HIDDEN IMPACT OF PARAMEDIC INTERVENTIONS

Objective-To examine current patterns of deployment and use of emergen cy ambulance crews in Nottinghamshire, with particular reference to cr ew status (technician or paramedic), case mix, interventions performed , and operational times.Methods-A retrospective survey of routinely co llected computerised ambulance service despatch data, and patient trea tment forms for 242 randomly selected emergency callouts in Nottingham shire, during September 1994. Data were collected on patient demograph y, broad diagnostic group, crew status and operational times, and para medic interventions performed. Results-170 of 242 callouts (70%) invol ved a paramedic crew; extended skills were used on 31 of these occasio ns (18%), predominantly for medical emergencies. Paramedic crews recor ded significantly longer on-scene times (median time: 14.0 v 11.5 min, P = 0.04). An examination of the difference between paramedics who pe rformed interventions and those who did not revealed that ((intervenin g)) paramedics recorded significantly longer on-scene times (median ti me: 23 v 12 min, P < 0.001), turnaround times (median time: 28 v 18 mi n, P < 0.001), and total out-of-service times (median time 73 v 51 min , P < 0.001). Conclusions-The additional time taken by paramedics at t he scene of an emergency incident relates to their performance of an i ntervention, rather than time spent assessing the patient to decide wh ether stabilisation or immediate evacuation would be most appropriate. Paramedic interventions were most often performed for medical emergen cies. The performance of paramedic interventions also extended turnaro und times and total out-of-service times.