The Effect of Ambulance Staffing Models in a Metropolitan, Fire-Based EMS System

2017 ◽  
Vol 32 (2) ◽  
pp. 175-179 ◽  
Author(s):  
Eric J. Cortez ◽  
Ashish R. Panchal ◽  
James E. Davis ◽  
David P. Keseg
Keyword(s):  
Success Rate ◽  
Life Support ◽  
Advanced Life Support ◽  
Emergency Medical Technician ◽  
Publication Type ◽  
Protocol Violation ◽  
Difficult Decision ◽  
Emergency Medical ◽  
Different Levels ◽  
Medical Technician

AbstractIntroductionThe staffing of ambulances with different levels of Emergency Medical Service (EMS) providers is a difficult decision with evidence being mixed on the benefit of each model.Hypothesis/ProblemThe objective of this study was to describe a pilot program evaluating alternative staffing on two ambulances utilizing the paramedic-basic (PB) model (staffed with one paramedic and one emergency medical technician[EMT]).MethodsThis was a retrospective study conducted from September 17, 2013 through December 31, 2013. The PB ambulances were compared to geographically matched ambulances staffed with paramedic-paramedic (PP ambulances). One PP and one PB ambulance were based at Station A; one PP and one PB ambulance were based at Station B. The primary outcome was total on-scene time. Secondary outcomes included time-to-electrocardiogram (EKG), time-to-intravenous (IV) line insertion, IV-line success rate, and percentage of protocol violations. Inclusion criteria were all patients requesting prehospital services that were attended to by these teams. Patients were excluded if they were not attended to by the study ambulance vehicles. Descriptive statistics were reported as medians and interquartile ranges (IQR). Proportions were reported with 95% confidence intervals (CI). The Mann-Whitley U test was used for significance testing (P<.05).ResultsMedian on-scene times at Station A for the PP ambulance were shorter than the PB ambulance team (PP: 10.1 minutes, IQR 6.0-15; PB: 13.0 minutes, IQR 8.1-18; P=.01). This finding also was noted at Station B (PP: 13.5 minutes, IQR 8.5-19; PB: 14.3 minutes, IQR 9.9-20; P=.01). There were no differences between PP and PB ambulance teams at Station A or Station B in time-to-EKG, time-to-IV insertion, IV success rate, and protocol violation rates.ConclusionIn the setting of a well-developed EMS system utilizing an all-Advanced Life Support (ALS) response, this study suggests that PB ambulance teams may function well when compared to PP ambulances. Though longer scene times were observed, differences in time to ALS interventions and protocol violation rates were not different. Hybrid ambulance teams may be an effective staffing alternative, but decisions to use this model must address clinical and operational concerns.CortezEJ, PanchalAR, DavisJE, KesegDP. The effect of ambulance staffing models in a metropolitan, fire-based EMS system. Prehosp Disaster Med. 2017;32(2):175–179.

Basic-Level Emergency Medical Technician Administration of Fluids and Glucose via Enzyme-Assisted Subcutaneous Infusion Access

2012 ◽  
Vol 27 (3) ◽  
pp. 220-225 ◽  
Author(s):  
Olanrewaju A. Soremekun ◽  
Melissa L. Shear ◽  
Jay Connolly ◽  
Charles E. Stewart ◽  
Stephen H. Thomas
Keyword(s):  
Glucose Uptake ◽  
Life Support ◽  
Advanced Life Support ◽  
Mass Casualty ◽  
Emergency Medical Technician ◽  
Gas Chromatography Mass Spectrometry ◽  
Subcutaneous Infusion ◽  
Emergency Medical ◽  
Basic Level ◽  
Medical Technician

