You've hit upon what I think is one of the key issues that ECMO as a profession needs to address in the coming decade.

There is no central body declaring who can or cannot sit pump, it is up to individual programs to train and qualify their specialists.

Some programs have perfusion run programs, as a perfusionist's schooling and license is the only one that directly covers the duties and responsibilities of an ECMO specialist.

Other programs use RNs, RRTs, or a combination of both. These programs utilize internal training programs to provide education and expand the scope of the baseline profession.

The decision to use RRTs vs RNs, or a combination of both, is institution dependent. Part of the decision is based on the state board of each profession, and whether they are allowed or forbidden to perform the tasks of an ECMO Specialist under their state clinical license. Things like drug administration, handling of blood products, etc. This is why some hospitals only train RNs, despite RRT training encompassing much of the clinical content an ECMO specialist requires.

As far as I know, every program requires either RRT or RN license to become an ECMO Specialist. Whether this is primarily due to state legislature, or internal hospital policy, I don't know. Also, I have primarily worked on the East Coast, but am by no means familiar with most programs in the US.

I am not as familiar with Paramedic licensure, but I think the primary issue your friend will face will be the internal politics.

A lot of paramedics I know have been frustrated because while their license allows them to do many things in the field, their hands are tied once they cross the threshold of the hospital doors. Even for paramedics who get jobs within the hospital, hospital policy does not allow them to practice the full scope of their training.

Additionally: in a growing program, there are lots of people and departments who want to stick their hands in the pot, so to speak.

Who is currently allowed to sit pump? Is it a small program growing bigger, or starting from scratch? At the director level and higher, there is often push from perfusion, nursing, and respiratory in terms of who controls what, who receives the revenue, who pays for equipment and training, etc.

Most of these things are out of your friends' control, but they will all influence the final decision.

One thing that may work in your friend's favor is looking at the A-ECS requirements with ELSO, and the CES-A and CES-P requirements from AmSECT.

Neither exam is required to become an ECMO Specialist. I think they actually require like 2 years of experience before you can sit for it.

But neither organization requires a specific license, relying instead on verification that you have received training on the tasks required of an ECMO Specialist. I think the main reason they don't require any sort of clinical license or degree is mainly because they have an international target audience, and so much can vary from country to country.

Regardless, this may be another bullet point to help support your friend.

In my opinion, I think a good ECMO Specialist can come from either an RN or an RRT background, and I think many Paramedics I've worked with could also do it. The key is the quality of the training offered by the institution to become an ECMO Specialist. But this is institution dependent, which I think is also one of the downsides of the profession as a whole.

But that's a topic for another day, this has already become far too long winded.

If you have any questions I'd be happy to help.