Fewer medics, more lives saved?

[Jason762 2]

Fewer paramedics means more lives saved By Robert Davis, USA TODAY

Mon May 22, 7:12 AM ET

Cities that deploy fewer paramedics - who in turn treat more victims of sudden cardiac arrest - save more lives, according to a new study.

Cardiac-arrest survival rates, considered a key measure of an emergency medical service's performance, vary from city to city. The study of five unidentified cities sought to find factors that have an impact on survival.

"Our data seem to show that cities with the fewest number of paramedics for a given population are more likely to have higher survival rates," says Michael Sayre of the emergency-medicine department at Ohio State University in Columbus. "Having a smaller number of paramedics who are very highly trained is probably a better strategy for delivering good patient outcomes."

Cities use survival from sudden cardiac arrest - an abrupt loss of heart function often caused by misfiring electrical impulses in the heart - as a performance indicator because victims either live or die based on critical care delivered in the first minutes after collapse.

The report, presented Friday at the Society for Academic Emergency Medicine in San Francisco, supports the similar findings of a USA TODAY study last year that called into question the national trend of putting paramedics on fire engines, often the first to reach the scene of an emergency.

"The major reason to have paramedics on first-response vehicles is because of the possible impact on cardiac arrest," Sayre says. "If that is not there, it would suggest to me that there isn't a good reason to have paramedics on first-response vehicles. It would be better to put a much smaller group of paramedics on a second-tier response."

In fact, new study found that more lives are saved in the cities with fewer paramedics even when those responders arrive as much as five minutes later than less-trained rescuers.

Among the 50 largest cities in America, those that save the highest percentage of cardiac-arrest victims - Seattle, Boston, Oklahoma City and Tulsa - use such a tiered response, USA TODAY found in an investigation published in 2003.

Researchers believe the individual paramedics in such cities deal with a higher volume of critical cases, keeping sharp such tricky skills as intubation, the insertion of a tube into the trachea to open an airway.

"There are a number of procedures required regularly to stay expert," says Corey Slovis, Nashville's EMS medical director. The study's lesson is "we've got to demand expertise from our experts," he says.

EMS physicians say the study is timely because of perceived paramedic shortages.

"Nobody knows what is the right number of paramedics per 100,000 population, and what is the best way to deploy the paramedics you already have in order to save the most lives," says Marc Eckstein, medical director for the Los Angeles Fire Department. "The need for research to answer these questions has never been greater."

[20y2 43]

Sounds correct, the problem with having so many paramedics in a system (like NYC) is that there is a VAST difference in the abilities and skills from one paramedic to another for two reasons; 1.)there is little in the way of actual medical control. A paramedic in NYC can go their entire career without ever actually meeting the medical control doctor on the other side of the phone and 2.)with so many paramedics and relatively few true ALS emergencies in the response area (only about 25 percent of so called ALS calls are that in most of NYC), the amount of time one can go without a 'hot' call can be substantial. I know that I have gone for more than2 months without a cardiac arrest job more than once in my career.

[ny10570 745]

Do any major Cities run an ALS flycar system like we have here in Westchetser? Seems it could be a more efficient method for distributing medics to ture emergencies.

[MICP2823 0]

I also think that useing Medic Flycars, Like used almost everywhere in NJ, is the best way of getting ALS out. This way you usually don't tie up ALS on a BLS assignment because there is no one else to send.

[Guest]

I couldn't agree more with MICP. Putting medics in fly cars frees them up from BLS calls and makes them available for more serious calls.

[WAS967 97]

Jersey might be a little better off too if they didn't have to run all dual medic. :angry:

[Guest Rich DD]

Jersey might be a little better off too if they didn't have to run all dual medic.

←

Don't include Newark in the above statement. Its the volunteer areas of Jersey that can benefit.

[WAS967 97]

I thought Newark ran double medic. My understanding was that MONOC was the only Jersey agency that ran single medic (how they got exempt is beyond me).

[EMS Solutions 0]

Some cities outside NYC do not work up asystole arrests. They confirm in 2 or 3 leads and pronounce. So, maybe having fewer medics and less workable arrests contribute to this study.

The sheer call volume within NYC makes it difficult to have a comparable

save %. If the amount of actual saves in NYC is looked at compared to other cities it will most likely be as high or higher than other areas with a lower call volume.

My "hot jobs" are the AMI, APE, Tight Asthmatic etc. Not the cardiac arrest who has a small % of survival should I even be able to regain pulses.

My skills are better challenged making good clinical judgement with a COPD or APE than just running a code that any acls trained professional can do.

Meeting my medical control physcian is not important to me or my patient. The fact that I contact medical control and the MD knows my name is enough to know that together we can agree on continued treatment.

The differences in skills between medics in NYC is due more to having too many medic programs and too much money being thrown into them and "at" them.

Not necessarily becuase of OLMC contact and %of real ALS calls.

Many als calls are truely not even bls - but that is the nature of the system within NYC where the city allows the continued abuse of the system by its residents. Where everyone gets to go to the hospital no matter how they look upon arrival.

Until that abuse is addressed, medics will always be too far and too long from the "hot jobs". It won't matter how many medics there are or how they get there, fly car (tried that), ambulance or ricshaw(done that). But then it is the callers emergency and not ours and that is the important thing to remember,

To the patient - "They" are the hot job. As the EMT or Medic responding, they are "our" patients. Cardiac Arrest or otherwise.

[Guest]

In fact, new study found that more lives are saved in the cities with fewer paramedics even when those responders arrive as much as five minutes later than less-trained rescuers. The medics arrive later BUT in five mins. Also cardiac survival rates should not be the sole criteria that is looked at. What about severe asthmatics, seizures, etc...that a medic has a greaterchance of affecting a positive outcome.

[Guest]

I agree they should include the "other " saves the ones that without ALS intervention the patient would probably died , APE, AMI, sever ANAPHYLACTIC REACTION ,OD, HYPOGLYCEMIA, PSVT and the list goes on............BE SAFE