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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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 7 times as many patients resuscitated with good outcomes 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.
.
4 comments:
I will take it one step further for you RM. Imagine if everyone was a physician....
Grrr. Really trying to make an inflammatory post, aren't we RM ?
Couldn't find a copy of the ACTUAL study, and I'm never a fan of quoting USA Today as a source of anything, other than maybe a horoscope.
Did, however find this nugget in 'Emergency Medicine News' from the MD that authored that study. Note his last comment in the excerpt.
Excerpt:
The study was presented at the annual meeting for the Society for Academic Emergency Medicine. Almost instantly, it was the darling of the media, hitting the pages of USA
Today under the banner, “Cities that Deploy Fewer Paramedics Save More Lives.”
“It touches a nerve,” said Dr. Sayre in explaining why the findings of an academic presentation made such a splash.
For one thing, it’s a sound bite that sounds too odd to be true: The fewer the paramedics in the system, the more likely patients are to survive.
More Skilled?
He cautioned, however, that what
remains unexplained is whether the data reflect a direct result, achieved because a relatively low number of paramedics who administer advanced life support are likely to become more skilled at it or whether the correlation is a sign that something else may be occurring, such as more intensive training among systems that have fewer teams or personnel. “It could be a marker; it could be a causal. We don’t know,” said Dr. Sayre,
an associate professor of emergency
medicine at Ohio State University Medical Center in Columbus.
Adam,
I will take it one step further for you RM. Imagine if everyone was a physician....
I thought about it, but I didn't want to be too inflammatory. Besides, solving the health care issues in one brief post only leaves me world peace and a few other minor things. What would I write next week. ;-)
Anonymous,
I posted my response at Too Many Medics? comment from Anonymous.
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