Management Decisions: The Effectiveness and Size of the Emergency Medical Team

Abstract

In Poland, often for economic reasons, the staffing of medical rescue teams is limited to the legally required minimum. This gives rise to problems related to the effectiveness and efficiency of medical rescue teams. A literature review did not find any sources addressing the issue of the verification of the effectiveness of paramedic teams depending on the personnel composition of units. The aim of the study was to analyze the effectiveness of resuscitation depending on the size of the medical rescue team, comparing the work of two- and three-person teams. In total, 100 two-person teams and an analogous number of three-person units were studied. Statistical analyses were performed using the IBM SPSS Statistics 24 package. The results showed that the assessment of the condition of the victim as well as the ability to assess the heart rhythm and monitor the condition during advanced measures were more effective in three-person teams; three-person teams also used oxygen more frequently during advanced life support (ALS). Most of the elements influenced the quality of resuscitation and it can be unequivocally stated that the work of three rescuers is more efficient and definitely more effective.

Efficiency of two-member crews in delivering prehospital advanced life support cardiopulmonary resuscitation: A scoping review

“… 14 Several simulation studies demonstrated superior CPR quality (chest compression quality and fraction) in teams larger than two, along with a more efficient achievement of critical CPR endpoints such as rhythm recognition, adrenaline administration, and tracheal intubation. 20 , 21 , 22 No significant difference in the no-flow fraction was observed between teams of two, three, and four paramedic students in one simulated ALS/CPR study. 23 One study comparing team compositions found that teams of two paramedics were more prone to errors and generally slower in most interventions (except for tracheal intubation), compared to paramedic-emergency medical technician (EMT) teams.…”

“… Robak (2020) 27 Paramedics ( n = 40) ALS/CPR with pre-filled medication syringes Time to critical interventions The use of pre-filled adrenaline syringes: shorter time to intraosseous access, shorter time to adrenaline. Robakowska (2022) 22 Paramedics ( n = 463) Team size comparison CC quality, time to critical interventions 3-member teams: critical interventions faster, quality of CC comparable. Siebers (2009) 26 EMTs and paramedics ( n = 104) Early TI during ALS/CPR CC interruptions.…”

“…One and five studies investigated the effect of ALS team configuration on clinical outcome and quality of CPR respectively. 14 , 20 , 21 , 22 , 23 , 24 Five of these examined the effects of team size. 14 , 20 , 21 , 22 , 23 One retrospective clinical study involving 10 057 OHCA patients found that having more than two paramedics at the scene did not improve survival to hospital discharge (2 paramedics − 8.7%, 3 paramedics − 8.7%, ≥4 paramedics − 8.4%, p = 0.88).…”

“… 14 , 20 , 21 , 22 , 23 , 24 Five of these examined the effects of team size. 14 , 20 , 21 , 22 , 23 One retrospective clinical study involving 10 057 OHCA patients found that having more than two paramedics at the scene did not improve survival to hospital discharge (2 paramedics − 8.7%, 3 paramedics − 8.7%, ≥4 paramedics − 8.4%, p = 0.88). 14 Several simulation studies demonstrated superior CPR quality (chest compression quality and fraction) in teams larger than two, along with a more efficient achievement of critical CPR endpoints such as rhythm recognition, adrenaline administration, and tracheal intubation.…”

“…Larger crew sizes appear to be less error-prone and more efficient in airway management and overall performance, including CPR quality. 20 , 21 , 22 , 23 However, clinical outcomes for OHCA patients treated by two-member crews have only been evaluated in a single retrospective study, which did not detail specific protocols or contributions of first professional responders beyond crew size. 14 …”