AbstractIntroductionDuring disasters and mass-casualty incidents (MCIs), there may be insufficient numbers of advanced life support (ALS) providers to provide intravenous (IV) access to all patients requiring parenteral fluids and/or medications. Enzyme-assisted subcutaneous infusion (EASI) access, in which human recombinant hyaluronidase (HRH) augments subcutaneous fluid dispersion and absorption, may be useful when ALS resources are insufficient to meet intravascular access needs. The utility of the use of the EASI lies, in part, in its ease of placement by ALS personnel.ObjectivesThe objectives of this study were to document the feasibility, comfort, and speed/degree of infused-glucose uptake through EASI lines placed by basic-level emergency medical technicians (EMT-Bs).MethodsEighteen EMT-Bs instituted EASI access on each other. A total of 150 units (1 mL) of HRH were administered through the EASI line, followed by the administration of 250 mL of tracer-labeled D5W. Timed phlebotomy enabled gas chromatography/mass spectrometry characterization of glucose uptake. Enzyme-assisted subcutaneous infusion placement and comfort ratings were tracked and analyzed using non-parametric statistics and Fisher's Exact Test.ResultsIn all 18 subjects, EASI access required only one attempt and was rated by the EMT-Bs as easy to accomplish. Glucose was absorbed quickly (within five minutes) in all subjects. The rate of infusion was rapid (median 393 mL/hour) and was comfortable for the recipients (median pain score 1/10).ConclusionsThe use of EASI may be viable as a fast, simple, and reliable method for the administration of fluid and glucose by EMT-Bs.Soremekun OA, Shear ML, Connolly J, Stewart CE, Thomas SH. Basic-level emergency medical technician administration of fluids and glucose via enzyme-assisted subcutaneous infusion access. Prehosp Disaster Med. 2012;27(3):1-6.

scholarly journals Impacts of Emergency Medical Technician Configurations on Outcomes of Patients with Out-Of-Hospital Cardiac Arrest

2020 ◽  
Vol 17 (6) ◽  
pp. 1930
Author(s):  
Pin-Hui Fang ◽  
Yu-Yuan Lin ◽  
Chien-Hsin Lu ◽  
Ching-Chi Lee ◽  
Chih-Hao Lin
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Emergency Medical Technician ◽  
Population Database ◽  
Emergency Medical ◽  
The Impact ◽  
Hospital Cardiac Arrest ◽  
Medical Technician

Paramedics can provide advanced life support (ALS) for patients with out-of-hospital cardiac arrest (OHCA). However, the impact of emergency medical technician (EMT) configuration on their outcomes remains debated. A three-year cohort study consisted of non-traumatic OHCA adults transported by ALS teams was retrospectively conducted in Tainan City using an Utstein-style population database. The EMT-paramedic (EMT-P) ratio was defined as the EMT-P proportion out of all on-scene EMTs. Among the 1357 eligible cases, the median (interquartile range) number of on-scene EMTs and the EMT-P ratio were 2 (2–2) persons and 50% (50–100%), respectively. The multivariate analysis identified five independent predictors of sustained return of spontaneous circulation (ROSC): younger adults, witnessed cardiac arrest, prehospital ROSC, prehospital defibrillation, and comorbid diabetes mellitus. After adjustment, every 10% increase in the EMT-P ratio was on average associated with an 8% increased chance (adjusted odds ratio [aOR], 1.08; p < 0.01) of sustained ROSC and a 12% increase change (aOR, 1.12; p = 0.048) of favorable neurologic status at discharge. However, increased number of on-scene EMTs was not linked to better outcomes. For nontraumatic OHCA adults, an increase in the on-scene EMT-P ratio resulted in a higher proportion of improved patient outcomes.

Compensation of Emergency Medical Technician (EMT)-Basics and Paramedics

2016 ◽  
Vol 31 (S1) ◽  
pp. S87-S95 ◽  
Author(s):  
Jonathan R. Studnek
Keyword(s):  
Mail Survey ◽  
Emergency Medical Technician ◽  
Publication Type ◽  
Factors Associated ◽  
Emergency Medical ◽  
Number Of Factors ◽  
Stratified Sample ◽  
And Gender ◽  
Annual Earnings ◽  
Medical Technician

