What's the point of dual medic?

[CAR1]

In NYC 911 is mandated that ALS units must be dual medic. I think they should

split them up and give every ALS unit one EMT and one Medic. Eitherway for

the serious calls that require two medics on the patient here in NYC they send

one BLS and one ALS (2 EMT & 2 Medic). the advantage of my proposal is simple

you are spreading out your ALS providers providing a shorter response time to

ALS care.

 

[Jambi]

The best purpose of dual medic on a transport unit is to, (1) split tasks on scene, and (2) split spread the daily call load between 2 people.

IMO

 

[terrible one]

LA county mandates a minimum of two paramedics on every rescue as well. I believe there reasoning is 2 > 1, so it must = better patient care. Honestly though I'm not sure.

 

[Jambi]

There was research and a graph somewhere where someone correlated number of paramedics to patient outcomes.

Essentially, Pt outcomes peak at 2 paramedics, declines at 3, and stays flat at 4.

I'll see if i can't dig it up.

 

[CAR1]

There was research and a graph somewhere where someone correlated number of paramedics to patient outcomes.

Essentially, Pt outcomes peak at 2 paramedics, declines at 3, and stays flat at 4.

I'll see if i can't dig it up.

That would be interesting. I guess the two minds are better than one theory has some truth.

 

[NJEMT95]

Same in NJ. In our back-asswards system, all ALS providers are hospital-based. Unless a city's 911 service is contacted with a hospital-based ALS service, all primary ambulances to a scene are BLS only. On ALS calls, the dispatcher can dispatch an ALS crew (2 medics in either a rig or an SUV) at the same time as the BLS crew or the BLS crew can request ALS on scene.

It's a waste of resources and adds to on-scene time on our most critical patients while we wait for ALS to arrive or attempt to meet them enroute to the hospital.

 

[terrible one]

There was research and a graph somewhere where someone correlated number of paramedics to patient outcomes.

Essentially, Pt outcomes peak at 2 paramedics, declines at 3, and stays flat at 4.

I'll see if i can't dig it up.

I guess we don't need two paramedics on a squad, one on an engine, and one on a truck then? If we are talking tiered response a more effective system would be one on an engine and a P/B transport rig.

 

[Jambi]

Not what I was looking for, but it's a good article

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

 

[Schroeder]

I've been led to believe that a dual Medic system lends to an internal checks and balances feature (for lack of a better term). It is much more likely that the second medic would catch a mistake, or see something the other one missed. If they were paired with an EMT-B, you lose some of the checks and balances.

Out here in king county, we run dual medics. The system runs pretty well if you ask me.

 

[Jambi]

If we are talking tiered response a more effective system would be one on an engine and a P/B transport rig.

That is what I see most of around here in riverside county. It works fine as long as there no or little inter-agency conflict.

If there's more than one patient I just don't see the need to have more than one or two paramedics on scene because it's easy for the whole thing to degenerate into too many chiefs and not enough indians...

 

[nocoderob]

Spoken like a true EMT. Our system is slowly moving single ALS provider sadly enough. The county mandates two medics on scene which means only one of us is needed if fire is ALS. Having two medics lightens the workload, add's a second opinion if needed, is there for multiple pts, and can assist with any care needed.

 

[NYMedic828]

Spoken like a true EMT. Our system is slowly moving single ALS provider sadly enough. The county mandates two medics on scene which means only one of us is needed if fire is ALS. Having two medics lightens the workload, add's a second opinion if needed, is there for multiple pts, and can assist with any care needed.

50% of the time I despise being dual medic. The 50% I like is when I have a competent partner.

Checks and balances only work when your partner is not an airhead... The time that they are, it hinders care because I have to argue to perform treatments the patient should receive but partner doesn't want to administer.

 

[Jambi]

Spoken like a true EMT. Our system is slowly moving single ALS provider sadly enough. The county mandates two medics on scene which means only one of us is needed if fire is ALS. Having two medics lightens the workload, add's a second opinion if needed, is there for multiple pts, and can assist with any care needed.

Like NYMedic said. It can be a blessing or a curse. It's easier to deal with a crappy EMT partner than it is to deal with a crappy medic partner that feels entitled to his or her opinion and feels compelled to constantly share the fact.

 

[nocoderob]

Sure but, thats not a "dual medic" thing, that is a crappy partner thing. I have found EMT's to be more mouthy and opinionated than other medic's.

 

[abckidsmom]

50% of the time I despise being dual medic. The 50% I like is when I have a competent partner.

Checks and balances only work when your partner is not an airhead... The time that they are, it hinders care because I have to argue to perform treatments the patient should receive but partner doesn't want to administer.

Right but then you're being the check and balances...isn't it fantastic?

I prefer having a bls partner and doing all the calls myself. I hate doing mobile on the spot QA, so even if my partner is ALS, I offer to do all the calls. Save me some headaches.

 

[johnrsemt]

I have been on trucks with Dual medics; doesn't make much difference. I alway made sure that my FT partners knew the protocols ALS and BLS and could check me on protocols (just like check and Balance). Worked great.

Problem with 2 medics is when you really need the 2nd medic he/she is driving and it was harder to get an extra set of hands from fire: "you already have 2 medics, what more do you need"

 

[firetender]

Functionally, when we used to run two paramedics, we'd alternate. One was the "Patient-man" the other Assist, the idea being clarity on who's in charge with the partner's job to BE the checks and balances but in an advisory capacity while making sure all the other non-ALS wheels turn properly.

Of course, this means knowing how to cooperate like adults!.

 

[medicsb]

Potential pros:
- "Checks and balances"
- New medics can learn from the more seasoned medics (default mentoring)
- More patient pathology seen per medic (you don't have to be in the back to get experience evaluating and initiating treatment).
- Extra set of hands (and brain) for critical patients.
- Switching responsibilities from call to call.
- Possibly, the crew can complete more procedures than a lone medic (this was a finding in an Australian study a few years ago).

In my opinion it is an ideal set-up for a tiered system in dense, high volume areas. (In low density, low volume areas, a single medic responder would probably be better.)

In my opinion, this is an area in need of research. Staffing and practitioner experience is intrinsically related to patient care. Most likely too little is bad (can't get to patients in a reasonable amount of time) and also too much (only very rarely see sick patients or the costs go up while benefit plateaus). So which is the right amount?

 

[the_negro_puppy]

Whats the point of even having EMTs?

Why not all Paramedics?

 

[STXmedic]

Whats the point of even having EMTs?

Why not all Paramedics?

That way it's easier for 18yo Ricky Rescue to go woowoo down the street to save somebody's life...