# "Paramedics Say New Mass Ambulance Law can Cost Lives"



## Shishkabob (Aug 7, 2010)

http://www.boston.com/news/health/a...w_mass_ambulance_staffing_law_can_cost_lives/


Essentially scare tactics by the fire association, so not much new.  New law says ambulances can go from being dual medic to Medic/EMT...



Especially considering, as the story says, the vast majority of ambulance companies already have waivers to be Medic/EMT anyhow.


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## Aidey (Aug 8, 2010)

Someone needs to come up with that study that shows the correlation between mortality and number of paramedics on scene.


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## bstone (Aug 8, 2010)

If they require EMT-I/EMT-P staffing then this wouldn't be such a big deal.


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## JPINFV (Aug 8, 2010)

Except plenty of regions in MA (and plenty of companies in regions that don't have waviers) already allow P/B staffing.


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## MrBrown (Aug 8, 2010)

The UK has one Technician and one Paramedic

We have one Technician or Paramedic and one Intensive Care Paramedic

Many states in Australia have one Paramedic and one Intensive Care Paramedic (some have two ICPs)

Canada generally has one Advanced Care Paramedic in a vehicle 

... so this is a problem, how?


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## terrible one (Aug 8, 2010)

Aidey said:


> Someone needs to come up with that study that shows the correlation between mortality and number of paramedics on scene.



I would absolutely love to see a study like this done! 
apparently LAco thinks if there aren't 10 paramedics on scene adequate care is not provided. Therefore lets staff a squad with 2, an engine with 3 and a truck co with another 5 and send them to every single medical aid 

(yes my example is a little over exaggerated but is actually possible within LAcoFD)


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## rhan101277 (Aug 8, 2010)

Over here in Mississippi most services are run with one EMT and one EMT-P.

Some even have EMS-Driver and EMT-P


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## JPINFV (Aug 8, 2010)

terrible one said:


> I would absolutely love to see a study like this done!
> apparently LAco thinks if there aren't 10 paramedics on scene adequate care is not provided. Therefore lets staff a squad with 2, an engine with 3 and a truck co with another 5 and send them to every single medical aid
> 
> (yes my example is a little over exaggerated but is actually possible within LAcoFD)



Better than some OCFA who put their paramedics on type 2 ambulances, but refuse to use them to transport, hence requiring a private company to also be dispatched for the actual transport (with the fire department riding along if paramedics are "needed").


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## Aidey (Aug 8, 2010)

terrible one said:


> I would absolutely love to see a study like this done!
> apparently LAco thinks if there aren't 10 paramedics on scene adequate care is not provided. Therefore lets staff a squad with 2, an engine with 3 and a truck co with another 5 and send them to every single medical aid
> 
> (yes my example is a little over exaggerated but is actually possible within LAcoFD)




I wasn't being sarcastic, there was a study done. I think it was if there were more than 3 medics on scene the mortality started to increase.


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## medicdan (Aug 8, 2010)

I agree that PB staffing is the norm elsewhere... but MA has always had a steadfast rule requiring two personnel of a certain level in order for the ambulance to be that level (Two EMTs=BLS, two medics=ALS, as opposed to one EMT and a CPR certified driver being BLS). It speaks well to, and in fact works well to provide more experience for ever decreasingly well and comprehensively trained EMTs and Paramedics-- having the second set of equally trained eyes to say "what do you think of this?" or correcting eachother's mistakes, or teaching eachother... 
I'd argue that PB staffing may lead to more MVCs, because the basic is driving all shift, or medic errors, and perhaps higher burnout or turnover? I'd be interested in data, though. 
Do we have a sense of how many ALS services exist with a PB waiver? How many without?


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## medicdan (Aug 8, 2010)

Correction, I see 146/180 ALS services have a PB waiver... humm...  Will PB trucks continue to be able to work to "full ALS" with only one medic (including IV, meds, monitor), or will they require a second set of ALS eyes?


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## jjesusfreak01 (Aug 8, 2010)

emt.dan said:


> I'd argue that PB staffing may lead to more MVCs, because the basic is driving all shift, or medic errors, and perhaps higher burnout or turnover?


Why do you think the basic would be driving all shift? Sure its possible, but its just as likely that you will be running B(L)S calls all day that the basic can handle just fine.


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## Aidey (Aug 8, 2010)

I work on a PB bus, and my partner does drive all shift. I take all of the BLS calls. Mostly because the BLS calls we get are so few and far between I wasn't driving much anyway, and I felt more comfortable having my partner drive. Neither my current partner nor last one minded at all (I discussed it with both of them before hand).


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## medicdan (Aug 8, 2010)

jjesusfreak01 said:


> Why do you think the basic would be driving all shift? Sure its possible, but its just as likely that you will be running B(L)S calls all day that the basic can handle just fine.



