Does the Number of System Paramedics Affect Clinical Benchmark Thresholds?

Abstract

Objective. Competency is affected by skill exposure, skill complexity, andtraining program quality. The purpose of this study was to reevaluate the biennial (24-month) critical care skill andexperience benchmark thresholds established by the Milwaukee County Emergency Medical Services (MCEMS) system in 1997. Methods. This was a retrospective review of annual experience profiles for paramedics working during 2001–2005 using the MCEMS patient care record (PCR) database. The number of patient contacts, role as team leader/report writer, adult andpediatric endotracheal intubations, adult andpediatric intravenous (IV) access initiations, medication administration, and12-lead electrocardiogram (ECG) acquisitions were analyzed. t-tests anddescriptive statistics were performed for comparison with the 1997 study. Results. Over the five-year study period, 1,215 paramedic profiles gleaned from 107,524 PCRs documented a total of 297,900 patient contacts. Annual means ± standard deviations [ranges] were as follows: patient contacts 245 ± 133 [12–788]; team leader: 106 ± 119 [0–739]; intubations: adult 2.57 ± 2.54 [0–20], pediatric 0.1 ± 0.3 [0–3]; IV starts: adult 44 ± 37 [0–267], pediatric 0.34 ± 0.77 [0–5]; treated cardiac arrests: adult 8 ± 6 [0–34], pediatric 0.26 ± 0.61 [0–4]; treated hypotensive trauma: 5 ± 6 [0–42]; andECGs acquired: 31 ± 19 [0–144]. The 1997 analysis (1987–1996 data) included 1,450 paramedic profiles representing 467,559 patient contacts generated from 172,131 filed PCRs. All comparable experiences decreased significantly between the 1997 analysis andthe current study, except medication administration, which increased 25%. Conclusion. These data show a decreased opportunity anda wide variability in the frequency of successfully completed paramedic technical skills andexperiences in this EMS system. Limited exposure to critically ill adult andpediatric patients reaffirms that high-risk skills are performed infrequently. A multifaceted approach should be considered for maintaining provider competency.

Key words:

• benchmarks
• emergency medical services
• prehospital care
• policy
• competency
• paramedic