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Someday, there will be a way to get online (without lots of cut-and-pasting) the full abstracts to these ICEM presentations I’ve been reviewing.  Until then, you’ll just have to take my word for it.

Abstract #262 purports to be a comparison of the effectiveness of one vs. two paramedics on scene in chest pain calls.  This was a prospective study, which is good, and fairly unusual in prehospital research.  They compared 92 patients, 37 treated by 2 medics, and 55 treated by 1 medic.  The only test that reached statistical significance was that, on average, patients treated by 2 medics had their chest pain resolve 2.4 minutes earlier.  There was no statistical difference between time to IV, first nitro, or second nitro (although there was a trend towards decreased times for two-medic crews).

The authors’ conclusion?

The augmentation of ambulance crews with a second advanced life support paramedic enhances the effectiveness of care for patients with potential acute coronary syndromes as demonstrated by more rapid relief of chest pain as compared to crews with a single paramedic.

I really hope that they get this study published somewhere I can access it, since the list of problems (and potential problems) is longer than my arm:

1. Nitroglycerin does not have a clear mortality benefit in the medical literature, unlike aspirin and beta-blockers–and neither of these interventions appear to be part of the study.  Then again, neither was time to oxygen delivery (although that has little effect).
2. Relief of pain has not been shown to decrease mortality.
3. The most important time doesn’t appear to have been measured, namely the time it takes to get someone having a clear MI to the cath lab.  Of course, if you presume that everything that happens after you reach the hospital is the hospital’s fault, a scene time would be useful instead–and that isn’t mentioned in the abstract.
4. In order to get to the cath lab, you need to take a 12-lead ECG; this time to pull this off doesn’t appear to have been measured, either.
5. There’s no mention of whether these patients were correctly given treatment for chest pain–and there’s no sense in a crew doing something faster if they’re potentially doing it wrong.
6. The abstract isn’t even clear whether we’re comparing a 2-medic crew to a medic/EMT crew, or three-person crews (1 or 2 medics), or 2 medics/1 EMT to a medic/EMT crew.  (Note the “augmentation” in their conclusion–if I had to bet, I’d guess that refers to adding a crew member.)

If I were cynical enough, I might suggest that there’s a certain attempt to justify personnel.  However, I’d like to think that this group of folks was honest in their efforts to answer the penultimate staffing question.

Filed under: EMS Research