I work on a PB truck also, and because of the system we work in (private, fairly few 911), we spend all day doing ALS (CCT IFT)-level calls, albeit most often transfers requiring a monitor or fluids/meds running. If we get a BLS call, I'm likely to tech it, but again, they are few and far between.

Our ALS trucks are also on 24-hour shifts, although we try to schedule our basics to drive on 12s, but it's not always possible.


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## Martyn (Aug 8, 2010)

Just to add to the total, Polk county EMS in Florida runs one paramedic, one EMT-B per ambulance. Not too sure about surrounding counties as a lot of them are not just county run but private as well.


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## terrible one (Aug 8, 2010)

JPINFV said:


> Better than some OCFA who put their paramedics on type 2 ambulances, but refuse to use them to transport, hence requiring a private company to also be dispatched for the actual transport (with the fire department riding along if paramedics are "needed").



Sounds like Santa Monica FD




Aidey said:


> I wasn't being sarcastic, there was a study done. I think it was if there were more than 3 medics on scene the mortality started to increase.



no surprise there


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## atropine (Aug 8, 2010)

terrible one said:


> I would absolutely love to see a study like this done!
> apparently LAco thinks if there aren't 10 paramedics on scene adequate care is not provided. Therefore lets staff a squad with 2, an engine with 3 and a truck co with another 5 and send them to every single medical aid
> 
> (yes my example is a little over exaggerated but is actually possible within LAcoFD)



Hey cool guy, as this amount of personnel may be true on any given scene, only two of the fire guys are medic, the two on the squad are indeed ALS, and I can assure you the engine company and truck companies are BLS, as well as the private ambulance company. So lets try this again there are only two medic on a medical aid call within LACO fire call.


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## JPINFV (Aug 8, 2010)

jjesusfreak01 said:


> Why do you think the basic would be driving all shift? Sure its possible, but its just as likely that you will be running B(L)S calls all day that the basic can handle just fine.



Because of a strict reading of MA rules (albeit I'm not completely sure how much it's actually practiced/enforced).

"The information below provides EMTs with some common complaint findings that are of concern and in violation of the regulations. Please take note of the following issues while practicing as an EMT. 
...
19. Failure to have the EMT with the highest level of certification attending to the patient during transport."


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## medicdan (Aug 8, 2010)

My understanding of the law is that if a PB truck does an emergency, which they determine to be BLS, the medic needs to do a PCR documenting why they down-triaged, in addition to the Basic's PCR from the run.  It's just easier for the medic to do one PCR...
Whether it's all enforced or not, I'm not sure...


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## jjesusfreak01 (Aug 8, 2010)

That doesn't sound efficient at all. 911 MB systems run lots of basic level calls in my area and the basics attend to all of those. In fact, for an EMT of any level to be released from third rider (in my area) requires that they have run many many precepted calls over a number of months. I know those states have everyone's best interests at heart, but keeping the basics at the drivers seat isn't going to help anyone when they run into an MVC or a disaster and the basic is having to work on their own.


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## medicdan (Aug 8, 2010)

Again, remember, I work for a private, that does mostly transfers. We have many more BLS trucks then ALS, and basics when they start at the company work only BLS for a long time, and get experience teching 911. We only allow EMTs who have been at the company for some time work PB.


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## terrible one (Aug 8, 2010)

atropine said:


> Hey cool guy, as this amount of personnel may be true on any given scene, only two of the fire guys are medic, the two on the squad are indeed ALS, and I can assure you the engine company and truck companies are BLS, as well as the private ambulance company. So lets try this again there are only two medic on a medical aid call within LACO fire call.



I guess you forgot about ALS engines. Also since LAcoFD does not promote out of medics like LAFD there are some Captains and Engineers that still work as medics. And with trades and OT medics can end up on the truck co, they dont all stay on those squads. 
When I worked in Inglewood one station, 171 or 172 was a Light Force Co. The truck went everywhere the Engine went (all medical aids) with the squad. It was possible to end up with half a dozen medics on scene, although unlikely, and I'm sure they tried to keep medics to ALS engines, squads, or  Quints you still had an abundance of personnel on-scene. LAco doesn't have any priority dispatching like LAFD (not 8-ball RAs) you had the squads going to calls with ALS engines already on-scene. If it was an ALS call rarely (although sometimes) would an engine go with the ambulance to the hospital. So we'd wait for a squad with another 2 medics to show up and take over from other medics on-scene. 

I have no problem with FD having medics. I liked the systems with Ambulance with one medic and an engine with one medic. That way on a critcal call you have the EMT drive and the ambulance medic and fire medic in the back with the pt. I just didn't like being on-scene with 2 medics from a squad another one or two on an engine for some BS call, waste of resources (and ya I know my early example was a bit much but it could happen)


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