AbstractObjectivesThe objective of this paper is to identify factors associated with compensation for Emergency Medical Technician (EMT)-Basics and Paramedics and assess whether these associations have changed over the period 1999-2008.MethodsData obtained from the Longitudinal EMT Attributes and Demographic Study (LEADS) surveys, a mail survey of a random, stratified sample of nationally certified EMT-Basics and Paramedics, were analyzed. For the 1999-2003 period, analyses included all respondents providing Emergency Medical Services (EMS). With the addition of a survey in 2004 about volunteers, it was possible to exclude volunteers from these analyses.ResultsOver 60% of EMT-Basics reported being either compensated or noncompensated volunteers in the 2004-2008 period. This was substantially and significantly greater than the proportion of EMT-Paramedic volunteers (<25%). The EMT-Paramedics earned significantly more than EMT-Basics, with differentials of $11,000-$18,000 over the course of the study. The major source of earnings disparity was type of organization: respondents employed by fire-based EMS agencies reported significantly higher earnings than other respondents, at both the EMT-Basic and EMT-Paramedic levels. Males also earned significantly more than females, with annual earnings differentials ranging from $7,000 to $15,000.ConclusionsThere are a number of factors associated with compensation disparities within the EMS profession. These include type of service (ie, fire-based vs. other types of agencies) and gender. The reasons for these disparities warrant further investigation.StudnekJR. Compensation of Emergency Medical Technician (EMT)-Basics and Paramedics. Prehosp Disaster Med. 2016;31(Suppl. 1):s87–s95.

scholarly journals Why do Emergency Medical Services (EMS) Professionals Leave EMS?

2016 ◽  
Vol 31 (S1) ◽  
pp. S105-S111 ◽  
Author(s):  
Gary Blau ◽  
Susan A. Chapman
Keyword(s):  
Emergency Medical Services ◽  
Further Education ◽  
Emergency Medical Technician ◽  
Medical Services ◽  
Publication Type ◽  
Exit Survey ◽  
Emergency Medical ◽  
Exit Decisions ◽  
New Location ◽  
Medical Technician

AbstractObjectiveThe objective was to determine why Emergency Medical Technician (EMT)-Basics and Paramedics leave the Emergency Medical Services (EMS) workforce.MethodsData were collected through annual surveys of nationally registered EMT-Basics and Paramedics from 1999 to 2008. Survey items dealing with satisfaction with the EMS profession, likelihood of leaving the profession, and likelihood of leaving their EMS job were assessed for both EMT-Basics and Paramedics, along with reasons for leaving the profession. Individuals whose responses indicated that they were not working in EMS were mailed a special exit survey to determine the reasons for leaving EMS.ResultsThe likelihood of leaving the profession in the next year was low for both EMT-Basics and Paramedics. Although overall satisfaction levels with the profession were high, EMT-Basics were significantly more satisfied than Paramedics. The most important reasons for leaving the profession were choosing to pursue further education and moving to a new location. A desire for better pay and benefits was a significantly more important reason for EMT-Paramedics’ exit decisions than for EMT-Basics.ConclusionsGiven the anticipated increased demand for EMS professionals in the next decade, continued study of issues associated with retention is strongly recommended. Some specific recommendations and suggestions for promoting retention are provided.BlauG, ChapmanSA. Why do Emergency Medical Services (EMS) professionals leave EMS?Prehosp Disaster Med. 2016;31(Suppl. 1):s105–s111.

scholarly journals Emergency Medical Technician Education in Saudi Arabia: History and Challenges

2017 ◽  
Vol 32 (6) ◽  
pp. 699-699 ◽  
Author(s):  
Yassar Alamri
Keyword(s):  
Saudi Arabia ◽  
Emergency Medical Technician ◽  
Publication Type ◽  
Emergency Medical ◽  
Medical Technician

AlamriY. Emergency medical technician education in Saudi Arabia: history and challenges. Prehosp Disaster Med. 2017;32(6):699.

