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EMS News in Focus
by Arthur Hsieh

Sizing up staffing models on ambulances

Many EMS providers have converted their "dual paramedic" ambulance configuration to a "1+1"

By Arthur Hsieh

The Austin EMS system has had a solid reputation as an excellent service provider. Yet it, too, is not immune to the pressures of change and responding to the various challenges that face all systems.

While I don't know the exact statistic, it seems that many EMS providers have converted their "dual paramedic" ambulance configuration to a "1+1" staffing model. There have been several reasons given:

  • It saves money. It is, on the surface, simply cheaper to staff each 1+1 unit compared to dual paramedic.
  • In two-tier systems, it can increase the number of available ALS units.
  • As this article points out, the experience level may increase for individual ALS providers.
  • It standardizes the physical configuration of each unit, simplifying the restock, maintenance and replacement of each unit.

Yet, as an old-time medic, I do mourn the opportunity to work alongside another paramedic.

Make no mistake, a well trained and experienced EMT is a tremendous partner. But to bounce ideas and differential processes off a paramedic partner is different than that with an EMT.

It's a bit like being an airline pilot. The captain flies alongside another pilot, both who are trained to the same level. The junior pilot may have much less experience and may have fewer qualifications, but for at least that plane both individuals can fly it and make the decisions necessary to keep it from crashing.

EMS systems such as the one in Boston deploy such a system, where dual paramedic units support many more EMT-staffed units.

Because we operate in systems, I would love to see more research conducted that outlines the differences in outcomes and efficiency between differently staffed systems.

I recognize it would be tough to define all of the measurements. In addition, each system does have unique characteristics. Yet there must be a way to find the common parameters that can be used to find out what differences exist, if any.

The information would be very useful in EMS system development in the future.

About the author

EMS1 Editorial Advisor 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
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