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EMS leaders propose changing number of paramedics on Austin ambulances

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February 02, 2012

EMS leaders propose changing number of paramedics on Austin ambulances

Group is proposing to do away with 1 of 2 paramedics currently on ambulances, adding basic EMT

By Shelton Green
KVUE

AUSTIN, Texas — Since the mid-90's, Austinites and residents of Travis County could always count on seeing two paramedics showing up on an ambulance during an emergency. That could soon be changing if Emergency Medical Services brass get their way when they pitch a proposal to the Austin City Council in mid-February.

Chief Ernesto Rodriguez, head of Austin Travis County EMS and Paul Hinchey, M.D. the medical director, are proposing to do away with one of the two paramedics currently on ambulances and adding a basic EMT.

"Paramedics are getting more and more difficult to find and one of the things that we wanted to do is instead of staffing with two paramedics, we want to staff with a paramedic and a basic life support provider," says Chief Rodriguez.

EMS leaders say the proposal if passed could save the agency money but all made it very clear that cost-cutting was not the main motivation.

"That is the motivation, to improve the quality of care that we provide," says Dr. Hinchey.

"We want to focus the paramedic's energy and their skills on the most critical patients and then we want to use basic providers to take care of the patients that don't need those critical skills and need basic life support so by dividing the two roles we think that we're going to actually provide better care for our patients," added Rodriguez.

A similar proposal was pitched by EMS leaders in December 2010, but that idea went over like a lead balloon when it was presented to both the Public Safety Commission and city council.

"If I were a paramedic and didn't have another paramedic backing me up I'd be very nervous and very scared," said Michael Levy, an Austin Public Safety Commission member.

Chief Rodriguez told KVUE that paramedics have 10-times the training than a basic EMT does.

Dr. Hinchey added that half of the nation’s 50-largest cities have already gone to the system that he and other local medical leaders are proposing.

"Most of our patients are not critical patients so by placing an EMT partner with that paramedic, the EMT can manage the basic patients and the critical patients can be managed by the paramedic," added Hinchey.

The proposal will be presented to the Public Safety Commission next week before it goes to the council for approval.

