A Paramedic on every truck
At the system I currently work at we staff one Firefighter/EMT-P and one Firefighter/EMT-I on every ambulance. A small private ambulance staffed usually with EMT-Basics and some EMT-Intermediates handle all the hospital to hospital, discharges, etc... Every 911 call for service gets a "paramedic level unit," but generally the EMT-I and EMT-P switch off on every call. I don't know about Victoria MICAs, but EMT-Is here fall a little below ASNSW ICP.
I have worked for other services which staff two EMT-Is on each ambulance and are dispatched with a single regional EMT-P on certain calls. The problem I have seen with this model stems from dispatch. ie Dispatched to "a man exp difficulty moving" arrived on scene and he was having trouble moving bc he was coded. Or Dispatched to a "man having chest pain" he was having chest pain because he had been shot in the chest. Every call has the potential to go south, so why doesn't every call get a MICA medic? Is it theoretically possible to put a MICA medic on every truck partnered with an ALS provider so you could just switch calls? Also, if there is such a shortage of medics, how come Victoria doesn't recruit from overseas like Queensland has been doing?
Agreed, dispatching is major headache and no less so here. We've got around the problem partially by having a MICA Paramedic "clinician" in the control room who vets calls coming in. He can downgrade the case or upgrade it. He can also look at odd sounding cases and dispatch a MICA unit if he smells something brewing. It has worked pretty well in tidying up MICA dispatch. It makes a mockery of how good the old AMPDS system is supposed to be.
The idea here was always a two tiered approach. Every case will get a normal road unit (as I have said they are roughly equivalent to EMT-I's, maybe even better than that) as a bare minimum. MICA units are supposed to be dispatched to the sickest pts.
We have 16 MICA units and a few single responder MICA units in sedans. That's changing next year to mostly single responders but that's another story.
The system has worked very effectively because the average ambo is skilled and educated above most models in the US eg and the MICA units are a big step above that again. So even moderately sick pts can get a fair bit of care above and beyond the bare minimum EMT-B level with the MICa units carrying the bag on the very sick pts.
Things are changing, (not for the better) as workload and response times grow and our bosses are getting far too pragmatic about standards, ages of students, minimum recruitment levels etc.
You really don't need a MICA Paramedic at every case as despite it's flaws the AMPDS system plus PROQA which is how our docs have modified the categories of calls as to the level of despatching required plus the clinician has been a big help. When it works MICA goes only to the sickest pts + or - a normal road car. Two sets of hands and two crews with above average skill sets makes life a lot easier as well at most cases. So MICA here is really like (supposed to be like) a kind of special forces unit.
All MICA would be overkill for a number of reasons not the least of which is getting hands on experience in sick pts on a regular basis - ie leading to dilution of skills.
As for importing "MICA" Paramedics - well OS systems are so different to transition imports would be a big headache. When our service isn't killing of MICA troops through neglect or discouraging roadies to step to MICA through a lack of incentive we haev kept our numbers up.
As for "mixed crewing" ie one -P and one -B eg; we tried it ten years ago - big mistake. They spent more time going to low level cases, attracted crappy staff and all the MICA guys saw it as a step away from the way MICA should be used - special forces stuff etc. The service used the units as just another rig for despatching to keep response times down. Two tier only works when the MICA units are letp as the second tier. Once you go to the clsoest car approach or abandon dual response (two tier) due to wrokload the MICA system is totally invalidated.
Not to brag but at least in Australia, the Melb MICA troops are the benchmark for ALS Paramedics in Australia and have a pretty good rep OS as well.
But who knows what the future holds - when we go majority MICA single responders I see the end of MICA as an effective second tier happening real fast.
MM