Paramedic and Emergency Medical Technician Reflections on the Ongoing Impact of the 9/11 Terrorist Attacks

2019 ◽  
Vol 34 (1) ◽  
pp. 56-61 ◽  
Author(s):  
Erin C. Smith ◽  
Frederick M. Burkle
Keyword(s):  
New York ◽  
Evidence Base ◽  
Emergency Medical Technician ◽  
Terrorist Attacks ◽  
Publication Type ◽  
Emergency Medical ◽  
Eye Problems ◽  
Long Term Impact ◽  
Medical Technician

AbstractIntroductionIn the years following the September 11, 2001 terrorist attacks in New York City (New York USA), otherwise known as 9/11, first responders began experiencing a range of health and psychosocial impacts. Publications documenting these largely focus on firefighters. This research explores paramedic and emergency medical technician (EMT) reflections on the long-term impact of responding to the 9/11 terrorist attacks.MethodsQualitative methods were used to conduct interviews with 54 paramedics and EMTs on the 15-year anniversary of 9/11.ResultsResearch participants reported a range of long-term psychosocial issues including posttraumatic stress disorder (PTSD), anxiety, depression, insomnia, relationship breakdowns and impact on family support systems, and addictive and risk-taking behaviors. Ongoing physical health issues included respiratory disorders, eye problems, and cancers.DiscussionThese findings will go some way to filling the current gap in the 9/11 evidence-base regarding the understanding of the long-term impact on paramedics and EMTs. The testimony of this qualitative research is to ensure that an important voice is not lost, and that the deeply personal and richly descriptive experiences of the 9/11 paramedics and EMTs are not forgotten.SmithEC,BurkleFMJr.Paramedic and emergency medical technician reflections on the ongoing impact of the 9/11 terrorist attacks.Prehosp Disaster Med.2019;34(1):56–61.

scholarly journals Emergency Medical Service in Rural Mountain Areas in Taiwan: A Nantou Mountain Areas Based Study

2014 ◽  
Vol 21 (6) ◽  
pp. 373-381 ◽  
Author(s):  
Sc Hung ◽  
Yh Li ◽  
Mc Chen ◽  
Sw Lai ◽  
Fc Sung ◽  
...  
Keyword(s):  
Response Time ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Life Support ◽  
Advanced Life Support ◽  
Patient Characteristics ◽  
Emergency Medical Technician ◽  
Mountain Areas ◽  
Emergency Medical ◽  
The Mean

Background This study explored the emergency medical service (EMS) in rural mountain areas in Taiwan to establish the public health policies in rural mountain areas. Methods This was a retrospective study. Based on mission records available at 3 EMS branches in Ren-Ai and Sinyi townships of Nantou County, we evaluated dispatched status, patient characteristics, and pre-hospital emergency managements. Results From January to June 2011, a total of 765 EMS were dispatched from these 3 mountain branches. Each dispatched EMS team was consisted of one official emergency medical technician (EMT) with EMT II certificate (100%), and one (88.0%) or two (11.2%) volunteers as EMT I personnel. Most of missions were conducted in the daytime and peaked during 10am to 12pm. Patients were characterised with more men and elderly and predominant with non-traumatic medical complains (55.0%). Approximately 38.7% EMS patients required the advanced life support. Of these 3 mountain EMS branches, the mean response time was 15.3±16.9 minutes, the mean management time on site was 6.1±6.9 minutes and the mean transport time was 38.0±15.9 minutes. The response time and transportation time of EMS in rural mountain areas were relatively longer than that in urban towns in Taiwan. Conclusions The rural EMS is under the challenges of providing appropriate and adequate medical care. Each EMS team should be equipped with adequate emergency care facilities and well trained personnel. (Hong Kong j.emerg.med. 2014;21:373-381)

The Longitudinal Emergency Medical Technician (EMT) Attributes and Demographics Study (LEADS): The First 10 Years and a Look at Public Perception of Emergency Medical Services (EMS)

2016 ◽  
Vol 31 (S1) ◽  
pp. S1-S6 ◽  
Author(s):  
Remle P. Crowe ◽  
Melissa A. Bentley ◽  
Roger Levine
Keyword(s):  
Emergency Medical Services ◽  
Public Perception ◽  
Emergency Medical Technician ◽  
Medical Services ◽  
Publication Type ◽  
Emergency Medical ◽  
Medical Technician

CroweRP, BentleyMA, LevineR. The Longitudinal Emergency Medical Technician (EMT) Attributes and Demographics Study (LEADS): the first 10 years and a look at public perception of Emergency Medical Services (EMS). Prehosp Disaster Med. 2016;31(Suppl. 1):s1–s6.