View the video from KVUE


Comments
The comments below are member-generated and do not necessarily reflect the opinions of EMS1.com or its staff.
Tanya Gash Caldwell Tanya Gash Caldwell Thursday, February 02, 2012 5:44:48 PM Im finding myself offended by this. I am an EMT-intermediate and with the exception of reading cardiac strips and pushing drugs I can do just as much as a paramedic. As a matter of fact I am actually better at my skills and in tough situations, then some paramedics I know. The one gentleman mentioned above said he would be nervous if the
Patrick Nance Patrick Nance Thursday, February 02, 2012 5:47:23 PM Ummm... I was a Paramedic in Texas and there was no shortage of Paramedics... good ones are hard to come by but Travis County and Austin EMS is one of the highest paying services in the state and they have very rigorous standards. If you don't think this is about money, then you are a fool. It is always about MONEY!
Tanya Gash Caldwell Tanya Gash Caldwell Thursday, February 02, 2012 5:48:30 PM There was not two paramedics. I live in a small town whrte paramedics are few and far between, so its common to have a paramedic and a basic on the truck, sometimes an intermediate and a basic and every once in a great while TWO BASICS. Pt care OS not compromised in any way. If someone knows their skills no matter what level, any pt can be taken care of. And not because having two paramedics is safer!
Justin Bland Justin Bland Thursday, February 02, 2012 6:44:24 PM "If I were a paramedic and didn't have another paramedic backing me up I'd be very nervous and very scared," said Michael Levy, an Austin Public Safety Commission member. Is that so? I work in an EMS system where I am the only paramedic on scene 90% of the time. I am the only paramedic providing patient care en route to the hospital 99% of the time. Michael Levy, you insult EMT-B's and EMT-I's everywhere with that statement. You have no business speaking for paramedics because YOU ARE NOT A PARAMEDIC! Also, if a medic is scared being the only medic on scene and/or en route to the hospital, I highly recommend him/her to tear their certs and repeating the paramedic program.
Justin Bland Justin Bland Thursday, February 02, 2012 6:46:37 PM A dual-paramedic unit is a luxury, not a necessity.
Debby Ksiezopolski Ciccone Debby Ksiezopolski Ciccone Thursday, February 02, 2012 7:43:07 PM As a Pennsylvania paramedic for both private and public systems, I never had the luxury of being on a two medic crew. We have always been a medic and EMT basic system, or a single medic meeting up with rural volunteer BLS ambulances. I wouldn't want a scared medic to take care of me.
Marty Munro Marty Munro Thursday, February 02, 2012 8:37:44 PM Up here in the great white north of Canada, in the service that I work for, we do not have two ALS paramedcs on an ambulance. Canada has a different system, as we don't have EMTs, but have primary care paramedics (PCPs) and advanced care paramedics, the latter being the equivelant of the U.S. paramedic. I am an advanced care paramedic, and I have never had a problem running a call with my PCP partner. Although, PCPs are above what you would consider to be BLS, I have never had a problem being the only ALS provider on the ambulance. In fact, there have been a few times where I have been with another advanced care paramedic, and on a hot call, things seemed to be confusing, as both of us had it in our minds that we needed to take over ALS stuff because that's what we were used to. I suppose that might change if I were used to it, but I think there is something to be said about a good BLS partner. I fully understand why an EMT-B would be insulted by the statement made. Remember, good ALS starts with good BLS.
Jim Breedon Jim Breedon Thursday, February 02, 2012 9:42:45 PM I agree with the sentiments of my peers. A 2 paramedic rig is no better than a paramedic-EMT-B unit. One of the 2 has to drive and therefore is of little use to the medic with the patient. On scene, a second medic may be helpful but if you are in a "load and go" situation the 2nd medic has little opportunity to do more than an EMT. In reality, a majority of EMS calls could easily be handled by a BLS unit. Partner wise, I'd take a good basic over a fair medic any day. In the field, a majority of what we do goes back to being a good basic. I worked rural EMS when I got into the field. If we ever needed 2 providers, in the back, we had a volunteer firefighter of law enforcement officer (on scene) drive while we provided care. Austin has the right idea.
Wyatt Blair Wyatt Blair Friday, February 03, 2012 1:49:39 AM Lol...paramedics are hard to find? Right now I am trying to get my reciprocity from NM
Wyatt Blair Wyatt Blair Friday, February 03, 2012 2:11:42 AM Sorry, as I was saying....I am trying to get my I85 reciprocity here in TX from NM and all its really for is to attend paramedic school. The ALS unit with one Medic and another EMT is a very viable option. Its done everyday where I come from and in a metro area backup isn't far away if needed. A code 3 hour long response time is not out of the realm for a lot of communities outside of Albuquerque. I have had the privilege to work with and meet some of the finest Paramedics in the profession who dothat everyday, and they are people who are great at their craft. There are also plenty of great Intermediates and Basics who help make a great ALS unit. As far as finding Paramedics......tell Austin to get off their fat asses in the EMS Bureau. I licensed since 2008 a Paramedicning there. Texas issue with finding paramedics is not from a lack off qualified candidates....its from
Wyatt Blair Wyatt Blair Fri Feb 3 02:15:40 PST 2012 Darn phones.....but to say lack of qualified candidates is an issue its not....its all red tape for not a whole lot of reward. I don't know how my post came across like that but I am an I 85....not a paramedic. But I have been licensed since 2008 as a basic and now am an intermediate.
David Doc Krebs David Doc Krebs Friday, February 03, 2012 3:35:07 AM I'm the lone paramedic and I have no EMT's to assist me and the nearest back-up is an hour and half away by helicopter...6 hours by boat. I'm a remote paramedic and I work offshore. I'm not scared.
Austin Ems Atcemsea Austin Ems Atcemsea Friday, February 03, 2012 3:39:37 AM The Austin EMS Association is in the process of negotiating an MOU, with city management, on proposed staffing to define some parameters. It is unfortunate that this became a media issue before the memorandum could be shared with the Paramedics and Community. http://www.statesman.com/news/local/ems-officials-change-in-ambulance-staffing-could-mean-2142057.html These early articles are not representative of the important distinctions within the proposal that was made which will be released on completion of the memorandum. The implementation will take place over years by attrition and the new entry level position will be called an M1(medic 1 and will be filled by Paramedics or EMT's credentialed to some intermediary level as decided by the Office of the Medical Director. Details will be posted on completion of negotiations. We respect all EMS providers and appreciate your work, regardless the patch you happen to wear. Thank you.
