One vs. two paramedics: Does ambulance crew configuration affect scene time or performance of certain clinical skills?
Creators: name: Hawkins, Eric
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2006

description: Background: Emergency Medical Services (EMS) organizations have a wide range of options in the design and composition of their individual systems. Many have opted to provide a paramedic on every emergency call in a single-tiered response plan, but little evidence exists to demonstrate that ambulances staffed with two paramedics provide a different level of care than those with a single paramedic and another prehospital provider. The Wake County EMS System is unique in that one half of all ambulances have dual paramedic crews while the other half has single paramedic crews, all under the same organization and training. Objective: The purpose of this study is to compare scene times and performance of specific clinical skills for two-paramedic and one paramedic crews for a variety of high acuity emergency response scenarios. Methods: We conducted a retrospective cohort study by examining electronic medical records from the Wake County EMS system from 6/1/2003 to 6/1/2006-05. We selected patients treated for traumatic injuries, cardiac arrest, cardiac emergencies, and respiratory distress that required emergent transport using lights and sirens. For these clinical scenarios, we defined our cohort as patients that received response from ambulances with a Two Paramedic Crew (TPC) versus those with a Single Paramedic Crew (SPC). For each group, we abstracted information on patient demographics, scene times, placement of IVs, and performance of endotracheal intubation. For analysis, we compared continuous variables with T-Tests for all means and categorical data using Chi Square of Fisher's Exact test. Results: A total of 5,770 patients met inclusion criteria for all clinical scenarios. For scene time for all patients, no significant difference between TPC vs. SPC groups was noted (17.8 vs. 17.6 minutes, p = 0.35). When stratified by clinical scenario, TPC groups had a non-significant shorter scene time for trauma and cardiac arrest patients and SPC groups had a shorter scene time for respiratory distress. No difference was seen between groups for cardiac emergencies. For all intubations, TPC groups had a slightly higher rate of success for both eventual success (0.89 vs. 0.86, p=0.23) and first attempt success (0.63 vs. 0.59, p=0.12) when compared to SPC groups. For IV placement, TPC groups had a small but significant higher rate of eventual success (0.89 vs. 0.87, p=0.04), but not for success on IV placement on the first attempt (0.71 vs. 0.69, p = 0.24). When stratified by clinical scenario, TPC and SPC groups did not differ significantly on performance of either intubation of IV placement for any group. Conclusions: We noted that TPC ambulances had similar scene times and slightly improved rates of intubation and IV placement success when compared to SPC staffed ambulances. These differences were small and should be placed in context with the clinical scenario. For our four groups of high-acuity patients there was little difference noted if care was provided by either a TPC or SPC ambulance.