Paramedic use of advanced life support procedures: experience and attitude survey

To gather information about paramedic use of 11 advanced life-support (ALS) procedures, 74 emergency physicians and 171 paramedics practicing in Utah were surveyed. Response was 66% and 65%, respectively. Performance difficulty, frequency of use, and success rate were evaluated. The willingness of physicians to order, and paramedics to perform each procedure were compared. Physicians' and paramedics' difficulty ratings were significantly different (P less than .001) for only 3 of the 11 procedures. During the study period, paramedics successfully performed 455 procedures; 229 were performed by 15 (13%) of the responding paramedics. The reported success rate for all attempted procedures was 82% (455/557). The number of attempts and the success rate was significantly higher (P less than .05) for paramedics with secondary medically affiliated employment. Paramedics were significantly more willing to perform 7 of the 11 procedures (P less than .001) than physicians were willing to order. We conclude that paramedic and physician difficulty ratings were generally similar, that many types of ALS procedures are rarely performed, that a small percentage of paramedics perform the largest number of ALS procedures, that secondary employment increases paramedics' procedural attempts and improves success rates, and that they are more willing to perform ALS procedures than physicians are to order them.