Double Paramedic Units

[waldie25]

Hello Folks,
My service has recently decided to stop allowing two paramedics to bid the same unit. The reason they give is that we have had a recent influx of EMTs and the medics are needed to spread out the labor pool. Well, when the numbers are done, there will still be enough medics for some double medic units. Here's my question.... As you all probably know, govt managers are numbers driven. I have a meeting with our director soon and I want to show him the benefits of using double medic units. I can go in there and tell him it cuts the workload leading to less burn out but how do I quantify that. I need stats to show the benefits. Can anyone help me out here? I guess a need a list of pros and cons. Any help will be appreciated.

Thanks Group,
John J

[tbonetrexler]

Are we talking double medic transport units or QRS only?

[DrParasite]

my service only uses double paramedic units. in fact, the entire state of NJ only permits double paramedic units.

the problem is if the 1:1 system works fine, then there really is no reason to go back to double medic units.

The problem is, if you have competent medics, then they should be able to work solo. maybe pair a senior medic with a newbie medic until they are deemed "competent" and able to function solo. but once they are deemed experienced enough to function on their own, then they should be able to work without a safety net (but they do have medical control to fall back on).

you can use the reason that this way you have another person to bounce ideas off off, a person to catch a mistake, another set of eyes if you can't get an IV or a tube, reduce burnout, and share the paperwork.

But once you go from 2 medics to 1 EMT & 1 Medic, the the EMT is cheaper than the medic, and you can still bill at the ALS2 rate, but your costs are lower. so in theory you can keep your fleet at 100% ALS capable, with a reduced overhead. Management will love that.

Good luck on trying to convince management, but i fear you might be in for an uphill battle.

[dr-exmedic]

I can go in there and tell him it cuts the workload leading to less burn out but how do I quantify that. I need stats to show the benefits. Can anyone help me out here?
Actually, the best stats would be stats from your own service, like calls per shift, and staff turnover numbers. Can't help you with that. :)

[waldie25]

I appreciate all the responses. I suppose the only appeal that we can make is that the double paramedic units cut down on work load and stress. Both items which can be hard to put numbers to.
Some have said that if the medic is competent, a second one is not needed. I'd agree with that but the purpose of the second medic isn't so much a matter of competency as it is a relief when that 15th call in a 12 hr shift comes in.
At my service we refer to employment here as the "golden handcuffs". In order to make the same money that we do at my current job, we'd have to go to a different part of the state. Meaning at least 200 miles. Mgmt knows this and turnover is low. So turnover really can't be used to gauge effect stress has.
If anyone has any other suggestions, please feel free to let me know. We meet with our chief tomorrow.

Thanks,
John J

[croaker260]

Heres the deal, if you rrunning a mix of BLS , ALS and the occasional critical (rare) ALS call, medic/EMT works OK.

If you deploy your system to prevent paramedic oversaturation, and to keep the High Acuity call to paramedic ratio high, to maintain clinical competence, (like The King county/Seattle Medic One system) then double medic cars are an essential part of that. In that case, use the extra EMTs to man ILS/BLS units to take the BS calls, and EMD to triage the high acuity calls to the medics.

Dont know if you have the run volume or system depth to make that a reasonable possibility.

[SkipKirkwood]

The Wake County EMS System has for many years had a mix of units in the system. "County trucks" were always staffed with two paramedics, while our contract agencies use paramedic-EMT or paramedic-intermediate.

We had some folks doing research (medical and public health students) examine several years worth of standard, electronically-kept patient care report data. While (like everybody else) we can't measure patient outcomes, we found no significance difference between the two groups in terms of the care delivered (procedures, hot transports, etc.).

We do know (based on other folks research) that it is important to have an EXPERIENCED (not longevity, but recent critical incident) medics on critical calls. If you have seen one code this year you are less likely to have good results than if you have seen 20. So (for this and a variety of other reasons) we are moving from two-medic trucks to medic-EMT, AND putting very experienced medics in QRVs to support critical calls. There is also pretty good data that TOO MANY paramedics contributes to poor outcomes (like 6 medics on ever call, between first responders and ambulances). So we will have ALS on every call, AND a very experienced (and more trained and more closely supervised) "clinical specialist" on critical calls.

If you google Wake County and "advanced practice paramedic" you will find some stuff that may help.

Skip Kirkwood, MS, JD, EMT-P
Chief, Wake County EMS Division
Raleigh, North Carolina, USA

[croaker260]

Skip, if I ever leave Idaho, Wake county will be my first application..nice approach to a severe problem.

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