Recruitment and Retention of New Emergency Medical Technician (EMT)-Basics and Paramedics

2016 ◽  
Vol 31 (S1) ◽  
pp. S70-S86 ◽  
Author(s):  
Susan A. Chapman ◽  
Remle P. Crowe ◽  
Melissa A. Bentley
Keyword(s):  
Rural Areas ◽  
Small Towns ◽  
Demographic Characteristics ◽  
Emergency Medical Technician ◽  
Publication Type ◽  
Recruitment And Retention ◽  
Emergency Medical ◽  
Demographic Study ◽  
Insight Into ◽  
Medical Technician

AbstractObjectivesThe purpose of this paper is to describe factors important for the recruitment and retention of Emergency Medical Technician (EMT)-Basics and EMT-Paramedics new to the Emergency Medical Services (EMS) field (defined as two years or less of EMS employment) through an analysis of 10 years of Longitudinal EMT Attributes and Demographic Study (LEADS) data.MethodsData were obtained from 10 years of LEADS surveys (1999-2008). Individuals new to the profession were identified through responses to a survey item. Their responses were analyzed using weights reflecting each individual’s probability of selection. Means, proportions, and 95% confidence intervals (CIs) were determined and used to identify statistically significant differences.ResultsThere were few changes in the demographic characteristics of new EMT-Basics and Paramedics across survey years. New EMT-Basics tended to be older and less likely to have a college degree than new EMT-Paramedics. More new EMT-Basics than EMT-Paramedics worked in rural areas and small towns and reported that they were working as a volunteer. There were differences between new EMT-Basics and EMT-Paramedics in several of the reasons for entering the profession and in facets of job satisfaction.ConclusionsThe findings provide guidance for recruiters, educators, employers, and governmental EMS policy organizations and will provide better insight into how to attract and retain new entrants to the field.ChapmanSA, CroweRP, BentleyMA. Recruitment and retention of new Emergency Medical Technician (EMT)-Basics and Paramedics. Prehosp Disaster Med. 2016;31(Suppl. 1):s70–s86.

A Survey of Advanced Life Support Practices in the United States

1992 ◽  
Vol 7 (2) ◽  
pp. 144-150 ◽  
Author(s):  
Robert F. Lavery ◽  
James Doran ◽  
Bartholomew J. Tortella ◽  
Ronald P. Cody
Keyword(s):  
United States ◽  
Local Governments ◽  
Life Support ◽  
Mail Survey ◽  
Advanced Life Support ◽  
Advanced Cardiac Life Support ◽  
The United States ◽  
Emergency Medical Technician ◽  
Study Objective ◽  
Emergency Medical

AbstractStudy Objective:A national survey was conducted to determine the sponsorship of emergency medical services (EMS) projects, composition of EMS advanced life support (ALS) teams, types of medications and equipment carried, and procedures approved for use by EMS systems in the United States.Methods:A mail survey was sent to 211 training supervisors of EMS services across the United States in 1989. The survey requested demographic and service-related information, including types of EMS sponsorship, composition of ALS teams, medications and equipment carried, and procedures which personnel have been trained to use. Medications carried were correlated with advanced cardiac life support (ACLS), the American College of Emergency Physicians (ACEP) recommended drug lists, and with the sponsoring agency.Results:One-hundred seventy (70%) survey forms were returned. The major providers of ALS in the United States are fire departments (36%), followed by private providers (26%), hospitals (22%), and local governments (16%). The most common ALS team composition was two paramedics followed by one paramedic and one emergency medical technician (EMT). Most ALS services carry all of the recommended ACLS medications; a much smaller percentage carry all of the drugs recommended by ACEP. Fire department based ALS units carried the least number of medications; hospital-based ALS units carried the highest number of medications. Combined, over 80 different medications were carried by the services responding to the survey.Conclusion:The use of ACLS drugs and procedures are well-established nation-wide; less accepted are the medications recommended by ACEP. While over 80 different medications are carried by the EMS systems that responded to this survey, only a small fraction have been investigated in the prehospital setting.

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