RICHARD MARINUCCI

There seems to be more emphasis on data and statistics in government to drive decision making. This leads to generalization and promoting mediocrity-especially in emergency medical services (EMS).

However, if an organization is looking to continually improve, it will have to look past some of the statistical information that may show good but not great performance. In the area of EMS, looking at anecdotal evidence may be appropriate to find cases where a higher level of care leads to a better outcome.

Establishing Value

Occasionally I come across an article or information that questions the value of fire-based EMS and, even more specifically, advanced life support (ALS) or paramedic-level services provided by fire departments. I have also seen information that suggests that having too many paramedics in a fire department is not necessarily good in that they cannot get enough practice to maintain their skills to a level that makes a difference in outcomes. In these cases, like others, statistics and data are cited to “prove” the author’s case and show that there is no statistical difference in results between those that provide the higher level of service-and its implication that it is more expensive-or the number of paramedics on a department.

From a purely scientific perspective, I can’t argue with this. Bu, I am sure people who have been saved by fire-based EMS don’t really care about the statistics. I would guess that virtually every fire service paramedic with a little time on the job can cite instances where the advantages of fire-based EMS led to a positive outcome. It could be a case where the good response time made the difference. It could be that the staffing on the call led to having enough hands to do the job. It could be that the organization invested in quality training. Regardless, often the best chance people have is getting the highest level of service as quickly as possible. This means the fire service in many communities. Unfortunately, unlike television and movies, not every ending is happy, so the raw data doesn’t support the expense. Regardless, it should be the potential for a good outcome that drives decisions-not solely statistics and data.

To compete with the bean counters who rely on numbers, fire-based EMS professionals must be well versed in the benefits of the service they provide and must take every opportunity to tell their stories. They cannot stand by idly when accusations are made based on the inhuman statistical analysis of providing emergent care in the field. All emergency service is as much about the emotional aspects of the incident as it is about the actual technical part. If an individual is revived and returns to normal activities because of the right response, it doesn’t matter to that person or his family if he is only one or two out of a hundred. To that person, the system worked.

Often the services provided by fire-based EMS offer the best opportunity for success-even if some may argue that there is no statistical difference in the outcomes. There are some things that can be discussed and they are, for the most part, indisputable. For example, the medical profession has promoted the fact that irreversible brain damage can occur in as little as six minutes. It has also trumpeted the advantages of quick service and even has begun advertising the need to get to the right facility as quickly as possible. They brag about their “door to balloon” time. If this is the case, if all else is equal, then getting an ambulance to the patient with the highest level of care quicker will translate into better outcomes. Of course, this only applies when the outcomes could have been affected.

Keep the Right Score

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