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Places of work
Paramedics are employed by a variety of different organizations. Paramedic can be employed by government agencies as part of a public hospital system, as a separate municipal EMS service, or sometimes, especially in the United States, as part of a fire department. Paramedics are also employed by private sector organizations (private hospitals, private ambulance companies, corporations, mines, air ambulances, racetracks etc.). Paramedics may also work on a volunteer basis, receiving no monetary compensation for their services (i.e. Volunteer Rescue Squad / Volunteer Fire Department and community response units).
Examples of skills performed by paramedics
Although there is a great deal of variation in what paramedics are trained and permitted to do from region to region, some skills performed by paramedics include:
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- Emergency Operations
- Emergency vehicle response
- Emergency scene operations
- Patient extrication and rescue
- Mass casualty triage and staging
- Emergency medical transport
- Radio communications and notifications
- Basic Life Support
- Rescue breathing and CPR
- Obstructed airway maneuvers
- Splinting and bleeding control
- Cervical spinal immobilization
- Oxygen therapy and vital signs
- Medical and shock trauma assessment
- Advanced Life Support
- Asthma and respiratory crisis intervention
- Treatment of anaphylaxis/severe allergic reactions
- Drug therapy for diabetic shock and seizures
- Pharmalogical stabilization of cardiogenic shock
- Chemical Sedation, Restraint, and Analgesia
- Intravenous fluid replacement therapy
- Drug therapy for pre-eclampsia/post-partum hemorrhage
- Advanced Cardiac Life Support (ACLS) such as:
- Defibrillation;
- Synchronized cardioversion;
- Transcutaneous pacing;
- Cardiac monitoring and interpretation of EKGs, including 12-lead ECG;
Electric and pharmacological treatment of cardiac arrest
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- Thrombolysis (Clot busting Drug)
- Pediatric care, such as Pediatric Advanced Life Support (PALS) or Pediatric Education for Prehospital Professionals (PEPP);
- Trauma care, such as Prehospital Trauma Life Support (PHTLS) or Basic or Advanced Trauma Life Support (BTLS or ATLS);
- Medical Care, such as Advanced Medical Life Support (AMLS)
- Basic and advanced airway management, including:
- Visualization the airway by use of the laryngoscope
- removal of foreign bodies with Magill forceps;
- Endotracheal and nasotracheal intubation;
- Esophageal intubation using an EOA (now discontinued), LMA or a CombiTube;
- Rapid Sequence Induction (RSI);
- Surgical cricothyroidotomy or needle cricothyrotomy;
- Continuous positive airway pressure (CPAP);
- Vascular access for medication administration and fluid resuscitation via several routes:
- Central venous access (central venous catheter by way of external jugular or subclavian)
- Intraosseous (IO) cannulation (placement of needle into marrow space of a large bone)
- Pulse oximetry and capnography;
- Needle thoracentesis for tension pneumothorax;intercostal drainage
- Glucometry (testing blood sugar);
- Ventilator and IV pump management;
- Administration of medications via intramuscular, subcutaneous, intravenous, sublingual, endotracheal, rectal, oral, intranasal, intraosseous, inhaled.
Paramedics in most jurisdictions administer a variety of emergency medications; the individual medications vary widely based on physician medical director preference, local standard of care, and law. These drugs may include Adenocard (Adenosine) that will slow the heart for a short period of time to Atropine that will speed a heartbeat that is too slow, sympathomimetics like dopamine for severe hypotension (low blood pressure) and cardiogenic shock. Diabetics often benefit from the fact that paramedics are able to give D50W (Dextrose 50%) to treat hypoglycemia (low blood sugar). They can treat crisis and anxiety conditions, as well as perform RSI, a rapid way of obtaining an advanced airway with the use of paralytics and sedatives, with such medications as Versed, Ativan, or Etomidate, and paralytics such as succinylcholine, roccuronium, or veccuronium. They can also sedate combative patients using antipsychotics like Haldol or Geodon. Medications for treating respiratory conditions such as salbutamol , albuterol, atrovent, and methylprednisolone are common. Paramedics may also be permitted to administer medications such as those which relieve pain or decrease nausea and vomiting. Nitroglycerin, baby aspirin, and morphine sulfate may be administered for chest pain. Paramedics may also use other medications and anti-dysrhythmics like lidocaine and amiodarone to treat cardiac arrhythmias such as ventricular tachycardia and ventricular fibrillation not responding to defibrillation. Paramedics also treat for severe pain, i.e. burns or broken bone, with narcotics like morphine sulfate, pethidine, fentanyl and in some jurisdictions ketalorac.
