The following abstract was developed during the 2010 Research Summit and presented at the 2010 NAEMSE Symposium in Chicago.

The Effect of Patient Acuity on Frequency of Paramedic Student Team Leads

John Gosford, MS, EMT-P, Todd Cage, MEd, EMT-P, Sherm Syverson, BS, NREMT-P, Suzann Schmidt, BA, NREMT-P, Ashley Young, BA, NREMT-P, Joshua Salzman, MA, EMT-B

Introduction: Although many believe paramedic student team leads are less frequent in cases of more serious patients, there is no evidence to support this assumption. The purpose of this study was to examine the effect of patient acuity on the frequency of paramedic student team leads.

Methods: A retrospective review of student records from FISDAP, a national, online emergency medical services (EMS) student tracking system, was completed. The database provided 546,147 encounters from 6,267 students between 2001 and 2009 who met the inclusion criteria for analysis: graduated from a paramedic program; data verified for accuracy by a preceptor; and student provided consent for research. The acuity score was developed from existing FISDAP data points, with 1 point assigned to each skill performed on the patient. Acuity scores were divided into four groups: 1) non acute (score 1–2); 2) mild acuity (3–4); 3) moderate acuity (5–8); and 4) severe (9 or higher). Logistic regression was used to determine whether team leading was predicted by acuity level in general, or acuity level by primary impression (cardiac, medical, trauma, obstetrics [OB], respiratory, or other).

Results: Paramedic students performed as the team leader in 66% (n = 360,457) of all calls. Compared with team leading in nonacute patients, paramedic students were 44% more likely to lead in mild-acuity cases (odds ratio[OR] = 1.45, 95% confidence interval [CI] 1.43–1.45), 49% more likely to lead in moderate-acuity cases (OR = 1.49, 95% CI 1.47–1.52), and 30% less likely to lead in severe-acuity cases (OR 0.73, 95% CI 0.71–0.75). Team leads in cardiac, trauma, respiratory, and other primary impressions followed the same statistically significant trend as above. Medical and OB team leads followed the same statistically significant trend for mild- and moderate-acuity cases, but not for severe cases (OB team lead OR = 2.16, 95% CI 0.61–7.64; medical team lead OR = 0.99, 95% CI 0.99–1.09).

Conclusion: Paramedic students are leading teams less frequently in severe-acuity cases, which is consistent with anecdotal evidence from paramedic programs. Further research is required to determine the effect of the paramedic preceptor and other factors that could explain this finding.