I think we've finally jumped the shark here in Massachusetts EMS.
A committee has recently been formed to tackle a pressing and completely new and unforseen problem here in Emergencyland: The Bay State Edition.
We need to make sure we get two paramedics on the scene of some ALS calls in Massachusetts.
("Some," apparently being synonymous with "all," but more on that later)
Those of you NOT currently hitting yourselves in the heads with tackhammers probably don't work in Mass EMS, and thus need a little history.
See, until recently, the state required that all ALS units be staffed by two paramedics.
Ergo, all ALS calls were serviced by two paramedics.
Then at the behest of people looking to either minimize expense, maximize profits, or both, those regulations were watered down so that, with the state's blessing, some services could operate an ALS unit with only one paramedic on-board, partnered by either an intermediate or basic EMT.
Not a great set-up, but the system had adapted, made peace with the arrangement.
THEN, this past Thanksgiving season, quietly and under the cover of darkness -- WHAM! That regulation was thrown out the door competely by the state legislature under the guise of planning for the next flu epidemic (you know, like the one we DIDN'T have last year) so now, in Massachusetts, all you need to have an official ALS unit is a single paramedic on-board.
So next time you call 911, try not to think about the fact that you're relying on the emergency planning accumen of a bunch of state reps and senators who can't balance the state budget, keep promises to roll back the income tax, or build a tunnel without going 15 times over budget.
As the various boards and committees left picking through the wreckage wrought by our elected overseers begin their work, one of their missions is to figure out A) do we need two medics on ALS calls?, and B) if so, which calls, and C) how the heck do we do THAT?
Now, I'm in favor of dual paramedic staffing, but not for the typical reasons.
I concur with the forces calling for single-medic ALS units who point out that there is very little evidence in the medical literature that dual medic units produce concrete improvements in patient outcomes.
There has even been some conjecture that state data indicates patients treated by dual medic units have fared worse, if the number of complaints generated by dual medic units vs. other configurations are an indication (which I don't think they are).
I also concur that the calls two paramedics are legitimately needed for are few and far between.
But I support the dual medic configuration for two reasons:
1 -- although it is a consideration that I am sure that those in charge of our profession could care less about, I think dual medic is a better configuration for the two paramedics themselves. Like my Nana always said, many hands make light work. Two medics on an ALS unit allows for perfect distribution of labor, and, I would argue, happier employees. Anyone who's ever worked P-B as the medic knows the joy of a shift consisting of three chest pains, a shortness of breath, a hypoglycemic and one sad person. Good shift for the basic, bad shift for the medic. With a two medic system there's no debate or worry over who does what, you just split the calls down the middle
2 -- I think skills dilution is less of a problem with dual medic ALS units. If every ALS unit were forced to consist of two medics, that would by necessity cut down on the total number of ALS units even while the total number of calls stays constant, meaning more medics would see more sick patients.
Of course, this being Massachusetts, we're working diligently on applying a $1,000 solution to a $10 problem that we created in the first place.
The current proposal, as I understand it, would call for a second ambulance to be dispatched to certain ALS-level calls, although from my early perusal of the list of qualifying chief complaints, pretty much ANY ALS call would get a second ambulance dispatched to it.
This might not be much of a problem in urban systems with ambulances to spare (all you city guys try not to spit coffee out of your noses when you read that -- that stuff'll burn...), but what happens in my neck of the woods, in the suburban-rural interface?
As I understand it, any ALS call would have to involve multiple communities, leaving two towns unable to adequately provide ambulance service, instead of one.
And who's going to pay for the increased cost of call-backs at local ambulance and fire services to cover while the primary ambulance crew is chasing down yet another chest pain in a neighboring town?
My guess is that certain folks think amending the new law with these regs might in some way aid the wet dream that is regionalization.
I think regionalization is by far the best model for EMS delivery, but I am a lifelong Massachusetts resident, and thus know better than to believe in Santa Claus, the Easter Bunny, and statewide regional cooperation.
This is a horrible idea on so many levels, unless of course you think that what the EMS system in Massachusetts needs is additional complexity.
Just stop the madness and put two medics back on the bus.
Jumping sharks is dangerous.
Show me the Money
4 hours ago