More paramedics equals improved outcomes?

[MontvilleFire39]

Hello,

I am looking for any studies pertaining to the number of paramedics vs patient outcomes. Any assistance would be appreciated...

Edited March 8, 2012 by MontvilleFire39

[DFIB]

What are your parameters?

More paramedics per Square mile, per 1000 people, per neighborhood, per department?

More paramedics as compared to what? EMT's, Nurses, Firefighters?

Are you taking in account experience?

[DwayneEMTP]

As DFIB said, medics on scene v patients on scene?

I would think that the results would depend on the experience of the medics working together. Turn a bunch of medics from different areas together on an MCI and they'll look like a bunch of monkeys humping footballs with central leadership.

Take the same medics that have trained together and they friggin' rock it.

Not taking shots at you Brother. There are a ton of folks here that are Google Ninjas and others that live for research, but you will have to be a bit more specific. Particularly as I'm neither...

I'm excited to see how this goes though! I've been here a while and don't remember ever hearing of such a topic here, and that's a rare thing.

[Kiwiology]

You could very strongly argue that the dismal results in the "Paramedics make intubation studies" from North America and the San Diego RSI trial are your answer.

More ALS people is not the answer; you get a large number of people vying for a small number of opportunities to use procedures requiring complex cognitive process and experience not gained leads to attrition of that knowledge and poor performance, just look at all these "Paramedics make intubation worse" studies.

Let's be clear, a bit of midazolam for a fitting kid or cardioverting somebody who is Super Crook^TM with VT is not a complex medical procedure requiring high levels of cognitive knowledge and clinical decision making, parenteral analgesia is a bit more towards the requiring a high level of knowledge and clinical nouse side of things but is still not quite at he top end of the scale.

Now on the other hand, things like rapid sequence intubation, thrombolysis and a few other bits and pieces are procedures that require high levels of clinical knowledge and decision making ability because they represent disproportional risk compared to putting a drip into some bloke.

The trend internationally is to up-educate and upskill whatever level is below ALS in the respective jurisdiction (e.g. Paramedic in AU/NZ or Emergency Care Technician in South Africa) so that your "ALS" people are kept free for those patients who are crook thus ensuring maximum possible exposure to use their ALS-specific clinical knowledge and experience.

[MontvilleFire39]

Kiwi,

You are hitting on what I am looking for. I work in a very high volume urban system but despite the high volume the acuity is quite low overall. This fact coupled with the plan to place paramedics on every street corner seems to create an environment where skills retention is an issue (or not building them at all). I am just looking for some facts to back me up before I voice the issue...

[Kiwiology]

There are no EMS specific studies that I know of however you can probably find something related to medicine generally on PubMed or Ovid or the like

[croaker260]

Before you proceed, I suggest you read this article:

http://www.emsnetwork.org/artman2/publish/article_28849.shtml

[jonas salk]

check out the OPALS study. You might find some decent information in it.

[Kiwiology]

Before you proceed, I suggest you read this article:

http://www.emsnetwor...cle_28849.shtml

This is exactly how many places in the world (AU, NZ, SA) are configuring their systems, combined with an aggressive approach to up-educating and upskilling their non "ALS" providers so that the top-tier ALS people are kept free to see more crook or potentially crook people to maximise use of their specialised knowledge and skill set.

check out the OPALS study. You might find some decent information in it.

The OPALS study tells us what we already know or have long suspected

1. No difference in cardiac arrest survival when ALS is included,

2. No difference in major trauma survival when ALS is included,

3. Decreased morbidity and mortality in respiratory distress patients with ALS intervention, and

4. Decreased morbidity and mortality in chest pain/acute coronary syndrome patients with ALS intervention