Onslow County, North Carolina, is piloting a new way to handle low-acuity 911 calls — dispatching a single paramedic instead of an ambulance crew. The “paramedic-first” model aims to ensure transport units remain available for critical emergencies while allowing trained medics to assess whether patients truly need transport.
The program reflects a growing trend in EMS toward community-based triage and resource optimization. But it’s also sparking discussion among EMS professionals about safety, workload and the role of EMTs in managing non-emergency calls.
| MORE: N.C. county shifts to paramedic-first dispatch for assessment of low-priority 911 calls
“Some low-priority calls can masquerade as low-priority but may be a high-priority call after all. An experienced medic would catch these outliers.”
EMS1 reader comments
EMS1 readers respond to the question, “Can EMTs effectively handle low-acuity calls in place of paramedics?”
“Absolutely. As a BLS responder in a rural area, with a BLS crew, we regularly make decisions on alerting ALS or flight response. We have some paramedics, but they are not always covering. That being said, many EMTs are working on ALS crews and not doing patient care. I’ve encountered several who came to work at our department who had very limited skills in patient care decisions. They were able to get up to speed, but there was a learning curve, so not all EMTs hold the same skills or variances.”
“Yes. Most forget that the main difference between EMTs and paramedics is simply a matter of the level of interventions that are taught and trained for at each of these respective certification levels. Paramedics and EMTs both have the same basic powers of assessment and observation, and, with some additional training, education and mentoring within their own departments, could very easily be well suited for these types of low acuity calls.”
“We were doing this back in the ’90’s. We call it the ‘Fly Car.’ It’s a fully equipped SUV, with all capabilities for care except for transport. As stated in the article, one medic goes out to assess the need for care and provides ALS care as needed, with ambulance dispatched then. Often, we join up with outlying ambulance crews who have no available paramedic, meeting them on-scene or en route. We hop in their rig while one of their crew drive the Fly Car to the hospital. It works well.”
“As a retired career paramedic with broad experiences, I have an observation: I think the motivation for this may be a ‘just in case’ approach. If right, I suggest this will burn out your paramedics faster than usual. Additionally, it often takes more than one person to do a safe lift.”
“Yes and EMTs can handle most low-level acuity calls. But that’s not what the article said. They are sending a paramedic out to make that decision. Not all low-level calls end up at low level. For example: a fall. The person calling in only knows the person fell, no other information. The paramedic gets there and does an assessment and could find a simple fall that an EMT could handle or the person fell because of a seizure or a heart issue or a stroke. Then no; it now becomes a higher level of call. However, a fully equipped paramedic calls for and ambulance and begins the higher level of care.”
“Yes. Tying up a medic for BLS skill!”
“Of course EMTs can do good patient assessment and clinical judgement. Engaged medical direction, and robust training and QA are a part of any program’s successful implementation.”
“I think one paramedic response to low priority EMS calls is a worthwhile effort to free up ambulances for high priority calls. One caveat would be that the paramedic for low-priority calls be an experienced medic. Some low priority calls can masquerade as low-priority but may be a high-priority call after all. An experienced medic would catch these outliers.”
“Eighty percent of calls are BLS. Would be a great idea with proper dispatch assessment training.”
“Without question, EMTs should be out there doing a quick assessment of the patient.”
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