Texas EMS System: Plan to Decrease Number of Paramedics on Units All About Patient Care

In the current economic climate, the plan that was approved last week by Austin-Travis County EMS to decrease the number of paramedics per ambulance may have been seen as a cost-saving measure by some, but officials are quick to point out that the change is all about patient care.

Medical Director Paul Hinchey -- who became a paramedic in 1989 -- says he was a big proponent of the all-ALS system that became popular in the early 1990s, which was the same time Austin-Travis County went that direction.

The department's new plan calls for the switch from two paramedics on a unit to one paramedic and one EMT. The paramedic would continue to provide advanced care while the EMT would provide basic life support.

"The thought was if one (paramedic) is good, two is better," he said. "Since that time we've learned quite a bit about the business in which we serve."

Hinchey says that studies have shown that when medical professionals perform a procedure more often, they become more proficient. Under the current model, the paramedics alternate calls, meaning that of the number of patients that unit sees, each would only be in charge of half.

He said that Austin-Travis County is actually behind the times and that most big cities have already made or in the process of making this switch.

One department that is currently transitioning is Wake County EMS in North Carolina -- where Hinchey previously served as the deputy medical director.

The process to change the system that was historically a dual-medic system began in 2009 in combination with an Advanced Practice Paramedic program.

The department is now comprised of 75 percent paramedics and 25 percent EMTs. He said that since inexperienced paramedics are still paired with veteran paramedics, they will never have a perfect 50-50 split, but that one day he sees it being more like 60-40.

"(Before) when a citizen called 911, they may get a paramedic with 10 years who had a cardiac arrest call last year or a paramedic with two years that's never had one before," department head and Medical Director J. Brent Myers said.

Wake County's paramedics are now gauged by experience and not response time with at least one cardiac arrest and one airway call as a goal each month.

"One of the keys to its success has been that it's been a gradual process. We didn't wake up one day and say we were going to do this and fired a bunch on medics."

Wake County also enhanced its hiring academy after making the switch. What used to be an orientation is now a five-week program.

"That's been a very important part and a lot of paramedics have had interest in the academy since they know that a product of that may end up becoming their partner."

Myers agrees that patient care is the main goal of making the change, and that any cost-savings incurred by the switch is minimal.

"The costs don't change a whole lot since we pay on years of experience as well as their accreditation level," he said, noting that a EMT with 10 years on the job could make the same amount as a paramedic with two. "It does expand the application pool though. There is a shortage of paramedics ready and trained to step into the system."

The transition for Austin-Travis County -- much like Wake County -- will take a number of years to accomplish as no layoffs will be made. Officials plan to filter in EMTs gradually by filling the department's current 48 vacancies and other by attrition.

"We rely heavily on our paramedics," he said. "What this would allow us to do is bring in some folks (as EMTs) and let them grow within the system and eventually move up to be paramedics."

Officials first began considering the move back when Hinchey became the medical director in 2009, but the idea was met with some apprehension when it was first proposed the following year.

Since then they have taken steps to sit down with the Employee Association to further discuss the plan.

"The Employees Association has been great in all this. They see this as an essential part in the future of this department," he said, noting that EMS is always evolving.