Different qualification levels across the world
United States
In the United States, there are 4 levels of emergency prehospital care defined by the U.S. Department of Transportation, which regulates prehospital education. In order of their level of training, from the most basic to the most advanced, they are Medical First Responder, Emergency Medical Technician-Basic (EMT-B), Emergency Medical Technician-Intermediate (EMT-I), and Emergency Medical Technician-Paramedic (EMT-P). The paramedic is the most advanced level of EMT; however, in order to avoid confusion about the level of care, in practice the term "EMT" usually refers to Emergency Medical Technicians below the paramedic level. Official paramedic insignias and laws that designate level of care have codified this custom. Paramedics in the United States, working under the direction of emergency medical control physicians, provide the most advanced level of emergency medical care available to the general public in an emergency situation outside of a hospital setting. Exceptions to this include physicians who sometimes operate with air ambulance services and some jurisdictions that honor Critical Care Paramedic courses, which are usually not acknowledged by the state but may be required by that service for hospital ICU to hospital ICU transfers.
Canada
In Canada there are 3 levels of Paramedics: the Primary Care Paramedic with limited pharmaceutical protocols, the Advanced Care Paramedic with full ACLS qualification, and the Critical care Paramedic with very advanced qualifications. Paramedics in Canada, provide the most advanced level of emergency medical care available to the general public outside of a hospital setting. Advanced Care and Critical Care Paramedics are able to perform more delegated medical acts than any other health professional besides physicians in the pre-hospital setting.
Ottawa paramedics use a 12-Lead ECG to diagnose ST-Elevated Myocardial Infarction (STEMI), a specific type of heart attack. This procedure was recently a topic of an article in the New England Journal of Medicine.[1] [2] Ottawa paramedics were the first paramedic service to have this STEMI protocol which is now being implemented across the world.citation needed
Europe
In many parts of Europe a different paradigm is used for prehospital care in which doctors, nurses and occasionally medical students function as prehospital providers, either in conjunction with or instead of paramedics.
Hong Kong
Hong Kong is currently progressing toward a system staffed with paramedics.[3] Different from United Kingdom and Australia,ambulance service is run by Fire Services Department, Hong Kong.
- St. John Ambulance in Hong Kong A charitable organization with
a long history stretching back over a century and has been serving the community since 1884. In Hong Kong, the St. John Ambulance Association was established in 1884.It provides ambulance service,first aid and caring training course.
- Auxiliary Medical Service An independent government department
that trained, committed voluntary medical and health services provider in Hong Kong. Its mission is to supply effectively and efficiently regular services.
South Africa
All health practitioners in The Republic of South Africa are regulated by a standards generating body (SGB), the Health Professions Council of South Africa (HPCSA).
The Department of Education has initiated the phasing out of short course training. This is to be replaced with a mid-level worker, and a prehospital clinician. The mid-level course is 2 years in duration , and exits on a level just above what many know as Intermediate Life Support (ILS), but below Advanced Life Support (ALS). They are placed on the Emergency Care Technician (ECT) register. The clinician qualification is a four year professional degree in Emergency Medical Care (Bachelor Emergency Medical Care), and is placed on the Emergency Care Practitioner (ECP) register. The only four institutions in the country to obtain the ECP qualification are the:
- University of Johannesburg
- Central University of Technology
- Durban University of Technology
- Cape Peninsula University of Technology
Medicolegal authority
Paramedics function under the authority (medical direction) of one or more physicians charged with legally establishing the emergency medical directives for a particular region. Paramedics are credentialed and authorized by these physicians to use their own clinical judgement and diagnostic tools to identify medical emergencies and to administer the appropriate treatment, including drugs that would normally require a physician order. The authority to practice in this semi-autonomous manner is granted in the form of standing order protocols (off-line medical control) and in some cases direct physician consultation via phone or radio (on-line medical control). Under this paradigm, paramedics effectively assume the role of out-of-hospital field agents to regional emergency physicians, with independent clinical decision-making authority that is typically enjoyed only by expert clinicians within the hospital setting. In certain jurisdictions, such as the United Kingdom and South Africa, paramedics may be entirely autonomous practitioners capable of prescribing medications.
