Extra Two Minutes given to paramedic Response Time

[codethree]

Where Im from the city has given AMR an extra two minutes to there response time once the fire truck arrives on scene. The reason behinde this is because the firetruck has a paramedic on it.

What are your thoughts on this?

 

[Aidey]

It is stupid. Unless they can get the patient packaged in 2 minutes there is no reason to restrict them to that.

 

[emscrazy1]

It doesn't sound like they're restricting them to 2 minutes after an engine arrives. It gives an additional 2 minutes because there is a medic on scene who can handle any ALS situation instead of the transport unit doing all of the work. Not a bad idea for AMR because they won't be penalized for the lag in response time.

 

[JPINFV]

BS because then the fire department will claim that they can arrive faster, therefore they're better, even though AMR is arriving within the contracted response times.

 

[Aprz]

I've heard it before, and I'll say it again, if it's a true emergency, the patient doesn't need a paramedic, they need a doctor. What if this is a significant trauma, a dissecting aneurysm, etc? What if it's a STEMI? Every second is cardiocytes. Does it matter if there is a paramedic on scene or not already? The patient needs to be transported as soon as possible.

I am sure right now, American Medical Response (AMR) time won't change significantly, but over time, I am willing to bet that they will be willing to put less units in service and hire less ambulance personnel because they don't need that many units to meet their contracted response time.

At the same time, I agree with JPINFV. I hate hearing about how Fire regularly beats transport to the scene, and they boast about being able to respond quicker. In my area, they are usually more expensive because of higher pay, more staff, more expensive equipment/vehicle (e.g. fire apparatus), and *usually don't do more than put the patient on oxygen, get the patient's first and last name, date of birth, age, and their chief complaint. I believe we should put less money into Fire and more into EMS. This will be just one more reason why they'll try to convince the public and legislature that they needed, and why more should be invested into them.

*Based on my empirical experience, which is limited in the 911 system, and conversations with Fire/Paramedics that teach at the schools that I attended or are currently attending.

 

[46Young]

I've heard it before, and I'll say it again, if it's a true emergency, the patient doesn't need a paramedic, they need a doctor. What if this is a significant trauma, a dissecting aneurysm, etc? What if it's a STEMI? Every second is cardiocytes. Does it matter if there is a paramedic on scene or not already? The patient needs to be transported as soon as possible.

I am sure right now, American Medical Response (AMR) time won't change significantly, but over time, I am willing to bet that they will be willing to put less units in service and hire less ambulance personnel because they don't need that many units to meet their contracted response time.

At the same time, I agree with JPINFV. I hate hearing about how Fire regularly beats transport to the scene, and they boast about being able to respond quicker. In my area, they are usually more expensive because of higher pay, more staff, more expensive equipment/vehicle (e.g. fire apparatus), and *usually don't do more than put the patient on oxygen, get the patient's first and last name, date of birth, age, and their chief complaint. I believe we should put less money into Fire and more into EMS. This will be just one more reason why they'll try to convince the public and legislature that they needed, and why more should be invested into them.

*Based on my empirical experience, which is limited in the 911 system, and conversations with Fire/Paramedics that teach at the schools that I attended or are currently attending.

It's easy for fire to routinely be the first on-scene when they have superior staffing/deployment, and have a much lower net utilization time. The bus may be coming from their second or third due, and/or the 911 EMS txp provider may be playing games like System Status Management and be out-of position as well.

Edit: It's rare to see an EMS system that has an adequate staffing/deployment plan. Usually, it's just enough units to cover normal call volume. Employers don't want to put out extra units to handle call surge and give relief to the busiest units that run all day and noght.

 

[Epi-do]

From this article by Dr. Bledsoe:

Now, what about response times? We had all assumed that the sooner an ambulance arrives, the better. However, like other things in EMS practice, this was not quite true. While significant evidence shows that response times less than four minutes are highly associated with improved outcomes, longer response times, especially the common referenced eight-minute response time, are not associated with improved outcome. A recently released study from one of the ambulance regions in the United Kingdom found that improving response times did not improve patient outcomes.

Whether it is 8 minutes or 10 minutes, since it is outside of the mentioned 4 minute window, does it really matter? Lots of areas that have separate fire and EMS do the same thing. Getting a medic onscene stops the clock, so they give the ambulance a couple extra minutes to get there. It's just like running lights and siren - if it truly is an emergency, that minute or two isn't going to make a difference.

(There are also some studies listed at the end of that article discussing response times if you want some additional reading.)

 

[rmabrey]

To my knowledge and verified by AMR's national medical director, my shop has significant evidence in favor of slower response times not changing the outcome. Supposedly we were the first AMR shop to do this. I don't know many details so take it for what you will.

 

[zmedic]

I think it's great because for 98% of calls the patient won't really be helped if you get there in 10 minutes or 15 minutes. So if this policy allows to AMR to slow down a bit because there are medics on scene it is safer for everyone else on the road. And if it is one of those 2% of calls the medics on the truck can do those same interventions. When I was on the ambulance we certainly drove a little faster because we knew that we had a county mandated average response time.

 

[Tigger]

I think it's great because for 98% of calls the patient won't really be helped if you get there in 10 minutes or 15 minutes. So if this policy allows to AMR to slow down a bit because there are medics on scene it is safer for everyone else on the road. And if it is one of those 2% of calls the medics on the truck can do those same interventions. When I was on the ambulance we certainly drove a little faster because we knew that we had a county mandated average response time.

I'll probably be flamed for this and called some bleeding heart FF lover, but I agree with the above simply because fire in both places I live is simply a lot better at driving. Especially here in Colorado Springs they drive very well and far slower than AMR units who are constantly flying by my house which is in a busy residential neighborhood. Where I work in Boston we aren't even required to take CEVO, with sometimes predictable results. An engineer has received extensive driver training, and it is far superior to what EMTs or Paramedics will ever receive with few exceptions.

 

[rmabrey]

To my knowledge and verified by AMR's national medical director, my shop has significant evidence in favor of slower response times not changing the outcome. Supposedly we were the first AMR shop to do this. I don't know many details so take it for what you will.

I should also add that we only get a fire response for priority one calls {exception is stroke/CVA, Abdominl pain, and priority two cardiac arrest} and fire is BLS

 

[medic417]

I hate hearing about how Fire regularly beats transport to the scene, and they boast about being able to respond quicker. .

Well if they claim that the police can claim even faster response times so maybe they should take over the fire department.

http://www.emtlife.com/showthread.php?t=32437

 

[medic417]

I'll probably be flamed for this and called some bleeding heart FF lover, but I agree with the above simply because fire in both places I live is simply a lot better at driving. Especially here in Colorado Springs they drive very well and far slower than AMR units who are constantly flying by my house which is in a busy residential neighborhood. Where I work in Boston we aren't even required to take CEVO, with sometimes predictable results. An engineer has received extensive driver training, and it is far superior to what EMTs or Paramedics will ever receive with few exceptions.

And police even get more driving training. Really I'm starting to think police should take over the fire department.

 

[zmedic]

My point isn't that the fire department are better drivers, it is that this agreement eliminates the argument of "yeah there is someone of equal or higher training on scene but we still need to get there as soon as possible so we don't get in trouble/ lose our contracts."

 

[Tigger]

My point isn't that the fire department are better drivers, it is that this agreement eliminates the argument of "yeah there is someone of equal or higher training on scene but we still need to get there as soon as possible so we don't get in trouble/ lose our contracts."

I figured as such, it was more of an aside.