Study Shows EMS Crew Size Affects Ability To Respond

A new study shows the size and configuration of an emergency medical service (EMS) crew and an advanced life support (ALS) crew have a substantial effect on a fire department’s ability to respond to EMS calls.

The study was conducted by a coalition of principal investigators from the National Institute of Standards and Technology, the International Association of Fire Fighters and Worcester Polytechnic Institute. They said the study was the first attempt to investigate the effects of varying crew configurations for first responders.

The coalition said the increasing number of EMS responses points to the need for scientifically based studies to measure the operational efficiency and effectiveness of the crews responding. Fire departments typically deliver first-on-scene, out-of-hospital care services, regardless of whether or not they provide transport.

The design of fire-based EMS systems varies across communities. Some departments deploy only basic life support (BLS) units and personnel, some deploy a mix of BLS and ALS units and personnel, and a few departments operate solely at an ALS level.

System design decisions affect the emergency medical response and care. Field experiments for the new study revealed that three-person or four-person crews completed patient removal 1.2 minutes to 1.5 minutes faster than crews with two first responders.

All crews with first responders completed removal substantially faster – by 2.6 minutes to 4.1 minutes – than an ambulance-only crew.

Crews with one ALS provider on the engine and one on the ambulance completed all tasks faster and started later tasks sooner than crews with two ALS providers on the ambulance. This suggests that getting ALS personnel to the site sooner is vitally important in providing patient care.

When assessing the ability of crews to increase on-scene operational efficiency for trauma patients by completing tasks simultaneously, those with an ALS provider on the engine and one ALS provider on the ambulance completed all required tasks 2.3 minutes faster than crews with a BLS engine and two ALS providers on the ambulance.

First responders with four-person crews completed all required tasks 1.7 minutes faster than three-person crews and 3.4 minutes faster than two-person crews.

Results for cardiac patients mirror the result for trauma patients. Regardless of ALS configuration, crews responding with four first responders completed all cardiac tasks more quickly than smaller first responder crew sizes.

The study was funded by the federal Assistance to Firefighters Grant Program. The report can be downloaded from the partner Web sites or may be requested from them. It is also available at

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