Dual Paramedic v. Medic/Basic

STXmedic

STXmedic

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Hey everyone! First off, I'm new to the forum, found this site yesterday and became addicted.^_^ There are some GREAT perspectives on here that I look forward to hearing; and I apologize in advance if I excessively pick your brains ;)

Okay, on to the topic. I work for two companies. I'm a firefighter/paramedic for a major city with fairly archaic protocols, extremely short transport times, and, sadly, a lot of poor medics (which partly explains our laughable protocols). The other service I work for is an EMS only system that covers ~250miles with 4 units and a roaming unit, pretty progressive protocols (for this region at least), transport times ranging from 5-60min, and some very talented (in my opinion) and driven paramedics. Both systems ride two paramedics on the box. As these are the only two companies I've worked for, this is what I'm accustomed to and can't imagine riding with a basic partner. However, I also know that we're the only two companies in the region that do this.

So my question is: What is everybody's thoughts on riding dual medics v. medic/basic? Pros and cons?



edit: Probably would've been better placed in the EMS Talk thread, as to gain more Basic's perspective also...
 
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From a basics perspective

It depends... I've worked in two different systems, both of which ran medic/basic.

In San Diego a great many fire fighters are medics. On a typical engine, the captain, the engineer, and one or both FFs can be medics. Engines are dispatched in addition to the ambulance on any level 1 or 2 call, so the medic has plenty of assistance on scene and to the hospital if needed.

The system I work in now runs medic/basic (sometimes dual medic if scheduling works out that way) and the FD doesn't staff any medics. The only way our medics can get an extra medic is if they request a second ambulance. It puts a great deal of responsibility on them.

The only pros I can think of letting EMTs work on 911 ambulances is giving them experience before and during medic school, and saving the system money. Other than that its definitely nicer for the medics to work together giving them a more experienced hand on scene as well as letting them rotate calls.
 
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Our company just requires driver and emt-b, and there can be a third rider of any level, We have medic intercepts in my area, the medics drive fly cars and either meet us at the highway or on scene. A normal crew for us, is driver, emt, and EMR/MRT which in ct is just under emt basic.
 
Medic/Basic or Intermediate is a cost saving measure, no doubt about it, that said, there is one advantage to it and that is I own all the tubes/IVs ect. Meaning there's less of an issue with skill degradation.

On the down side, I now have to be able to perform 100% all of the time for the patient to get the best care. Which is not humanly possible. I don't have a second set of educated eyes to see things I may not, or catch mistakes I may make. In addition I now have to formulate patient care plans myself 99% of the time with no-one to bounce ideas off of. Less of an issue for an experienced, educated medic but a huge elephant in the room for a brand new out of school medic.

If I could mandate how my service ran today, it would be dual medic with sort of a "residency" type program. The new medic would intern as a third rider prior to being released. Then released to a truck with a more experienced partner (call them a "super medic"). Through a program of educational/experience based goals the new medic would be gradually allowed to ride calls of increasing acuity until the new medic gradually became a "super medic". At this time the medic could then begin working with new medics.
 
Here they try to get as many units as possible to run with an ACP and a PCP. A PCP being considerably more quaified than an EMT-B. We still have someone to bounce ideas off of. However as USALSFYRE said "there is one advantage to it and that is I own all the tubes/IVs ect. Meaning there's less of an issue with skill degradation." At some of our bases when a new ACP comes out they are partnered with an experienced ACP for a few months. Partners are changed here every year or so. The amount of time a new ACP will have with an experienced partner may be limited. It is nice to have an equal sometimes. You can always back each other up. Everybody has days when you just can't buy a good IV.
 
Stream of consciousness here:

PRO:
- cost savings
- more exposure for emt's (IFT & 911 alike)
- requires the medic to stay sharp beyond skill competency (ie. more self motivation w/ maintaining clinical competence regarding assessments, differentials dx, etc)

CON:
- less accountability for emt's (ie. they will be driving for all "sick" pts, thus limiting their chances of implementing treatment/stabilizations for the acute situations)
- fewer second opinions for the more complex scenario's
- higher burn out for medics (for those busy systems requiring the medic to tech all calls)
- those days when you (medic) can't sink a tube or hit line to save your own life. ^_^
 
Wow from what I am reading about city EMS I am glad that I am in a area that has BLS only (well not from a pt care view.) I am only a EMT-B and I get primary pt care on major calls so I get tons of experience.

We are fire based EMS we get 911 and thats it (we don't transport.) But we try to run EMT-B/EMT-B but sometimes all we can get out is EMT-B/First Responder or even EMT-B/CPR & AED personnel.

To get the medic out here we have to wait usually 30-60 minutes (not including transporting the pt to the hospital!) So a lot of the major calls HAVE TO BE flown out, even just fractured limbs (due to the crappy dirt roads) have to be flown out.
 
I honestly prefer higher provider / lower provider, be it B/P or I/P. Calls just seem to run smoother when people know who's running the show.

