I have spent the overwhelming majority of my career as a paramedic working in single-medic systems. I had EMT-Basic partners and for the most part, all of the Fire Department first-responders functioned at the EMT-Basic level. That meant that I was ultimately in charge of every call. Assessments, documentation, and advanced-level procedures were all my responsibility. It was a great experience and it made me the medic I am today.
Now I work for a service that only employs paramedics, and I absolutely love it. I have a very experienced and well educated partner and we work seamlessly together. I only have to attend every other call and I have a second set of hands to perform ALS-level procedures during critical calls. For me, it’s a dream come true.
Here’s my dilemma……
While I love working in a dual-medic system, I can see that one of the reasons it works so well is because the majority of us came from a single-medic environment. Most of us spent our careers having to be responsible for all aspects of patient care. Yes, we made mistakes and we all had to learn hard lessons along the way, but we aren’t afraid to act. None of us have seen it all, but I can say with confidence that most of us wouldn’t hesitate to take on any scenario that comes our way. Would I be able to say the same if had we all come up working in a dual-medic system? I really don’t know.
I have always been of the opinion that having too many paramedics on scene (on a regular basis) can actually be detrimental to the quality of care provided. While many argue that 2 heads are better than one, I see it another way. Yes, it is nice to be able to bounce ideas off one another, but at what point does a resource become a crutch? Throughout my career, I have worked with plenty of paramedics that started out in systems that made it a practice to deploy multiple paramedics to every call. Some of them turned out fine, but in my experience, the majority of them struggled when it came time to make decisions and act independently. When everyone functions at the same level, it’s easy to hide weaknesses. For example, if I’m not very competent in a certain skill or area of care, it would be easy to “delegate” those tasks to another provider while I do something I’m more comfortable with. While I don’t encourage people to perform procedures that they are confident in, avoiding it all together doesn’t fix the problem.
Let me bring you back to a couple experiences I had as a brand new paramedic:
I had been working on my own for 1 week. We were dispatched to a call for a cardiac arrest. When we arrived on scene, I was absolutely shocked to see a sheriff’s deputy holding a 6-week-old baby in his arms, doing CPR. I was told this patient was an adult prior to our arrival. This was my first time not only intubating a child, but also running a critical pediatric call all together. I was scared out of my mind, but I had to act. I knew what to do. I had trained long and hard for that call, I was just scared. I had no choice but to overcome my fear and treat that child, and I did just that. Would I handle that call better today than I did 10 year ago? Absolutely, but at that time, I did the best I could and I’m confident that the outcome would have been same had I responded today.
Another scenario was 3 weeks after being released to work on my own. We responded to a lady in active labor. Being that this was her 10th pregnancy, with one time being twins, I made the decision that we were going to load her up and drive that ambulance like we stole it. The problem was, the baby started coming out as soon as I loaded her into the back. I gowned up, elevated her hips, put on my gloves and mask and probably repeated the words “Okay, Ma’am, Okay….” about 100 times. I was sweating profusely and could hardly get a word out. I don’t know why, but the thought of delivering a baby on my own scared the hell out of me. At one point, the lady actually placed her had on my shoulder and said “relax kid, It’s going to be fine. I’ve done this plenty of times. I’ll get you through it.” And that she did.
Both of those scenarios scared the living crap out of me, but only once. When I ran the 6 month old in cardiac arrest with a complete airway obstruction 7 months later, I was ready. Sure, it was scary, but I didn’t lock up. I was confident in my ability to treat that child and I can honestly say that I wouldn’t have changed a thing about that call had I ran it today. Likewise, when I responded to the woman delivering triplets over an hour away from the nearest hospital, I was ready. Could I say the same had I been able to take the path of least resistance and allow a more experienced paramedic to take control of those 2 calls? My guess would be no.
I’m simply torn. I absolutely love the system I work in, and when done right, I believe it’s one of the best ways to deliver quality patient care. I’m just not sure how to overcome the issues that a dual-medic system brings.
I would love to hear your thoughts and experiences. Do you, or have you worked in a dual-medic system? If so, how do you ensure that new paramedics are ready to function independently and with confidence?