Does the number of system paramedics affect clinical benchmark thresholds?

Area of Science:

• Emergency Medical Services
• Paramedic Education
• Clinical Competency

Background:

• Paramedic competency is influenced by skill exposure, complexity, and training quality.
• Established biennial benchmarks for critical care skills and experience require periodic reevaluation.
• The Milwaukee County Emergency Medical Services (MCEMS) system previously set benchmarks in 1997.

Purpose of the Study:

• To reevaluate the biennial critical care skill and experience benchmark thresholds previously established by the MCEMS system.
• To assess current paramedic skill frequency and experience levels in an urban EMS system.

Main Methods:

• Retrospective review of paramedic annual experience profiles from 2001-2005.
• Analysis of patient care records (PCR) data including patient contacts, team leader roles, intubations, IV access, medication administration, and ECG acquisitions.
• Comparison of current data with a 1997 study using t-tests and descriptive statistics.

Main Results:

• A significant decrease in most comparable paramedic experiences was observed compared to the 1997 study.
• Annual averages showed wide variability in skills such as intubations (adult 2.57, pediatric 0.1) and IV starts (adult 44, pediatric 0.34).
• Medication administration was the only skill that significantly increased (25%) over the study period.

Conclusions:

• Current data indicate reduced opportunities and high variability in paramedic technical skills and experiences.
• Infrequent performance of high-risk skills, particularly in critically ill adult and pediatric patients, is a concern.
• A multifaceted approach is recommended for maintaining paramedic provider competency in critical care skills.