Vineyard Question: Would Paramedics Save More Lives?

By JONATHAN BURKE

A proposal by Island medical personnel would establish a regional squad of paramedics on Martha's Vineyard.

Unlike the Island's basic and intermediate emergency medical technicians (EMTs), paramedics can dispense prescription medication and perform other advanced skills. The Vineyard and Nantucket are the only two communities in Massachusetts that do not have access to paramedic care.

The benefits of paramedic service, according to the proposal, would include increased patient survival and ongoing education of EMTs. But the cost is significant: an estimated $356,563 in the first year and $276,463 in succeeding years.

The plan would involve, as one of its central elements, hiring three full-time EMTs to provide coverage for the Island from a central location. The anticipated salary for each paramedic would be between $38,000 and $45,000 per year.

Chuck Cummens, one of the proposal's sponsors said, "In true life-threatening emergencies, we're actually bringing the most immediate intervention that the emergency room would perform to the scene. And the results are quite rewarding. Patients are arriving to the hospital in much stabler conditions."

Beyond increased patient survival, said Mr. Cummens, who lives in Vineyard Haven but works as a paramedic for the town of Weymouth, paramedic care leads to quicker turnaround time in the hospital for patients.

Judith Sibert, another of the proposal's main sponsors and an intermediate EMT for the Tri-Town Ambulance, said, "You get to the point where it depends how much money you want to spend for how many lives. For me, one life's enough." Ms. Sibert said the proposal evolved from discussions with Sheriff Michael McCormack this winter.

The proposal will be formally introduced at the Heart Safe Community awards next Tuesday which are tentatively scheduled for 10 a.m. in the main lobby of the Martha's Vineyard Airport.

The proposal has broad interest if not universal support.

Jennie Gadowski, a Tri-Town basic EMT for 15 years, said, "The concept is a forward moving, forward thinking one, and I think one that we should actively pursue."

Dr. Alan Hirshberg, director of the Martha's Vineyard Hospital emergency department, said he supports any improvements in the delivery of medical care.

"My involvement is extremely limited at this point. They've looked to me and the hospital - it's more the hospital. Is this a good thing for the population? And clearly it is. It's providing more definitive care in the pre-hospital setting than is currently being done. It doesn't mean that we're not doing a good job," said Dr. Hirshberg.

Dr. Hirshberg said a paramedic at the scene can administer more in-depth treatment. For example, he said, in the case of a patient with chest pains, according to current state protocol, a basic level EMT can dispense oxygen, put the patient on a stretcher and give an aspirin depending on the clinical history.

An intermediate EMT can start an IV, which would make the emergency department's job easier on arrival at the hospital.

But if a paramedic were available, said Dr. Hirshberg, a drug such as epinephrine that stimulates the heart to beat faster could be given.

Though all emergency personnel support improved patient care, not everyone is behind the paramedic proposal.

John Rose, captain of the Oak Bluffs EMT unit, said a plan is already in place to advance patient care toward the paramedic level and that the high costs associated with the paramedic proposal may not be justified.

Under the plan in place, said Mr. Rose, the skills of EMTs across the Island are advanced incrementally. A pilot program taught basic level EMTs to intubate patients, he said. From there, Mr. Rose said, the Island EMT departments agreed to fund the training for intermediate EMTs.

Mr. Rose said efforts are currently under way to introduce glucometers, a blood measuring device, and after that to introduce cardiac monitoring and the first line of cardiac drugs.

"I'm not against what's best for the patient. I'm for what's best for the Island as a whole, not an individual group," he said.

Mr. Rose said he is not convinced that paramedic care would lead to additional saved lives in Oak Bluffs. Given that the hospital is in his town, said Mr. Rose, it is likely that the Oak Bluffs ambulance crew can transport a patient to the hospital before a centrally located paramedic crew could even arrive on the scene.

Under the proposal, the Oak Bluffs share of the expenses would be $41,884 if the county formula for town assessments were accepted; $77,410 if costs are allocated according to the number of town ambulance runs, and $46,007 under an even distribution.

Scott Gerstmar, chairman of the Martha's Vineyard Association of EMTs Advanced Life Support (ALS) committee, said that ALS personnel will meet Thursday evening to discuss whether improved medical care is best achieved under the current plan or through the introduction of a paramedic intercept unit as outlined in the proposal. From 15 to 20 EMTs on the Island have the ALS rating.

"The roving rig," he said, addressing the proposed paramedic unit, "is something that will get us to that paramedic level. But it will do it at a cost - no longer in the confines in the volunteer system.

"The way we've been going is one way that will work. It works within the volunteer system. The other way is another way that it will work," he said.

The proposal, if adopted, would establish a centrally located, nonprofit intercept unit. Three full-time paramedics and a per diem roster would provide coverage around the clock.

Dispatch would be much as it is now.

"When ALS [advanced life support] is dispatched it would include the on-duty paramedic as well as the local Intermediate EMTs. A town ambulance would arrive with basic level EMTs who would initiate care. Intermediates and a paramedic would either arrive on scene or meet the ambulance on the way to the hospital. Each level would be performing care appropriate to their training," reads the proposal.