Granted, yes, on dual medic trucks there's an incharge and a helper, but there's often egos involved, differing ddxs, and each medic vying for the skills. I've worked a few emergent calls with other medics, and it's nice to have the extra set of eyes / hands that can do everything you can, and it's great when you're on the same wavelength, but it takes quite some time working with another medic to find eachothers work style. Dual medic could be of benefit in a busy urban environment.


If I had my way each first responder would be, well, a First Responder, than each ambulance would staff I/P.
 
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Each vehicle should have two crewmembers with the same qualification eg two Technicians, two Paramedics or two Intensive Care Paramedics.

One Intensive Care Paramedic with one Paramedic is acceptable as an alternate however. There is no place for a Technician/Paramedic or Technician/Intensive Care combination.
 
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I find it is much easier for a basic or intermediate to work with a medic versus two medics. Simply because around here, when two medics are on a truck...they tend to "butt-heads" and not be able to decide certain things, especially when there are different routes to follow when treating that pt. If it is a bad trauma call...or cardiac arrest, two medics usually get along well. It is when there are simple injuries or sicknesses that the medics disagree on.

That's just personal opinion and preference, and the way I observe things in the ems system i work in.
 
I would prefer Medic/Basic myself. Medic/Medic trucks will usually switch out every other call, but if there is even a chance that the two don't get along well, it can get ugly fast.
 
I have never had any difficulties or conflicts working basic/basic trucks.

I have never had any issues working basic/medic trucks.

No issues on Physician/medic rigs.

I have had plenty of issues on medic/medic rigs. Almost all of them stemmed from a conflict of "medical provider vs. strict protocol monkey" issues.

Remember, most "senior" medics are just that, senior, not superior, but it is more of a US problem because the older medics are usually the ones who went through a tech focused curriculum. There have now been 2 major overhauls, each moving move towards knowledge.

There are alos problems with the behind the back "guess what medic X did, I would not have done that!" It creates a very toxic work environment.

If the medic's skills/mind are sharp, there is no need for 2 medics. Additionally, a good medic can use alternative routes when a certain skill is not going well that particular day.
 
there is noting worse than working medic/medic and having a horrible medic as a partner.

If you are a strong, confident medic, medic/basic or how I work medic/spec (works perfect for me)


on the other had a new medic needs to learn how to be a medic and should work with one of those strong confident medics that can act as a basic and let the new guy treat but assist when needed.
 
"Specialist" is the Michigan version of Intermediate.
 
Having had the opportunity to work both...I've got to agree with the Medic/Basic route. Standard shift I work is dual medic, but we split up with basics when the system starts getting busy, and I find that to be pretty darn enjoyable :P

Run into the butting-heads thing quite a bit, different treatment modalities and just generalized pt. care conflicts. As was mentioned above, its nice to have another medic when that difficult intubation comes roaring at you, but I consider that all the more incentive to keep my skills top notch. When you have the knowledge gap between two medics it makes a call pretty difficult to run.

Now if you both have the same outlook on pt. care, enjoy running calls, and work well together then I think it'd be a blast...otherwise :wacko:
 
If i remember right i believe there was a study that indicated better pt outcomes on a basic/medic rig

like Linuss said, medic runs the show, basic assists, no conflict that is potential on a medic/medic rig.

i believe an i/p rig would be ideal, but if two medics work together well, medic/medic may work best.
 
The problem with only one advanced practitioner on a vehicle is that you decrease efficency and increase risk.

What if the one person on the truck who can start a line is unable to do so, what if he is busy doing something else like drug calculatons? If you have a sick patient often five things need to be done at once and if he is the only person who can do them then you either spend longer on scene or tie up anothe resource such as a second ambulance or a rapid responder in order to achieve the same level of efficency.

If the one advanced provider overlooks something or is not sure he has nobody to "catch" it if the second practitioner does not know what the other is looking for or what to look for. Disproportinate levels of knowledge and ksill means the advanced provider may be stuck with the largest amount of responsibility and risk with somebody who is little more than a second pair of hands to fetch and carry and give oxygen for him.

You should have two people on a vehicle with the same qualification eg two Technicians or two Paramedics. Two Intensive Care Paramedics is probably overkill.

We generally run two Paramedics or one Paramedic and one Intensive Care Paramedic and it works very well.
 
The company I am going to school at runs an I/Medic and the occasional I/CCP or I/CCRN (very very rare, usually just when they are down a unit they put a flight nurse on a rig) and they are one of the Top 5 EMS providers in the nation according to my instructor but this may be subjective. They are accredited through CAAS, CAMTS, and NAED. All the crews I have ridden with love this set up and it seems to work pretty well.

The expanded scope of the I over a B helps with the things such as starting lines, advanced airways (King and Combi, protocols don't allow the Is to intubate), and pushing the drugs within our scope that Bs can't use.
 
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