I saw a story on JEMS.com about possible staffing changes coming to Austin-Travis County EMS. (Here's the video story of that if you're interested. Here's another story about the same issue.) I have a particular interest in this EMS system. Our former assistant medical director for my place of employment is now the medical director for this system. He's been there for a little over a year now. We miss him up here, but we have a new assistant medical director trying to fill his shoes.
Anyway, the current staffing of those ambulances in A-TC is with two paramedics. A lot of places do that. A lot don't. What they are trying to move to (from what I heard in the story) is to a system with a paramedic and an EMT on each truck. Every rig will still have a paramedic on it.
Here's my take on this:
In my system, we used to have dual-paramedic trucks. That was it. We didn't hire EMTs or EMT-Intermediates. Just paramedics. About 2 years ago, we started to shift our thinking and, while still ensuring that each rig has a paramedic, began to hire EMTs and EMT-Intermediates to sit in the "second seat". There were a lot of people who were upset at this and did not want this to happen -- but most of those people aren't complaining anymore. They thought that because we were hiring non-paramedics, the remaining paramedics would be responsible for taking care of every patient ("attending") while the non-paramedic just drove the entire shift and escaped all patient care. As these non-paramedics hit the streets, they realized that was not the case and that they would be more than capable of taking care of patients who do not need paramedic-level care.
This benefited us in several ways. The first of which was that we could save on our budget. In a time when the economy was not doing very well, our system was asked to cut every expense possible without affecting patient care. We were able to help with this by saving in salary costs for the employees. The other way that it made a big impact was that we were able to hire from a wider pool of applicants. We have never exactly had a problem with getting people to apply to our system (they come from all over to do it) but there are only so many paramedics that schools can turn out at a time. It became a way to be able to ensure that we kept the vacancies to a minimum.
So, is it a good idea for Austin-Travis County EMS to move from a dual-paramedic system to a paramedic-EMT system? Sure! The news story is trying to make several exaggerations. The first: the EMT has less training than a paramedic. True. Through this, however, they are implying that patient care will be compromised. I highly disagree. The education required in order to get the EMT certification versus the paramedic certification is substantial. BUT, the real education begins (and continues) within your EMS system. In order to maintain a certification, you must accrue a certain number of continuing education hours.
In my system (and, I believe in A-TC) we have a training to attend every month or every other month, depending on the schedule for the year. Here, we learn, we study, we get better. In my system, we talk about previous calls and how we can improve upon them. We have our medical director, a guest speaker (like one of the trauma doctors at the local trauma center) or one of our own FTOs (field training officer) lecture on a topic such as respiratory distress, improving patient assessment or child medical problems (to name a few). Though we may have finished school, we never stop learning...and that goes for the paramedics AND EMTs. They are required to attend all sessions right along with the paramedics. The EMTs may not be able to perform all of the skills that a paramedic can but they have a fantastic knowledge base to work from and be able to lend a very helping hand to their partner. They can look at something and realize a lot of what's going to need to be done for the patient and can help prepare the necessary medical interventions. An example of this is getting an IV bag spiked and set up or hooking the patient up to the cardiac monitor. These things have to be done and, if you have two paramedics on the truck, one of the people doing those things will be a paramedic. It doesn't matter who hooks you up to the monitor or spikes the IV line. Patient care is not sacrificed in these instances. I have yet to come across a situation where I have said to myself "I wish I had a paramedic partner on this call instead of this EMT".
The news story also makes the point that there are approximately 40 positions open in the A-TC EMS system at this current time and they don't think that they will hire for those positions until an agreement on the staffing changes is made. In saying this, they are trying to say that patient care is again compromised. I disagree. I know a lot of paramedics like the extra overtime that they can get due to under-staffing. I feel certain the medical director has imposed a maximum length of work time for all of the system's employees (likely 36 hours as it was in his previous system). I say that to say it's not like these other employees are working for 6 days straight (24 hours, no breaks). In that case, I'd agree patient care is compromised but I seriously do not believe that to be the case.
The system would save money by making this move. If it does not compromise patient care, I don't understand the problem. Many people complain that the government spends too much money (period) and that they should reduce their spending. Here is a part of the government (or something that receives government funding) that is trying to limit the amount of money needed to run their service each year while still providing excellent care to the citizens -- and there's an outcry! You can't have in both ways.
Now, the system is not going to fire enough of it's paramedics in order to get a one-to-one ratio of paramedics and EMTs. What would likely happen is that they just won't hire any new ones until there is a closer ratio of one-to-one between the two groups. No one is going to lose their job (from my understanding) and the other positions will be hired for...and the system will save money in the process.
Ambulances staffed + saving money + uncompromising patient care = one smart EMS system
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