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Debate Swirls Around Offering Paramedic Care

COLUMBUS, Ohio -- For some, a bee sting can escalate from scary to fatal in matter of minutes.

That's why Columbus paramedics are trained to recognize and treat anaphylactic shock.

But a recommendation that the city compare the costs and quality of advanced life support (what paramedics provide) and basic life support (what firefighters provide) could change everything.

"A basic EMT can't give epinephrine. The child has to be transported (to a hospital) and can die on the way," said Battalion Chief David Whiting, spokesman for Columbus Division of Fire.

The recommendation was made by a committee appointed by Mayor Michael B. Coleman and Council President Michael C. Mentel to find ways to save the city money.

About 32 percent of all emergency medical calls last year required advanced life support.

The cost of providing advanced life support is at least $6.5 million a year. That's how much the city pays the 620 paramedics above what they would earn as firefighters trained in basic emergency medical care. There are a total of 1,517 firefighters in the division.

There would be other savings as well, including the drugs, intravenous drips and other equipment paramedics use.

Right now, if you call 911 with a medical emergency, Columbus paramedics are sent whether you need advanced life support or not.

In its recommendation, the city-appointed committee cited a 2005 study published in the Journal of Prehospital and Disaster Medicine that found that patients with advanced or basic life support fared about the same.

Coleman's spokesman, Dan Williamson, said the mayor "takes the entire report very seriously and is considering all of it."

The group's suggestion sparked discussion among emergency medical workers nationwide.

"I think it's terrible," said Skip Kirkwood, a national expert and chief of the Wake County Department of Emergency Medical Services in North Carolina.

"What I think they've done is read a couple of older, very narrow research studies and jumped to the conclusion they think might save them some money."

Kirkwood knows of no major U.S. city that has a basic-only life support system.

Columbus was one of the first cities in the nation to put paramedics on ambulances in 1969. Today, 12 percent of the cardiac-arrest patients who are taken to hospitals eventually are discharged. The national rate is 6.4 percent.

Basic EMTs are trained to, among other things, clear airways, use automated external defibrillators, give patients aspirin or glucose, and place splints on injured patients.

Paramedicsare trained to do a lot more, including sticking a needle in a trauma patient's chest to release air from the lungs, placing intravenous drips, administering some life-saving drugs and operating a 12-lead EKG.

In 2008, the Division of Fire responded to 110,739 medical calls. Of these, 35,028 were taken to the hospital needing advanced life support and 17,370 required basic care.

There were about 50,000 runs during which no one was transported. "I agree that it costs money, but I believe saving a life is worth the additional resources," said George Speaks, the city's deputy public safety director.

There's discussion within the Division of Fire to go back to a tiered system in which some ambulances would provide basic life support and others advanced life support.

Seattle and Boston, both considered industry gold standards, have tiered systems and fewer paramedics than Columbus. Supporters of tiered systems say these paramedics are more proficient.

"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," said Dr. Craig Key, director of the Center for Emergency Medical Services at Ohio State University Medical Center.

"I don't think you can maintain your skills."


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