In the media
The 1970s television show Emergency! was a very popular series which centered on the work of paramedics in the Los Angeles County Fire Department, and the staff at the fictional Rampart Emergency Hospital. Emergency! has been widely credited with inspiring many municipalities in the United States to develop their own paramedic programs, and has inspired many to enter the fields of emergency medicine. The show was a top rated program for its entire production run (1972 - 1979), as well as in syndicated television reruns -- even inspiring a Saturday morning cartoon series.
Paramedics is also the name of a show on the Discovery Health Channel, which details the life and work of emergency medical squads in major urban centers in the United States. It is also the name of a 1988 Comedy which highlighted the lighter side of EMS.
Paramedic: On the Front Lines of Medicine (1998), by Peter Canning, is an autobiographical account of a paramedic's first year on the job. Rescue 471: A Paramedic's Stories (2000) is the sequel.
Bringing Out the Dead (1999), directed by Martin Scorsese and starring Nicolas Cage is one of very few films about paramedics. The main character is paramedic Frank Pierce who works in New York's Hell's Kitchen. He's become burned out and haunted by visions of the people he's failed to save including a little girl. The film is based on the novel of the same name by Joe Connelly, a former New York City paramedic.
Into the Breach: A Year of Life and Death with EMS (2002) Book written by J.A. Karam is the true story of paramedics, emergency medical technicians, and heavy-rescue specialists fighting to control trauma and medical emergencies. Into the Breach offers an unusual opportunity to bear witness to unimaginable suffering, heroic stoicism, and the inventiveness of American EMS workers fighting to save lives.
Parts of Third Watch (1999) were devoted to adventures of the fictional 55th precinct FDNY EMS unit, created by ER executive producer John Wells.
Saved (2006), a TNT series centered on fictional paramedic Wyatt Cole (Tom Everett Scott), his partner, and their chaotic lives on and off the job.
See also
- Paramedics in Australia
- Paramedics in Canada
- Paramedics in France
- Paramedics in Germany
- Paramedics in the United States
- Paramedics in the United Kingdom
- National Association of Emergency Medical Technicians
- National Registry of Emergency Medical Technicians
- Flight Paramedic
- Critical Care Emergency Medical Transport Program
References
- ^ Le May, M. R. et al (1-17-2008). "A Citywide Protocol for Primary PCI in ST-Segment Elevation Myocardial Infarction" 358(3):231-40.. New England Journal of Medicine. Retrieved on 2008-03-27.
- ^ Harlan M. Krumholz, MD, SM (January 16, 2008). "Reducing Door-to-Balloon Times: The Transfer Factor". Journal Watch. Retrieved on 2008-03-27.
- ^ http://sunzi1.lib.hku.hk/hkjo/view/22/2200010.pdf
- American Heart Association (Jan. 2006)
- Meisel, Zachary (2005-11-08). "Ding-a-Ling-a-Ling— Ambulances can be dangerous places.". Slate. Washington Post.Newsweek Interactive Co. LLC. Retrieved on 2007-01-25.
- "Tribute to R Adams Cowley, M.D.". University of Maryland Medical Center. Retrieved on 2005-12-30.
- US DOT "National Scope of Practice Model". National Highway Traffic Safety Administration. Retrieved on 2007-04-16.
External links
- National Registry of Emergency Medical Technicians
- National Association of Emergency Medical Technicians
- NHTSA Emergency Medical Services National Page
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