The Commission on Fire Accreditation International (a part of the Center for Public Safety Excellence – CPSE) along with IAFC, IAFF, NIST published a paper exalting the theory that more providers on scene make for faster intervention. The CPSE Mission and Goal statement is:
CPSE serves as the governing body for the organizations that offer accreditation, education, and certification services to first responder and fire service industry professionals and agencies.
The study was funded by a grant from the FEMA and the Department of Homeland Security. The study, called Report on EMS Field Experiments used mock scenarios to access the time to patient intervention, using various crew configurations. From the Abstract:
The results and conclusions will directly inform the NFPA 17101 and NFPA 1720 Technical Committees, who are responsible for developing industry operational and deployment standards.
They used varying crew configurations, including
- 2-person engine crew
- 3-person engine crew
- 4-person engine crew
- One ALS provider on an engine & one ALS provider on an ambulance
- Two ALS providers on an ambulance
- One ALS provider on an engine & a BLS ambulance
- BLS engine company & One ALS provider on an ambulance
My first reaction to this paper was outrage. On the surface and in the EMS community it looked like the fire service was just trying to prove that fire based EMS was the best and only method for delivering prehospital care to the community. The rift between Fire Based EMS and third service EMS seems to be getting farther apart each time a national agency that supports fire service publishes a paper on how they can do EMS better than anyone else.
The IAFC had recently pushed out a white paper titled Fire-based and Private-EMS: Important Information for Metro Chiefs which just fueled the fire between services.
I read a majority of the Report on EMS field experiments. A main argument from the online EMS community was that this report does not consider patient outcome from the interventions. The study was never designed to evaluate weather having more paramedics on scene leads to better patient outcome.
The conclusion was that four person first response crew is better than smaller crew sizes in trauma and cardiac arrest. In the patient access and removal scenario, a larger first responder crew in conjunction with a two person ALS ambulance was the most efficient for completing the tasks. The study also found that having one ALS provider on the first responder crew and one on the ambulance lead to faster completion of tasks in both the cardiac and trauma scenarios. The summary concludes with the following paragraph:
These experimental findings suggest that ALS provider
placement and crew size can have an impact on some task start times in trauma and cardiac scenarios, especially in the latter tasks leading to patient packaging. To the extent that creating time efficiency is important for patient outcomes, including an ALS trained provider on an engine and using engine crew sizes of four are worth considering. The same holds for responder safety – for access and removal and other tasks in the response sequence, the availability of additional hands can serve to reduce the risks of lifting injuries or injuries that result from fatigue (e.g., avoid having small crews repeatedly having to ascend and descend stairs). Cost considerations for EMS response and crew configurations were not considered in this study.
The EMS portion of the Firefighter Safety and Deployment of Resources Study was designed solely to assess the personnel number and configuration aspect of an EMS incident for responder safety, effectiveness, and efficiency. This study does not address the efficacy of any patient care intervention.
The results also provide valid measures of total crew size efficiency in completing on-scene tasks some of which involve heavy lifting and tasks that require multiple responders to complete.
The authors are trying to provide proof that more people on scene can lead to safer practices and fewer injuries on the job. I say bravo, any attempt to make our jobs safer and reduce injuries will be welcomed. I also believe that there is need for more prehospital studies on efficacy of multiple ALS providers on scene on patient outcome, before we place a paramedic on every fire engine in the country.