Study: Fewer Paramedics Means More Lives Saved

Cities that deploy fewer paramedics -- who in turn treat more victims of sudden cardiac arrest -- save more lives, according to a new study.

Cardiac-arrest survival rates, considered a key measure of an emergency medical service's performance, vary from city to city. The study of five unidentified cities sought to find factors that have an impact on survival.

"Our data seem to show that cities with the fewest number of paramedics for a given population are more likely to have higher survival rates," says Michael Sayre of the emergency-medicine department at Ohio State University in Columbus. "Having a smaller number of paramedics who are very highly trained is probably a better strategy for delivering good patient outcomes."

Cities use survival from sudden cardiac arrest -- an abrupt loss of heart function often caused by misfiring electrical impulses in the heart -- as a performance indicator because victims either live or die based on critical care delivered in the first minutes after collapse.

The report, presented Friday at the Society for Academic Emergency Medicine in San Francisco, supports the similar findings of a USA TODAY study last year that called into question the national trend of putting paramedics on fire engines, often the first to reach the scene of an emergency.

"The major reason to have paramedics on first-response vehicles is because of the possible impact on cardiac arrest," Sayre says. "If that is not there, it would suggest to me that there isn't a good reason to have paramedics on first-response vehicles. It would be better to put a much smaller group of paramedics on a second-tier response."

In fact, new study found that more lives are saved in the cities with fewer paramedics even when those responders arrive as much as five minutes later than less-trained rescuers.

Among the 50 largest cities in America, those that save the highest percentage of cardiac-arrest victims -- Seattle, Boston, Oklahoma City and Tulsa -- use such a tiered response, USA TODAY found in an investigation published in 2003.

Researchers believe the individual paramedics in such cities deal with a higher volume of critical cases, keeping sharp such tricky skills as intubation, the insertion of a tube into the trachea to open an airway.

"There are a number of procedures required regularly to stay expert," says Corey Slovis, Nashville's EMS medical director. The study's lesson is "we've got to demand expertise from our experts," he says.

EMS physicians say the study is timely because of perceived paramedic shortages.

"Nobody knows what is the right number of paramedics per 100,000 population, and what is the best way to deploy the paramedics you already have in order to save the most lives," says Marc Eckstein, medical director for the Los Angeles Fire Department. "The need for research to answer these questions has never been greater." --- Results from five cities The study examined cardiac-arrest survival in five unnamed cities. The findings include:

p = City with best outcome

P = City with worst outcome

Cases of sudden cardiac arrest per paramedic each year 4.7(p) 1.6(P) Length of time paramedics arrive after first responders 4 minutes(p) 1 minute(P) Survival rate 27%(p) 4%(P)

Source: Researchers at Ohio State University in Columbus

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