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

- Rogue Medic

Allentown EMS will remain an all-paramedic squad

Another EMS agency looks at switching to paramedic/basic EMT crews, but passes up the opportunity to change to a level of service that would result in more experienced paramedics.

But Allentown Fire Chief Robert Scheirer, who in June was empowered by the city to make the final call, confirmed to city council tonight that EMTs will not be added.[1]

This is based on –

“I think we’re at an excellent level of service right now, and I don’t think we want to move backward,” Scheirer said. “I think an all-paramedic unit is far superior to one that also includes EMTs.”[1]

A lot of opinion, but no evidence.

The plan to switch to paramedic/basic EMT ambulances was a plan that was approved by the City Council in December.

Consider the history of this decision. Why did the leadership start departing from Allentown as if someone put a contract out on them?

But the overhaul was placed on hold after Van Allen abruptly resigned in December, and the future of the squad faced even further uncertainty after his successor also suddenly resigned in June.[1]

Now, the plan has been canceled.

Cause and effect? I don’t know.

Allentown EMS also needs to add an ambulance, but –

“We’re trying to figure out how to do it the least expensive way to the taxpayers,” he said.[1]

Is it economical to waste a paramedic as a driver for each patient who might benefit from paramedic level treatment?

While the second paramedic may come in handy on the rare call, too much paramedic treatment can be a huge problem.

Too much of what we do is not good for patients.

Too much of what we do is bad for patients.

Not enough paramedics understand the difference between good patient care and too much treatment.

Not enough medical directors understand the difference between good patient care and too much treatment.

How many patients will be better off because of faster aggressive paramedic treatment?

How many patients will be worse off because of faster aggressive paramedic treatment?

One defense of the more medics systems is to focus on being able to have faster protocol monkeys. Was this the alternative to giving the protocol monkeys amphetamines? Wouldn’t it be better to get rid of the protocol monkeys?

Another defense is that the medics have someone of equal decreased experience to bounce ideas off of. I’ll take the more experienced paramedic over the ones who can’t make a decision. I’ve seen what happens when we try to agree on where to go for food, and lives do not usually depend on those decisions.

The paramedics in Allentown do not appear to understand that more is a measurement of quantity, not a measurement of quality.

Watchful waiting is often, maybe even most often, more important than rushing through the protocol is essential to high quality EMS.

Footnotes:

[1] Allentown EMS will remain all-paramedic squad, no EMTs will be added
Published: Wednesday, August 15, 2012, 9:46 PM
Updated: Wednesday, August 15, 2012, 9:58 PM
By Colin McEvoy
The Express-Times
Article

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Comments

  1. Seriously, your lack of ultra-high volume EMS time is showing. Don’t even touch this one. Find me one high volume urban area that runs limited units and I’ll find two that run dual medic.

    • Just another rant. he has no information on this specific EMS system but thinks his idea is superior anyway (where is your research and data that 1+1 is better in this system???). there is a reason why high volume urban EMS systems use 2 medics; to prevent burnout. he totally omitted that from his analysis.

      • J

        Just another rant. he has no information on this specific EMS system but thinks his idea is superior anyway (where is your research and data that 1+1 is better in this system???).

        I will be providing evidence that all-medic systems are a bad idea, but nothing specific to this system, because this system has never studied this.

        there is a reason why high volume urban EMS systems use 2 medics; to prevent burnout. he totally omitted that from his analysis.

        I did only address part of the issue, which is too complex for one post.

        Since almost all calls are BLS, how does sending 2 medics on every BLS call prevent medic burnout.

        .

    • CS,

      Seriously, your lack of ultra-high volume EMS time is showing.

      Ultra-high volume?

      That means dangerously understaffed.

      Is that the kind of system that anyone should look to for anything other than examples of what not to do?

      Don’t even touch this one.

      Too late. 🙂

      Find me one high volume urban area that runs limited units and I’ll find two that run dual medic.

      Appeal to popularity is a logical fallacy, not evidence that the popular method of doing something is right.

      Furosemide used to be standard treatment for acute pulmonary edema.

      Therapeutic phlebotomy used to be standard treatment for pretty much everything.

      There are many things that the experts used to do, but now we acknowledge are dangerous.

      Appeal to popularity.

      .

    • Just about every non-fire-department EMS service in Connecticut uses 1 Medic + 1 EMT to staff the ALS ambulances. We have some cities like Hartford, New Haven and Bridgeport that get very high call volume.

  2. Ultra high volume doesn’t mean those running the system know more, or specifically, know better. A large city near where I work just trotted out 12-lead EKG monitors like they made some sort of EMS changing epiphany. Like the smaller departments around them haven’t been utilizing this technology for years. Ultra high volume just means you run more calls.

  3. Is there evidence more calls means a more competent medic? I’ve known plenty of 15+ year medics I wouldn’t trust with a cheese grater, much less RSI tools. Provide research that says more calls=more competent staff.
    Your argument about adding additional trucks seems an odd point. First, the addition of a unit involves a lot of cost (cost of the truck itself, medical supplies, fuel, maintenance, etc.) Does the difference in a medic salary and EMT salary really equate to enough to buy a new truck? You guys up north must be getting paid a lot more than us Texas medics. Provide data stating an EMT in lieu of a second medic would allow for another MICU to be added to the streets.
    You keep bringing up the medic/EMT combo means more trucks on the street. You’ve often brought out response times rarely matter. What good would adding another truck do? Lower average response times? Please provide research adding one additional truck would be beneficial to the pt.
    You say too much ALS can get in the way of pt care. True. Does two medics on scene mean any additional ALS than one medic would be providing? Do we start IV and cardiovert people for giggles when we have another medic to impress? Show some evidence ALS interventions go up with double medic trucks.

  4. 28 medics for a population of 119,000 ain’t bad – 23/100k. That’s less than most places (one of the busiest services in Bucks County, Pa has 30+ medics for a population of 60,000). On average, they probably have half the number of medics (relatively) of any ambulance service in SE PA, aside from the Philadelphia Fire Department. Could they trim? Certainly. But, as it stands, they do have “fewer” paramedics.

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