By Kory Hynes and Ken Larson
Nearly fifty years of EMS education has taught us very little about saving critically ill patients. Historically the dying patient has had little hope — the elderly person who quietly passes away in her sleep or the car crash victim who has only minutes to live when the ambulance arrives on scene.
This is changing. Old age is no longer a diagnosis. The quiet killer of sepsis has been unwrapped from its dark cloak. Traumatic arrest victims are now walking out of the hospital. Today, when we encounter patients who are truly dying, they are being cared for with knowledge, skill and speed.
This is critical care.
A critical patient is one that will die without continuous monitoring and interventions. These are the fragile patients who require a level of understanding beyond a shrug of the shoulders and treatment with a diesel bolus. A critical patient continually tests the limits of bedside clinical knowledge, intuition, and skill.
What is critical care?
Critical care is all about understanding the patient and the treatment. It’s about knowing why a heart failure patient should be treated with afterload reduction. It’s appreciating that hypoxic respiratory failure is best treated by increasing alveolar pressure rather than giving high flow oxygen.
Critical care is about understanding that profound patient care is centered on great diagnostic capability. There is a gap between the curriculum of EMS and the care of the critical patient. With advancing capabilities, research modalities, and proliferation of tertiary level centers, more and more patients are surviving profound ailments previously thought to be immitigable. These patients are far more complex than those for which EMS typically trains. How do we get these patients to specialized centers? Or more importantly, how do we get the ICU level of care to the patient?
Critical care paramedic training
Can more training close this gap? It can be difficult to change what is, address what is not, and embrace what is new. But beyond this, critical care patient management is not a definable curriculum or scope of practice. It’s more like artistry. It’s not about sitting in a chair and listening to lectures and trying to remember enough to pass a test. It’s about making a commitment to the patient whose life is being determined, with superior knowledge, a high level of skill, increased speed and experience.
Training in the form of critical care courses doesn’t magically turn out critical care clinicians, but it can be effective in providing the foundational concepts. Further and continued growth then involves personal commitment, acquired intuition, a fine touch, and passionate learning.
Ultimately, the concepts of critical care are easy. A good critical care course will concentrate on this simplicity in explaining how all critical patients are managed by balancing the diagnosis with the needs of airway, ventilation, blood pressure control and sedation.
Become a critical care paramedic
Here are five reasons to improve your capability as clinician by taking a critical care paramedic course:
1. Bring greater care to the fragile patient
Recognition of critically ill patients and their proper treatment greatly determines their outcome. For inter-facility transports, the paramedic needs to be familiar with and responsible for initiating, maintaining or titrating potent and complex medications. These patients may also be dependent on specialized supportive or diagnostic equipment with the paramedic responsible for initiating or maintaining mechanical ventilation, hemodynamic monitoring, central/arterial lines, intra-aortic balloon pump or extra corporal membrane oxygenation (ECMO).
2. Advance clinical knowledge
EMS is quickly moving from an industry of technicians to clinicians, implementing guidelines as opposed to hardline protocols, and increasing education standards. A critical care course will immerse the learner into more detailed concepts of pathophysiology and introduce more advanced assessment and diagnostic abilities.
3. Receive formal endorsement and alterations in scope of practice
Many states are recognizing the education process and need for critical care level providers. As a result, some states offer endorsements as a Critical Care Paramedic. In many cases, this endorsement will add to the scope of practice and open doors for employment opportunities. This endorsement will almost always require formal critical care program completion.
4. Preparation for advanced certification exams
The Board for Critical Care Transport Paramedic Certification (BCCTPC) offers advanced exams and certification for prehospital providers, including the Flight Paramedic exam (FP-C) and the Critical Care Paramedic exam (CCP-C). Completion of a formal education program is not needed to take these exams, but completing a training program will likely improve the odds of success.
5. Because we can
Keep pushing the envelope of EMS, both personally and as an industry. We’re an expanding industry comprised of highly motivated individuals, eager to learn, expand and leave something behind for future providers. Taking the knowledge gained in critical care education provides framework to continue to diversify and exemplify the profession, for ourselves and the industry.
The fate of dying patients has always rested directly in the hands of those taking care of them. Ultimately, protocols don’t save these patients, nor do EMS systems or hospitals, although all are needed. Individual effort is what’s necessary, backed by knowledge, skill competence, confidence and motivation.
About the authors
Kory Hynes is the clinical coordinator at Lakes Region EMS, in North Branch, Minnesota, and the clinical coordinator for the Critical Care Paramedic program at Hennepin County Medical Center. He has experience in both ground and aeromedical critical care patient transport.
Ken Larson is the director of Clinical Services at Lakes Region EMS, in North Branch, Minnesota, and a flight paramedic for Life Link III. He has been heavily involved over the last seven years with the development of Critical Care courses and educational material for EMTs, paramedics and nurses, including the Critical Care Paramedic program currently offered at Hennepin County Medical Center.