Ambulance Crew Configuration: Are Two Paramedics Better Than One?

What is the appropriate number of paramedics on a call?

  • 1

    Votes: 18 60.0%

  • 2

    Votes: 10 33.3%

  • 3

    Votes: 0 0.0%

  • 4 or more

    Votes: 2 6.7%
  • Total voters
    30
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In my experience, both NJ and CA are very unique in their approaches to EMS and EMS Delivery.
 
There’s definitely some truth to these studies. But ultimately it comes down to the experiences of the individual provider. I have always felt that in a 911 system, especially of the urban variety, I want another Paramedic with me. Full stop. Over the years I’ve had the pleasure of working with EMTs and Intermediates who are great providers. This is not a slight against their job / skill set. I’d certainly rather have an aggressive and enthusiastic Advanced than a donkey medic. My problem is that that working without a second medic has often put me in uncomfortable situations. Of course the severity of which run the spectrum. I honestly think the quality of BLS providers is strongly influenced by geographical location. There are places that breed better EMTs simply by the dictates of necessity. The EMS culture of New England isn’t going to perfectly overlap with Kansas. The reality of where I work is that the market is saturated with EMTs and to a lesser extent AEMTs. There’s little to no quality assurance. On most calls they are next to useless clinically. The routine usually degenerates into me handling the patients while they handle the stretcher and driving. When I’m with another medic, I’m usually with someone else who has made EMS their career. Not some college kid looking for a resume builder. During hard calls, I have someone functioning at or around my professional level. We can bounce ideas of one another. I have a real collaborator working next to me. I’m can’t pretend like there is no difference between my professional capacity and that of lower level providers. It doesn’t make them incompetent, even though that is too often the case. Yes, everything is fine most of the time because 90% of 911 is straightforward BLS or downright BS. But when I’m in a system where that other 10% is the real deal, I’m on my own. I’m lucky if I have an Advanced who can actually start a line or an EMT that can hook up a 12 lead properly. Train wreck medical patients need all the help they can get. And It’s downright nerve wracking not to have a professional ALS provider with me. The main reason I ended up joining a fire department was because it was a progressive ALS department. We have medics on engines and ambulances depending on the rotation. And I would gladly take the Pepsi challenge comparing our patient outcomes to any private running 911 calls with PA / PB rigs.
 
Comrade Snowflake NRP said:
There’s definitely some truth to these studies. But ultimately it comes down to the experiences of the individual provider. I have always felt that in a 911 system, especially of the urban variety, I want another Paramedic with me. Full stop. Over the years I’ve had the pleasure of working with EMTs and Intermediates who are great providers. This is not a slight against their job / skill set. I’d certainly rather have an aggressive and enthusiastic Advanced than a donkey medic. My problem is that that working without a second medic has often put me in uncomfortable situations. Of course the severity of which run the spectrum. I honestly think the quality of BLS providers is strongly influenced by geographical location. There are places that breed better EMTs simply by the dictates of necessity. The EMS culture of New England isn’t going to perfectly overlap with Kansas. The reality of where I work is that the market is saturated with EMTs and to a lesser extent AEMTs. There’s little to no quality assurance. On most calls they are next to useless clinically. The routine usually degenerates into me handling the patients while they handle the stretcher and driving. When I’m with another medic, I’m usually with someone else who has made EMS their career. Not some college kid looking for a resume builder. During hard calls, I have someone functioning at or around my professional level. We can bounce ideas of one another. I have a real collaborator working next to me. I’m can’t pretend like there is no difference between my professional capacity and that of lower level providers. It doesn’t make them incompetent, even though that is too often the case. Yes, everything is fine most of the time because 90% of 911 is straightforward BLS or downright BS. But when I’m in a system where that other 10% is the real deal, I’m on my own. I’m lucky if I have an Advanced who can actually start a line or an EMT that can hook up a 12 lead properly. Train wreck medical patients need all the help they can get. And It’s downright nerve wracking not to have a professional ALS provider with me. The main reason I ended up joining a fire department was because it was a progressive ALS department. We have medics on engines and ambulances depending on the rotation. And I would gladly take the Pepsi challenge comparing our patient outcomes to any private running 911 calls with PA / PB rigs.
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Then why aren’t you educating them if they’re so “useless”. You rant that nobody is up to par with you because they’re not “paramedic” level. I know many EMTs that can run circles around you BECAUSE they worked with good medics who taught, not pontificated.

Congratulations on Necroposting a five year old thread.
 
CCCSD said:
Then why aren’t you educating them if they’re so “useless”. You rant that nobody is up to par with you because they’re not “paramedic” level. I know many EMTs that can run circles around you BECAUSE they worked with good medics who taught, not pontificated.

Congratulations on Necroposting a five year old thread.
Click to expand...
Well how do you know they could run circles around me? We’ve never met sir.
 
For most 911 calls, I think 2 ALS providers on scene is ideal. How those two providers get there is where things can be a bit murky but as long as they arrive in a timely manner, who cares how they get there. I also think that a couple of good EMT/AEMT providers are worth their weight in gold. I would want, ideally, a P/AEMT ambulance and a P fly car available as a 2nd medic for scenes that would be potentially a difficult one. Otherwise, a P/AEMT crew can handle nearly EVERYTHING as the AEMT can do a LOT under direction. I've also worked with, and met, a lot of EMTs that could run circles around most medics, especially when doing BLS calls.

Furthermore, if I think my AEMT or EMT partner is sub-par, then it's incumbent upon me to train that partner to do the things I need them to do, within their scope of practice, so that I can focus on the things I need to focus on. I will also want that EMT/AEMT partner to take as many calls as they can so that they become excellent providers also.

I have been out of the field for a while but I also do work in an ED, so I'm not that removed. Want to know what slows me down? Actually, it's having to physically go to another place to pull meds or gather supplies. Don't get me wrong: I'm not stupid fast with tasks... I only get the tasks done as quickly as they need to be done and most tasks are monkey skills. I don't have to think about doing them, which frees my mind up for other needs such as doing a field diagnosis and devising/implementing a plan of care.

Also, good job with this necropost. It's only 5 years old... and with that, I'm closing the thread.
 
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