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Retention, learning by doing, and performance in emergency medical services
1The Wharton School, University of Pennsylvania, 202 Colonial Penn Center, Philadelphia, PA 19104, USA. gdavid@wharton.upenn.edu
Health Services Research
|March 19, 2009
Summary
Paramedic experience significantly improves emergency medical services (EMS) performance. Retaining experienced paramedics enhances patient care by leveraging accumulated skills and knowledge from past and present cases.
Area of Science:
- Emergency Medicine
- Health Services Research
- Medical Education
Background:
- The volume-outcome relationship is well-established in healthcare, but not previously studied for paramedics.
- Understanding provider-specific learning is crucial for optimizing prehospital care.
- The unique dispatch system in emergency medical services (EMS) allows for unbiased assessment of provider experience.
Purpose of the Study:
- To investigate the volume-outcome relationship in paramedics.
- To determine the impact of individual learning and experience accumulation on paramedic performance.
- To assess the value of paramedic retention in the context of skill development.
Main Methods:
- Analysis of incident-level EMS data from 1991-2005 in Mississippi.
- Utilized linear and quantile regression methods, with and without provider fixed effects.
- Examined trauma incidents, including motor vehicle crashes, falls, stabbings, and shootings.
Main Results:
- Higher individual paramedic case volume robustly correlates with improved patient care outcomes.
- Learning benefits accrue from both recent and past experiences.
- Experience impacts both average performance and the highest levels of care quality.
Conclusions:
- Sustained experience, both past and present, highlights the importance of paramedic retention.
- EMS management and policy should prioritize retention strategies to capitalize on paramedic learning.
- Individual learning by paramedics is a key factor in enhancing prehospital emergency care quality.
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