2010: A Year in Paramedicine

Last year I went through our electronic run forms and calculated my stats for the year. I have done the same again this year. Here are the 2010 results with (2009) in parenthesis. I did not include the calls I did with the commercial ambulance who came into town when I did not have a volunteer partner. Since I used their run forms, I have no accessible record of them. I would guess I did no more than 10-15 ALS calls with them, and do not recollect doing anything particularly unusual with them.

Observations from the data below:

I had by far my fewest annual number of intubations ever. My three ROSCs all came from PEA/asystole thanks to epi and good CPR. All three died in the ICU. I continued my concerted emphasis on pain management and comfort care. I increased my use of Solumedrol and also used Magnesium for severe asthma for the first time (It worked great!) Other than that, it was pretty much business as usual here in town.

451 Calls (466)
153 (156) Calls where medication was given
6 “Workable” cardiac arrests (all medical) (9)
3 ROSC (3)
0 Survivors to hospital discharge (0)
4 intubations (8)
2 LMAs (2)
0 defibrillations (2)

Drugs

Zofran – 49 (41)
Morphine – 43 (37)
ASA – 28 (36)
Nebs (DuoNeb, Albuterol) – 26 (21)
NTG – 20 (27)
D50 – 12 (19)
Solumedrol – 11 (7)
Atropine – 6 (11)
Epi 1: 10,000 – 6 (9)
Benadryl – 5 (4)
Cardizem – 3 (3)
Ativan – 2 (3)
Narcan – 2 (1)
Dopamine – 2 (1)
Metoprolol – 2 (0)
Versed – 2 (0)
Adenosine – 1 (2)
Epi 1:1000 – 1 (1)
Magnesium – 1 (0)
Tylenol – 1 (0)

Did not use: Amiodarone (2), Bicarb (1), Calcium, Tetracaine, Haldol, Vasopressin, Lidocaine, Lasix, Torodol

I am sure there are more sophisticated ways to data mine, here is what I did. Ran total number of calls. Ran total number of calls where medication was given. I then reviewed each medication call and tallied the meds I gave. The results below represent meds per unique patient. I may have given a patient three squirts of Nitro, but I tallied it as 1. As tallied above I gave Nitro to 20 different patients. I did not count oxygen or saline as drugs.

Every medic’s experience is going to be different based on the type of service they operate in, their medical control, the hours they work and the population served.

I work in a one-medic in one-primary ambulance system (I get the first call and if I am on a call, the next call goes to the backup commercial service. Once I am available, I get the next call again) in a urban/suburban town (bordering the city) 26 square miles with a resident population of 20,000 according to the 2000 census. 54% African-American, 40% white, 6% other. 1 out of five people are over 65. (A few years ago when we were only inputting demographic and dispatch time information into a computer, I ran a query that showed the average age of our patients was 69. I don’t know how to do that with our new software). There are two “luxury” retirement communities with convalescent homes attached and three stand-alone (non-luxurious) convalescent homes which together represented 19% of my calls. There are many doctor’s offices, and good amount of industry, ranging from insurance companies to a helicopter plant. The population is a mix of lower middle class and middle class, although there are a few upper middle class and wealthy neighborhoods on the north and west sides of town. We transport to four different hospitals with transport times from 10-30 minutes. I worked 40 hours a week Sunday 6-18, Monday 6-18, Tuesday, 6-22 (sometimes Saturday 6-22 instead of Tuesday). Weekdays are much busier than weekends. I took some vacation and days off and worked no overtime. We do no scheduled transfers (although many of the calls I did we call “emergi-fers” calls from nursing homes going to the ED for routine reasons where 911 was called).

Note: I have also been tracking meds given by one of the services I oversee. Here are the top ten meds they gave this year: ASA, Zofran, NTG, Nebs(DuoNeb and Albuterol), Morphine/Fentanyl, D50, atropine, epi 1;10,000, Solumedrol, Benadryl. The same ten as mine, although in slightly different order.

1 Comment

  • You guys use a lot of Zofran! Off the top of my head, I’d say that the top drugs we use are ASA, NTG, Combivent (same as Dou-Neb), D50, Thiamine (ya, I know), Narcan, Epi 1:10,00, Atropine, Cardizem, and Amiodarone. We’ll be giving more of the last one as we start to move away from Lidocaine on standing orders.

    I used a much smaller amount of Fentanyl, Versed, Ativan, or Etomidate than in previous years.

    Had about 10 or so intubations and two LMA insertions. No pacing, but a fair number of defibrillations. No cardioversion.

    A gazillion 12 lead ECGS, though.

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