New USAToday article

[Dustdevil]

Each EMSA unit is ALS and has a Paramedic, so I really do not know even how this study would involve them. This was in comparison of how ALS was being utilized. Unless is similar or identical to the same study, this is actually "old news"... The EMSA stats was also in regard that Fire Dept. ALS rigs made no difference in comparison of survival rate thus demonstrating BLS for FD was just as beneficial. This study was to emphasize that ALS is not needed on each call as well.

It sounds like some idiots set out to produce a document that discouraged FD's from training their monkeys to be paramedics in order to protect their EMS turf. While that is a very admirable premise, the way they have gone about it was stupid. Predictably, it is backfiring on them. Instead of proving that we don't need ALS firemonkeys, people are seeing it as an indication that we don't need ALS at all.

So yeah... this has Stout's stench all over it. And the fact that EMSA was the primary source only solidifies that impression.

[JPINFV]

Wasn't there an article not too long ago about a city that took ALS off their engines and found that their intubation rate went up? Basic idea was "same number of tubes" + "less medics" = more tubes per medic = more experience per medic.

[Scaramedic]

Key line from the article....

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.

This is a new study. The US Today article was last year.

The numbers cited for cardiac arrest saves did not come from the study, or any part of the study. The sudden cardiac arrest save numbers came from the AHA. So if you want to bitch about the study and the outcome of the study and any role that EMSA, Jack Stout or Dr. Sacra had then bitch about that. But the arrest save numbers were real.

Kudos to the medics of Medic One in Seattle, the medics in Boston and yes the medics at EMSA. I have worked in Denver, Portland and Tulsa. By far the best medics I worked with were in Tulsa. You can be an EMSA hater all you want but the people at EMSA are awesome. Dr. Sacra was a vast improvement over Mengis Khan, I commend him for being honest on the numbers as Rid quoted.

Another thing if this study is from 2002 or even yesterday, TFD has had Paramedics on rigs since 1999, most former EMSA Paramedics. That is why I think the study is BS.

Peace,

Marty

:thumbleft:

P.S. As I said before....Go EMSA!! :wav:

[chicagoambo]

It sure sounds like someone has a beef with fire dept. ems,maybe someone lost a private contract to a union fire dept?Lets put down fire ems and assure our private$$$$.

[JakeEMTP]

I don't think it is a beef necessarily. I believe, as some others do, that Fire and EMS should be 2 entirely separate entities. Cross training doesn't work. The majority of fire-medics would much rather fight fires. Since however, the number of "real" fire calls has diminished over the years due to better fire codes for new buildings as well as public education, EMS is a necessary evil for the FD.

Now back to the original topic.

[actualparamedic]

I wonder why they are re-running a story that was initially published in 2002 ? The study as well as the article was full of flaws. EMSA, number(s) was totally misconscrewed, and I had read others were too. News must be boring.... to have to "dig up" old articles.

R/r 911

OK, the data used in this story is that old (collected during 2002), not the newspaper story.

What the article proposes as a 'new idea' has been the basis of the Medic One EMS System in King County, WA for several decades. Their working code resuscitation rate is reported to be in excess of 40%, and their ET intubation success rate is one of the best in the nation. It is not unusual for a medic to get 50 tubes a year as well, due to the high acuity of their calls. King County medics work in a system that the ALS only rolls on critical calls, there are no ALS first responders, and basic life support rigs take a huge share of the transport load.

They also have a paramedic program approximately double the length of most others in the US, currently exceeding 3,000 hours. It's not exactly the 'paramedic assembly line' classes I've seen many folks on this forum bemoaning for months on end.

In reading this article, many have expressed that this is statistical smoke and mirrors, and can't possibly sustain itself in the long run. Truth be told, this model has been in use for more than two decades and shows no signs of slowing down. Kudos to Boston and EMSA as well: busy systems who deserve recognition for the commitment of their skilled and competent field providers.

Too bad other EMS systems can't learn from this. It reinforces, at least at face value, that a tiered BLS-ALS response system does work to provide excellent patient care with measurable outcome improvements (at least from a cardiac arrest standpoint). EMT-B personnel can and domake up an important delivery component of a 9-1-1 system.

Disclaimer: I have not yet personally reviewed the study, but, seeing as how the data was already presented at a EM conference I'll take it as valid unless I hear/see otherwise.

[Ridryder 911]

First I am by far not an EMSA hater... but bull sh*t is Bull Sh*t.. short and simple. The article main intent was to describe that with increase number of Paramedics the higher the skill attribution rate is. What they do not discuss is that every truck has at least one Paramedic, and prior to that usually a F/F medic at the scene. Although, Tulsa F.D. isstudying to change to increase their EMT/I to be able administer medications. The save rates that was reported number had to be changed. EMSA does not have BLS response units, so that is not what the article is presenting as well.

Again, DUH!... more medics < ability to perform skills... no joke and that took a study? Hmmm.. so if we have fewer physicians .. the save rate would be even higher?

Like I have discussed many times before, EMSA has some outstanding Paramedics and some of their services are okay. They provide fair to adequate response for local urban calls.. but don't call if there is a critical patient from one facility to another with any I.V. med.'s other than Dopamine or Lidocaine...they still have a way to go.

Be safe,

R/r 911

[Dustdevil]

First I am by far not an EMSA hater...

Me neither. I am wondering who is being called an EMSA hater here. I said nothing disparaging about EMSA. :?

[RogueMedic]

Less means more??????? HMMMMMMMMM. What person has an ax to grind with EMS personnel. It sounds like someone is rallying the natives in order to thin the EMS herd.

[TechMedic05]

Less means more??????? HMMMMMMMMM. What person has an ax to grind with EMS personnel. It sounds like someone is rallying the natives in order to thin the EMS herd.

I don't think so, honestly. I believe they just didn't chose the most appropriate words to lead in an article.

"Having a smaller number of paramedics who are very highly trained is probably a better strategy for delivering good patient outcomes."

Is that not true? I mean, who would you want coming to your Grandmother's house? A Paramedic who does 20% ALS and 80% BLS for their 40 hours a week, or one who only does ALS? If the call they intercept on is not deemed an ALS call, they triage and off available for the next ALS call they go.

"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."

So, I believe it was San Diego Fire that found A Paramedic on every engine may not be the best thing. . I don't have it readily available [my apologies], but I recall one possible reason for poor intubation outcomes is the infrequency in which intubation was performed.

There is a certain number of patients we see every year. A concrete number of assessments performed, leading to a concrete number of skills [although there's the issue of people doing unnecessary skills 'Just because we can!" or "Because it's in my protocols!" which are another issue altogether...] that are being performed. Logically, having the people responsible to do such things should be doing them as often as possible? An ALS unit for every unit in a 911 system may not be the best thing. A Paramedic on every ambulance and every fire engine is not the right answer.

The best comparison I can make is of 'Street' Paramedics to flight Paramedics. The Aeromedical services in the areas I work [DHART, Worcester LifeFlight and Boston MedFlight, if anyone's familiar] all have, at least, Good Paramedics that work with them. The Paramedics that aren't that great get weeded out, eventually. 911 Isn't meant for everyone. Why shouldn't all 911 be similar to this? They perform more intubations, more RSI, and see more critical patients. Why shouldn't all Paramedics have this ability?

Paramedics in an Intercept or Dual-Response system get more assessments, and more treatments respectively. Isn't frequency one of the standpoints of [skill] retention?

The article also left some areas rather vague, like the number of Paramedics needed. I agree, having 2 Paramedics to serve the city of Boston would be absurd. The point was not having a Paramedic on every vehicle.

Just my $0.02