Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Too Many Medics?

Also posted over at Paramedicine 101. Go check out the rest of what is there.

In some of the posts on the recent intubation study,[1] this question keeps coming up: What is the right number of paramedics to provide the best care to patients?

There was an article that covered this.[2] Here is the chart from the article.

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RESULTS FROM FIVE CITIES
The study examined cardiac-arrest survival in five
unnamed cities. The findings include:

City with best outcome City with worst outcome
Cases of sudden cardiac arrest per paramedic each year 4.7 1.6
Length of time paramedics arrive after first responders 4 minutes 1 minute
Survival rate 27% 4%

Source: Researchers at Ohio State University in Columbus

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This does not mean that medics should not be sent at all. Rather, it strongly suggests, that in our desire for a quick ALS response for cardiac arrest, we may be making things, not just a little bit worse, but a lot worse.

These numbers agree with what I have been stating about ALS getting in the way of BLS during cardiac arrest treatments (CPR). The numbers do not prove what I have been stating, but they seem to be giving a very strong hint.

The places with fast ALS responses are able to respond quickly because they have a lot more medics. In other words, they have dramatically reduced the amount of experience per medic.

Why?

To make everybody feel good, even though it appears to be killing people.

Almost a 7 times higher survival rate in the cities with fewer medics.

Feel good?

More medics means that more people are medics, and can feel good about being medics.

More medics means that more people are having medics respond to treat them, and can feel good about receiving care from medics.

This is just to make people feel good. Then, why not make everyone a medic? The response time would be immediate, unless maybe you fall in the woods, and there is nobody else there to hear you fall. In which case the philosophical question is, If a patient falls in the woods and there is nobody there to call 911, is there a response time? Not, Does the patient make a sound? And, since the patient is a medic, there is already a medic on scene, so there is no worry about response time.

Do the response time rules state that the responding medic has to be alive?

Probably not.

We could have all of the patients in nursing homes become paramedics. Talk about cross-training leading to improved response times!

Too many medics = too many failed resuscitations.

Too much of a good thing can be a bad thing.

Footnotes:

^ 1 Prehospital intubations and mortality: a level 1 trauma center perspective.
Cobas MA, De la Peña MA, Manning R, Candiotti K, Varon AJ.
Anesth Analg. 2009 Aug;109(2):489-93.
PMID: 19608824 [PubMed – indexed for MEDLINE]

PubMed states that the full text article is free at the journal site, but it is not

^ 2 Fewer paramedics means more lives saved
Updated 5/21/2006 8:58 PM ET
USA Today
By Robert Davis
Article

The chart is from this article.

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