Rapid Response Vs Transport Only: The battle of intercepts

I was discussing with many of my coworkers lately what the benefit is to having 2 Paramedics always on transport vehicles. The question was raised if it would actually be beneficial to put all Paramedics on rapid response vehicles (commonly known in this area as “Fly Cars”) I figured it would be a good discussion topic to try and get going. Lets break it down:
First, the preferred method is having two paramedics always on a transporting ambulance. This improves transport times, limits intervention times, and seems to have the most bang for your buck. At least it seems that way, right? When an ALS level call is dispatched the response generally (in the Metro Boston Area) is a Fire Piece (engine or ladder) as well as the ambulance. ALS is dispatched to the scene immediately and patient care is initiated. The biggest problem with this type of system is, that if the patient doesn’t warrant a full ALS work up then ALS is tied up on a BLS transport. In my opinion, not the best use of resource

Wake County EMS Rapid Intercept Vehiclebut that isn't really anything that we can control now can we?

To the right this is a Paramedic response vehicle from Wake County EMS. Courtesy of the Wake/Raliegh Fire Blog. Now tell me that isn’t badass!

Second, the less utilized method is the fly car system. What is this? The fly car system sets 2 paramedics up in a patrol vehicle, this being an SUV, or large sedan. In that vehicle there are two sets of gear and 2 paramedics. The vehicle is registered as a class V ambulance and allows for much more flexibility in a busy system. When an ALS level call is dispatched, send a BLS Ambulance with an ALS intercept. If BLS gets there and determines that there is no need for ALS they can easily cancel the resource and now that resource now is available to the coverage area again. If one Medic is tied up on a transport, the other person on the fly car can split (pending patient status) and yet again the ALS is available for another patient. You can also use Fly Car’s for transfers within your coverage area as well if needed.

For some reason this seems to be a hot topic because as with everything else in this profession, everyone has their own opinion. From a grunt’s perspective it seems that the fly car option is much more cost efficient. When you look at it your resources are essentially doubled and not tied down to one municipality specifically. I would love to work in my service area in a fly car.

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