DRAFT July 2011/ January 2012/ March 2012
LEVELS OF CARE
Conclusions: Define levels of care and abandon the use of the term “critical care”. We
determined 5 broad areas to determine a level of care – Level 5 being the highest (teams are
capable of transporting patients requiring the highest level of care) and Level 1 being the
lowest (equivalent to the level of BLS) as follows. Received many comments that we should
reverse the numbers with Level 1 being the highest!
Level 5:
DEVICES - ECMO, VAD, ventilator capable of all advanced ventilator modes, IABP, mechanical
circulation, extracorporeal oxygenation devices, nitric-oxide, specialty gases,
CONDITIONS – includes but not limited to conditions listed in Level 4 plus: specialty teams such
as Neonatal, high risk OB, PICU transports
EDUCATION –Includes but not limited to criteria listed in Level 4 plus CCRN SKILLS - ability to
operate the devices,
VOLUME - parameters for establishing amount of exposure to the specialty skill set,
PROFESSIONAL LEVEL - based on training to advanced modality such as ECMO, nitric oxide,
IABP, VAD, not certification level
Level 4:
DEVICES – transvenous pacemakers, central lines, hemodynamic monitoring, ICP monitoring,
ventilators, blood products, vaso-active drips, MAC sedation, sonography
CONDITIONS – includes but not limited to the conditions listed in Level 3 plus open postsurgical cases, shock, multi-system organ failure, ARDS, MSOF, cardiogenic shock, septic shock,
patients with a transvenous pacemaker and with ICP monitoring.
EDUCATION - fundamentals of critical care support (or equivalent), use of simulation
modalities to optimize contextual learning, evidence of education and experience, clinical
rotation in ICU, in-house education, competency sign-off, minimal 3 years pre-hire experience
in critical care, CCRN required,
MD - board certified plus FCCS or equivalent. FP-C required. Required current competencies
include: BLS, ATLS, ACLS, PALS, NRP.
VOLUME - parameters for establishing amount of exposure to the specialty skill set
Level 3:
DEVICES - RSI, waveform capnography, conventional ventilation, chest tube management,
central line management, IO, foley catheters, temperature management, needle
decompression, drain management, sonography for determining death and placing lines,
pericardiocentesis, BiPAP,
CONDITIONS – Includes but not limited to: Sepsis and septic shock, ventilated patients (adult
and pediatric) GI bleed patients with PRBC transfusions, STEMI who do not reperfuse with tPA
or who are being transferred for primary PCI, Intracranial hemorrhage patients on FFP, DKA on
insulin drips, severe trauma and patients requiring a higher level of care than the facility they
are in currently.
EDUCATION - CEN, CFRN, CCRN, CTRN, FP-C, CCP-C, RRT, CTRN, NAEMSP Medical Director’s
course, AMPA Core Curriculum. Minimal 3 years critical care or ED experience and minimal 3
years ALS experience for paramedics. Required current competencies include: BLS, ATLS, ACLS,
PALS, NRP.
Level 2:
DEVICES - IV, ETT, secondary airway devices, CPAP, IO, cardioversion/defib, c/v monitoring,
needle cricos,
CONDITIONS – Not defined
EDUCATION - EMT-P, RN
Level 1:
DEVICES - AED, Oxygen
EDUCATION – EMT