Two Paramedics Are Better Than One, Because...
by James Farley, 3rd District Vice President
|(July 13, 2012) -- There is often public scrutiny of the number of Fire Department apparatus and personnel that arrive on scene of a medical call. The fact is that over decades of providing Advanced Life Support on medical emergencies a system has arisen providing effective and efficient treatment and transportation of patients to local accessible hospitals. A few examples of paramedic actions on emergency medical calls will help to identify their necessity as part of the team.
On a simple patient experiencing chest pain, the Fire Engine Company arrives with 4 personnel followed by a Rescue Ambulance with two Firefighter Paramedics. The Engine Company initiates patient care and Basic Life Support measures, including vital signs, oxygen therapy, basic airway management and more.
When the paramedics arrive they have their hands full and the clock is ticking as every second counts in these medical emergencies. Typically one paramedic is obtaining a pertinent medical history and current medical complaint while simultaneously obtaining an EKG reading of the heart and initiating an IV and starting medication therapy.
The other paramedic is scribing all information being obtained and making a phone call to the hospital to speak to a Doctor or Nurse to obtain further medical orders and to arrange for transportation to the appropriate hospital. The patient and all equipment are then carried to the Rescue Ambulance, which requires physical manipulation of a gurney and the patient is taken to the hospital.
The above scenario is simple because it is a very common medical response for the Fire Department and does not involve extenuating circumstances such as a person trapped in a car after an accident or a patient who is unconscious or not breathing. In a car accident with a trapped patient, as the Fire Department crews are gaining access to the patient, the first paramedic usually enters the wreckage and initiates patient care while the extrication is still ongoing.
The second paramedic is once again getting orders from outside the car for further patient care and speaking to the hospital alerting them that a Trauma Team must be activated.
Time is of the essence with the goals of being on scene for less then 10 minutes and arrival at the hospital within twenty minutes to preserve the "Golden Hour," the ticking clock in which surgeons are most effective on trauma patients. The unconscious patient becomes yet even more difficult if they are not breathing or in cardiac arrest.
While the Firefighter EMTís are positioning the body, establishing basic airways, ventilation and starting the compressions of CPR, one paramedic is intubating the patient while the other is attempting to gain IV access for medication therapy. Furthermore, the hospital must still be called, paperwork filled out, and EKG, advanced airway and medication therapy continued with simultaneous CPR en route to the hospital. The Fire Engine Company travels with the Rescue ambulance as manpower and drivers are still needed.
In summary, on the issue of two paramedics versus one, the glaring fact is that two paramedics offer the full range of necessary and life saving interventions in a far more efficient and effective manner. An EMT does not have even close to the same scope of practice as a paramedic and so replacing a paramedic with an EMT will mean less effective treatment provided with a far greater timeline.
The idea of one Paramedic and one EMT on an ambulance has arisen in places where that formula is still an enhancement of the medical system, i.e. some ALS intervention is better than none. But the underlying question in Los Angeles County, and more specifically in Long Beach, is whether this is a step toward increasing patient care and/or treatment, or simply a step backward to try and save money.
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