ONSLOW COUNTY, N.C. — Onslow County Emergency Services has adopted a new paramedic dispatch model that does not automatically send an ambulance to every call.
Previously, EMS units responded to all six of the county’s emergency medical dispatch levels. Now, single paramedics are automatically sent to the lowest-priority calls and to lift-assist calls, giving first responders more flexibility and keeping ambulances available for higher-acuity emergencies, The Daily News reported.
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On lower-priority calls, a paramedic will assess the patient to decide whether an ED transport is needed or if referral to urgent care or a primary care provider is appropriate. The changes will make EMS response more agile and focused, said Bradley Kinlaw, Onslow County Emergency Services director.
“Not every medical call needs an ambulance,” Kinlaw said. “Now, when someone calls 911 for something like lift assistance or other minor issues, we can send a community paramedic, which ensures that ambulances are available for the most serious calls.”
County officials said the EMS dispatch changes align with Onslow County’s new strategic plan. The focus area for the “Healthy and Safe Community” plan prioritizes investing in first responder services to keep residents safe.
Can EMTs effectively handle low-acuity calls in place of paramedics?
EMS1 readers respond
“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.”