Dave Joel Dave Joel Friday, February 03, 2012 4:07:05 AM Bad Idea
Ken Dunn Sr. Ken Dunn Sr. Friday, February 03, 2012 9:07:15 AM What Union represents Travis county EMS? Anyone know?
Bill B Zilar Bill B Zilar Friday, February 03, 2012 12:38:06 PM Interesting discussion...sounds like many benefits may be derived from this proposal. I believe it may also inspire EMT-Bs to pursue their advanced certifications as well. :0) Blessings.
Monty Stanford Monty Stanford Mon Feb 6 08:39:35 PST 2012 seems that at least in Austin higher education would place youreself out of a Job now that half the positions would be for basic emts
Patrick Nance Patrick Nance Friday, February 03, 2012 1:22:20 PM I have worked the dualmedic system in Arlington, TX and the P/EMT system as well in Texas and California. A good EMT is worth his weight in gold, and some Paramedics make lousy EMT's when they are not the primary caregiver... so just having two Paramedics on a rig doesn't make for "better care"... having two people who know what they are doing in their respective roles makes the difference. And like I said, if you really don't believe this is about money, then you need to talk with me about some ocean front property in Arizona...
Nick Jarman Nick Jarman Sunday, February 05, 2012 12:36:49 AM I do not think this is about the money. Dr. Hinchey is a smart man. He has a sincere desire to make EMS they best it can be for the patient, including supporting evidence based practices in medicine. The evidence is beginning to show more paramedics actually lead to worse patient outcomes. Most can agree increased opportunities to perform a skill should lead to increased proficiency. If there are 100 opportunities to perform Intubation in an EMS system each year and 100 paramedics in the system then on average each paramedic would intubate once per year. If we reduce the number of paramedics to 50, on average each paramedic should intubate twice per year. So the fewer paramedics have increased opportunity to perform skills. I use those numbers for simple math, but use your numbers, and any skill, the results are the same. My agency was dual medic for years, but we now target 65-75% paramedics, & 25-35% EMT-Basic/Intermediate.
Wayland Slater Wayland Slater Sunday, February 05, 2012 5:21:13 PM I might be telling my age, but we rarely had two Paramedics on a call, especially in the county. At one point for a brief time we had a unit respond to an emergency with just two EMT-A's or One EMT and an EMT-I. A Paramedic would be responding in another unit. If the call was not in need advanced life support, then the Paramedic would be cancelled and be available quicker for another call which did need ALS. I first started with a one unit BLS volunteer service the summer between my Jr. and Sr. years in high school. That's how hard up we were for just EMT's and people to just drive. But my goal was to become a Paramedic. Even while functioning at a Basic EMT I had already became a "trauma-junkie". A couple of months after graduating high school I was hired in a much larger city. I knew they had Paramedics, but little did I know the service was only an Intermediate Service, but were in the process of becoming an ALS service. In the city the Fire Dept. had their own Paramedics , but we did all the transporting. It was jusst like the "EMERGENCY" tv show. But we were the only service in the county. We did have a few Paramedics on the payroll. But gradually we had finally got enough Paramedics graduated and certified and became an ALS MICU service. But it was still just ONE Paramedic per call for the most part. We didn't think anything about having just one Paramedic. One thing we did do , especially with any EMT wanting to advance to Paramedic is to give them extra "training" in the field. Those who were EMT's that we knew and worked with often we taught them to "support" us. Even if it's setting up an IV, getting the ET equiptment laid out and ready, we would refer to them as "EMT-A or I's 1/2". Just little things like that made a Paramedics job easier. But it did get trickier when it was just you as the Paramedic and only one other person, no matter their rating, someone had to drive. This was quite some time ago and at least for our area it was common, so we didn't think we had it all that bad. We did talk about how great it would be to eventually have two Paramedics and someone to drive. But all in all, what we considered as a "dream crew" was a Paramedic, an experienced EMT-I, and an xperienced EMT-A to at least drive. To be fair to EMT's, I've known some EMT's that could run circles around a Paramedic especially when it came to a trauma assesment. Now I've been out of the field and Firefighting several years ago due to a neuro-muscular problem, so I know things have changed. And I am by NO means trying to stir anything up. But when I read how there has been complaints because they don't have "TWO Paramedics" on each call, I just can't help but remember how it use to be. Much of the time you were the only Paramedic. We didn't have the "luxury" of a back-up.
Adam Wennhold Adam Wennhold Monday, February 06, 2012 4:37:52 PM EMT Intermediate would be a better choice. IVs, IOs, intubations and such. It''s always nice having a partner who can do more than take a blood pressure and put on stickers.
Roland O'Leary Roland O'Leary Wednesday, February 08, 2012 1:29:48 PM Consider yourself lucky to have an EMT partner. I've been in the business over 30 years. Love it when I have a good solid EMT partner. Try being stuck in a county where your staffing 2 ambulances, 1st with a paramedic and a FF driver, and the 2nd with an EMT Basic IV and a FF driver. Oh and closest mutual aid is 45 min from your station, and can be over 3 hours getting to your location. Or run with an 18 year old driver who doesn't even have a 1st aid or CPR card. No stess. :) Or be in unit on a 3 hour transfer in a blizzard that goes 6 1/2 hours with a patient going down the drain. 2 medic car for 911's a dream, 2 medics and an EMT with a distance transfer and the patient on a vent with mutiple drips a luxery. A medic and EMT more my reality at work doing interfacility transfers and any combination of the above as a volunteer on my days off with a small frontier Colorado county service. As a medic you need to learn to adapt, improvise, and overcome. After all they didn't call law enforcement, they called for EMS. Suck it up like a Marine.
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