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Too many cooks or not enough?

EMS1.com News

June 22, 2010


EMS News in Focus
by Arthur Hsieh

Too many cooks or not enough?

There has been a philosophy over the past 20 years to place ALS personnel on all types of moving vehicles

Editor's note: A Calif. city could reduce costs by having paramedic squads consisting of a paramedic and an EMT, instead of two paramedics, respond to advance life support calls, according to a consultant. Check out the article on the suggested changes and read Editorial Advisor Art Hsieh's take on EMS staffing levels below.

It's difficult to understand the complexity of staffing, especially when it comes to the scope of practice of the crew working at the scene of a medical emergency.

There has been ongoing debate regarding the "optimal" staffing configuration of an EMS system — two paramedics in every ambulance? One EMT plus one paramedic? Single tier? Multi tier?

The challenge is designing and measuring the markers that can be measured definitively. Would that be cardiac arrest save rates? Time response? Mortality or morbidity from heart attack, stroke, respiratory emergencies?

And how does patient density factor in — rural versus suburban versus urban areas? What about areas with a significant proportions of volunteers —what impact does that make?

There are a lot of questions, and very few answers. Certainly no paucity of opinion though — just ask any EMS provider (including me).

That's the fundamental dilemma we face. I'm not sure how effective these discussions can be when we're not even sure if advanced life support services are effective, given the current delivery method.

There has been a philosophy over the past 20 years to place ALS personnel on all types of moving vehicles; a "paramedic in every pot" mindset.

Is this the best use of a highly trained health care provider? Data regarding poor intubation rates, low cardiac resuscitation rates, and decreasing opportunities to practice ALS skills may blunt the effect of having ALS everywhere.

Until we can answer the fundamental question of how and at what level prehospital care affects long-term outcomes of sick and injured patients, it will be difficult to address system issues. Now that would be the study to look at.

About the author

EMS1 Editor in Chief Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at Art.Hsieh@ems1.com.
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