Advantages for KCM1 medics include not having to fight with ALS first responders, about 14-field tubes/year, first full year pay around $70,000, liberal decision-making, and thinking you are the best in world. But EMS systems should be designed around caring for patients.
There was recently a study from Suburban King County showing ALS did not transport 30% of patients with life-threatening conditions (excluding trauma and cardiac arrest). There are no written guidelines about transferring care to BLS. The general philosophy with critical patients is if there is nothing the medic can do for you he or she very likely will turf you to BLS. Again it's all up to the given medic in charge.
Eight of the medics have been with M1 over 28 years. That's just not good for patient care.
KCM1 doesn't have CPAP, a supraglottic airway device, an IO-device, or adequate analgesia.
It's documentation system sucks. Medics have to fill out both paper and electronic forms. The electronic system was built custom and won't be compatible with new equipment.
South King County's Utstein (a controlled cardiac arrest benchmark) rate is exactly the same as Wake County, 1% lower than Boston's, and 2% higher than Austin-Travis County. However the rate is about 10% higher than systems with ALS first response.
BLS is a nightmare. BLS first response tells the BLS transport crews what to do even those the transport crews are ones getting yelled at by the docs and nurses. The quality of BLS varies significantly from department to department.
In 2004 there was a study looking at having the fire service take over KCM1. There will be another such study in a few years. For a variety of reasons it’s unlikely to be taken over soon.
The best system out there is Wake County. Every critical patient gets ALS and some of them get an advanced paramedic with greater exposure to critical calls.