.bryman-college.com/
You go big boy!

[mitllesmertz1]

The scope of what is taught in the Critical Care Paramedic program is meant for use on interfacility transfers. If you don't routinely do these, it is impossible to actually stay current with the skills and knowledge you obtain from this course.
In all, the course is worthwhile, but again, only if you are going to be able to actually use it. (Or you are going after a job where you will...i.e. a flight crew position.)
.
This makes the most sense yet.
If you do alot of interfacility transports, this would be a way to provide better care in between.
Have fun making those transports...

[mitllesmertz1]

Actually Mittle, I HAVE seen a foley placed in the field. The aid car was sent back to the ED for the kit and returned. The medic placed it and left the patient at home. He was a terminal cancer patient who had come home to die with his family and was in excruciating pain because he could not physicly urinate. The foley allowed him to empty his bladder and relieve the pressure on his diseased liver.

This actually occured in YOUR county and was done by one of the most respected Medics to come out of your system.
Actually I am the most respected medic to come out of any county.

And I would hardly say that this is a good example of why foleys aree needed in the field.

[Ridryder911]

I guess mitllesmertz1 never heard of strict I & O's.. Of course when you run calls just around the corner of a hospital, not much is expected to be performed, or even really justify having Paramedics.

I have performed foleys in the field, yet I think of patient care not procedures. Yes, short transport time has no purpose of doing so, but there are a lot of EMS services that provide care in rural or long transport times.

Ever been with a major burn patient for greater than a 2 hour transport, or even trauma patient for an hour, and yes given 80mg of Lasix or Demadex to that CHF patient or tranporting a hip fxr. with a hour transport time. It is not very comfortable for people to be off and on bed pan (sorry, females don't use urinals) and have to handle a 200-300 ml of urine in the back of the rig..

Not a glamor skill but still a procedure to monitor the functions and give the patient some comfort when needed.

Think outside the box ...
R/R 911

[mitllesmertz1]

To all of the providers that do interfacility transports, I apologize.
For those of you that do transports of burn patients for 2 hours, I apologize.
I have a different view of "emergent" than some other posters. I have a different view of what the role of a paramedic in EMS.
I'm just glad I don't have to shuttle people from one facility to another. Glad it's you, not me :)

[montet202]

"Actually I am the most respected medic to come out of any county.

And I would hardly say that this is a good example of why foleys aree needed in the field."--Mitlle


I am not saying that we should be carying this stuff, but a general knowledge of it is neccessary so in the off chance you are faced with a situation where you can work outside of the norm you have the ability to do so.

Isn't this why Copass has you peforming procedures in your clinicals that most programs don't even think about touching on?

And that blanket statements have no place in this field.