How many does it take?

All these guys are coming with us to the hospital?




A joke an old supervisor used to tell:

How many firefighters does it take to change a light bulb?
10. 2 to make entry, 2 to stand by outside in case of emergency, 2 to staff the ambulance in case of injury, 2 to vent the roof and 2 to supervise.

How many paramedics does it take to change a light bulb?
We'll find out in 13 minutes, they're responding from a distance.


Almost like reading my mind from across the pond, Medic999 recently posted a question about American EMS response and comparing it to his UK system as I was formulating a similar question to him.
As I was checking blog updates to gather my thoughts, he made a post about reading American blogs that seem to have multiple responders at a scene.

Coming from rural, suburban and now urban systems, I have seen many different ways of providing service.

So let me put out there what all those folks in the stories may actually be doing, 999, as well as inviting others to chime in on their response policies.

In my rural experience, we were 3 men total, all trained as firefighters and EMTs. On some days there was a Paramedic, most not. When a call came in, we rolled both of the 2 ambulances available so all 3 men could assist at the scene. I know now this was a waste of resources, but at the time I was under trained and believed the extra persons could help us.

The sub urban setting had us responding alone in an ambulance while a paramedic responded in a separate vehicle. Local police officers were trained as EMTs and firefighters and would also respond to drive or assist in patient care. At that time I saw the twinklings of a system that could work well and provide quality care while drastically saving money. It did neither. Every time the ambulance from one station went on a call the fire engine housed there was left unstaffed.

Here in my urban digs, we have so many people wandering an emergency scene we could sell tickets. On an average response we have a 4 person fire engine team, one of which will be an EMT or Paramedic. If there is no Paramedic, a second 4 man team will be dispatched, only so a Paramedic can be on scene as soon as possible. Then the 2 man ambulance arrives, always at least one Paramedic and sometimes a Paramedic supervisor.

On critical calls, such as stabbings, they'll add a 5 man Ladder truck team (I still don't know why) and a Fire Chief supervisor since the number of persons responding is now outside the span of control for the engine supervisors.

Long story longer, the American response model is tied to the Fire Department simply because of the "holy cow" status of the Fire Department. Many ambulance and EMS agencies are feeling the squeeze and need to be rolled into a Fire Agency or risk disappearing completely.
The model is hopelessly flawed. On average a $400,000 fire engine is rolled out simply because one of the people on it is a Paramedic. The same training and equipment could be delivered via a small car or motorcycle (UK model) with an ambulance to transport, and fire units if needed for assistance.

The problem is, if you remove the call volume the Paramedics create, the Fire Companies suddenly appear to run little if any runs. There will always be a need for fire suppression, but the bean counters at City Hall don't care about response times, only call volume.

So here I sit in a tiny little single Engine firehouse, who will likely run 6 calls this week, but is kept open solely because of the number of EMS related runs they receive.

Having so many folks at the scene isn't always a help. I'll have the driver stay with the engine, now we're at 3. I'll be performing my assessment and the EMT will try to get a set of vitals. The Engine officer will be misspelling the medications on the run sheet and standing in the hallway, clipboard in hand.

On every run I'll have 6 people respond where 2-3 would be fine. But if we go to a 2-3 person model a lot of resources will be shut down because they simply won't have enough calls to justify the expense. Sad to say, but true.

I invite my readers to view 999's blog and comment here, or there, or both with whatever thoughts you may have on the underlying question: "How many does it take?"
EDIT- 999's post was removed due to technical difficulties. Sorry.
HM