Too Many Paramedics?

City's emergency medical service well-staffed but cuts require trade-offs


 
 

| Tuesday, April 21, 2009


COLUMBUS, Ohio -- With city revenues faltering, Columbus is looking high and low for cost savings. An economic-advisory committee assembled by the mayor and City Council president was right to suggest that the city consider scaling back its emergency medical service.

Many emergencies do not require the advanced training of paramedics and could be handled more cheaply by emergency medical technicians.

For 2008, of the 52,398 EMS runs in which patients needed medical care, 67 percent were taken to the hospital needing advanced life support and 33 percent needed only basic care. Also last year, squads responded to about 50,000 calls where they weren't needed at all.

All Columbus firefighters are certified EMTs, which requires about three months of training. They can perform simple procedures, including stopping a patient's bleeding, splinting a limb and using a bag-valve mask to aid a patient's breathing.

The firefighters who choose to become paramedics receive an extra year of medical training and 30 hours per year of continuing education. They can do complicated medical procedures, including surgical opening of airways and administering drugs -- for example, giving epinephrine to treat a serious allergic reaction.

The 620 active paramedics in the division cost the city $6.5 million for the 8 percent they earn above an average firefighter's pay.

Are there too many paramedics? Dr. Craig Key, director of the Center for Emergency Medical Services at Ohio State University Medical Center, broke down the math: "If everyone's a paramedic in your system and there are 350 cardiac arrests roughly in the city of Columbus . . . paramedics see a cardiac arrest once a year. ... I don't think you can maintain your skills."

And for those 50,000 calls that turned out to be nothing: Is there a better method for determining whether medics are needed? Therein might lie the savings.

Switching solely to EMTs, as the panel recommended, likely wouldn't be feasible and certainly couldn't happen overnight: 40 percent of the division's 1,517 firefighters are licensed paramedics, and the squads already are equipped for advanced care, so those are sunk costs.

The Fire Division points out that in Columbus, cardiac-arrest victims taken to the hospital by EMS have a 12 percent survival rate, much higher than the 6.4 percent national average.

Plus, the city has to consider that the Fire Division is able to bill private insurance companies and other government bodies more for advanced-care transports to the hospital than it can for basic care. Columbus could lose that revenue by switching to a lesser system.

The city could consider a two-tiered system, as is used effectively by other major cities, including Seattle and Boston, both known for excellent emergency care. In those cities, dispatchers can send the type of squad appropriate for the injury or illness.

Since the committee's report came out in March, people across the city and even the country have protested. Those lambasting the panel should remember that it was charged with finding every possible way to save money. It is a credit to the participants that they did so without flinching at the outcry that was likely to follow. Also worthy of note is that the EMS recommendation amounted to a mere two paragraphs in the 104-page report.

City officials have implied that changing paramedic service is low on the list of moves they would entertain seriously. More likely, they will compare the benefits paid by the city to its public-safety workers with those enjoyed by employees in similarly sized cities and make changes there.

A full-service EMS is a quality-of-life measure. It boosts Columbus' livability, and downgrading would be a loss to the city. But if the city's finances continue to deteriorate, everything has to be on the table.




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