dr-exmedic.com

There is a long-running debate about the ideal composition of a 2-person EMS crew:  2 paramedics or 1 EMT and 1 medic.  Supporters of the 2-medic crew suggest that 1) the medics can more easily alternate calls, reducing workload on each, 2) two medics can work up a critical patient more quickly, and 3) the medics can bounce ideas off each other, reducing medical errors.  Those supporting the 1+1 configuration note that it is 1) cheaper, and 2) gives each individual medic a better shot at developing experience in the complex skills associated with each (since each medic sees more patients).  Research supporting either crew type is fairly sparse, and mainly concentrated on scene times and medic experience.

Looking to change that is a group out of Tennessee, who ran 15 crews of each type (who had already been working together) through a simulated V-fib cardiac arrest.  They videotaped the scenarios and recorded several factors, including total time to complete the scenario (statistically the same for both crew types), time to complete individual tasks (different only for intubation by 2-medic crews, who were faster by 60 seconds), and various quality factors.

Counterintuitively, the 2-medic crews averaged an extra error per scenario.  However, it’s hard to say that this would have mattered much, since so many of the extra errors were extra defibrillations–and that’s one of two interventions found to reliably help victims survive.

Which brings us to the other intervention found to help victims survived (and admittedly not emphasized enough in the 2000 AHA guidelines under which these studies were performed):  CPR time.  The crews managed to deliver effective compressions about 46% of the time, which is both about average for these sorts of studies and way too little.  The more telling value, however, was the range of crew compliance:  from a high of 84% to a low of 1.6%.  That’s right, during a scenario which the average crew completed in 8.5 minutes, one crew apparently only had their hands on the patient’s chest for less than ten seconds.  And a spread of 82% from the highest to the lowest means that you’re really rolling the dice when you dial 911.

Granted, this may not really reflect the real world–it was a tiny study, with a simulated patient.  However, I’d actually expect performance to be better during a simulation, since there were apparently none of the distractors that happen out there in the real world, like screaming families, not enough room to move the patient, etc.

Conclusion:  It’s almost pointless to debate the merits of crew composition when we have so much variability from crew to crew.