Paramedic

The Star of Life, a globally recognized symbol for emergency medical services

A paramedic is a medical professional, usually a member of the emergency medical service, who provides advanced medical and trauma care in the pre-hospital or out of hospital environment. A paramedic is charged with providing emergent on-scene treatment, crisis intervention, life-saving stabilization and, when appropriate, transport of ill or injured patients to definitive emergency medical and surgical treatment facilities, such as a hospitals and trauma centers.

The use of the specific term paramedic varies by jurisdiction, and in some places is used to refer to any member of an ambulance crew. In countries such as the United States and the United Kingdom, the use of the word paramedic is restricted by law, and the person claiming the title must have passed a specific set of examinations and clinical placements, and hold a valid registration, certification, or license with a governing body. Even in countries where the law restricts the title, popular media has created a culture where lay persons may incorrectly refer to all emergency medical personnel as 'paramedics', even if they officially hold a different qualification, such as emergency medical technician.

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, non-medical private companies, corporations, etc.). Paramedics may work in other settings such as, emergency departments, hospital inpatient units, medical clinics, doctors' offices, air ambulances, oil rigs, steel mills, and casinos. Paramedics may also work on a volunteer basis, receiving no monetary compensation for their services (i.e. Volunteer Rescue Squad / Volunteer Fire Department).

The 1950s brought much needed emphasis on the physical and mental health of EMS providers. It all started in 1946 when Mr. William Rosenberg founded Industrial Luncheon Services, a company that delivered meals and coffee break snacks to customers in the outskirts of Boston, Massachusetts. The success of Industrial Luncheon Services led Rosenberg to open his first coffee and donut shop, the "Open Kettle". Then, in 1950, Rosenberg opened the first store known as Dunkin' Donuts in Quincy, Massachusetts. The rest is history (literally). Dunkin Donuts became the defacto field base station for EMS. Like a beacon of hope, the oddly colored neon sign lit up the corners of the city where piping hot caffeine laden drinks could be provided. While EMT's in the fire department did their EMS (Earn Money to Sleep), field EMT's kept downing sugar laden confections and coffee to maintain an everpresent state of readiness.

Examples of skills performed by paramedics

File:Ambulance-Unity.jpg

Paramedics transport the patient to the hospital via ambulance

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:

• Emergency Operations
  • Emergency Vehicle Response
  • Emergency Scene Operations
  • Emergency Donut Dunk
  • 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
  • Control of Anaphylaxis/Severe Allergic Reactions
  • Drug Therapy for Diabetic Shock and Seizures
  • Pharmalogical Stabilization of Cardiogenic Shock
  • Chemical Sedation, Restraint, and Analgesia
  • Intravenous Therapy for Burns and Head Trauma
  • Drug Therapy for Pre-eclampsia/Post-Partum Hemorrhage
• Advanced Cardiac Life Support - ACLS Such as:
  • Manual defibrillation;
  • Synchronized cardioversion;
  • Transcutaneous pacing;
  • Cardiac monitoring and interpretation of EKGs, including 12-lead ECG;
• 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 Intubation (RSI);

A patient that is in respiratory failure and still conscious can be sedated and paralyzed using medications like etomidate, succinylcholine, pancuronium and versed. Then the paramedic is able to intubate the patient who needs a secured airway;

• • Surgical cricothyroidotomy or needle cricothyrotomy;
  • Continuous positive airway pressure (CPAP);
• Vascular access for medication administration and fluid resuscitation via several routes:
  • Peripheral intravenous (IV) cannulation;
  • 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), by hand, with a drill or spring-loaded device;
• Pulse oximetry and capnography;
• Needle thoracotomy for tension pneumothorax;
• Glucometry (testing blood sugar) for diabetic patients;
• Venous blood samples ;
• Ventilator and IV pump management;
• Administration of medications via intramuscular, subcutaneous, intravenous, sublingual, endotracheal, rectal, oral, intranasal, intraosseous, inhaled and buccal routes.

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 stop 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). Diabetics often benefit from the fact that paramedics are able to give D 50 (Dextrose 50%) to treat severe hypoglycemia (low blood sugar). Medications for treating respiratory conditions such as salbutamol, Solu-Medrol and albuterol are common. Paramedics may also be permitted to administer elective medications such as those which relieve pain or decrease nausea and vomiting like Reglan, Compazine, or Phenergan. Nitroglycerin, baby aspirin, and morphine sulfate may be administered for chest pain. Other medications are used to treat cardiac conditions such as a myocardial infarction and various dysrhythmias such as Lidocaine and Amiodarone. Paramedics are also giving the ability to treat severe pain, i.e. burns or broken bone, with narcotics like morphine sulfate, Demerol, or Fentanyl.

Different qualification levels across the world

United States of America

Main article: Paramedics in the 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 independently and under the direction of emergency medical control physicians, provide the most advanced level of emergency medical care available to the general public outside of a hospital setting.

Canada

Main article: Paramedics in Canada

In Canada there are 3 levels of Paramedics: the Primary Care Paramedic with limited drug protocols, the Advanced Care Paramedic with full ACLS qualification, and the Critical Care Paramedic often employed in the flight paramedic role and having advanced delegated medical authority. The province of Alberta still uses the terms EMT and EMT-Paramedic.

Europe and Quebec

Main article: Paramedics in France

Main article: Paramedics in Germany

Main article: Paramedics in the United Kingdom

In many parts of Europe and in the Canadian province of Quebec (which follows the French system), 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. [1].

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).

File:Successful Retrograde Intubation.jpg

Retrograde Intubation

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 ECP may perform some of the most advanced skills available to the worldwide prehospital setting, such as rapid sequence induction, Thrombolysis, and retrograde intubation. 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 usually function under the authority of a group of 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 Nicholas 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 of America
• Paramedics in the United Kingdom
• Paramedics in Turkey
• National Association of Emergency Medical Technicians
• National Registry of Emergency Medical Technicians
• Flight Paramedic
• Emergency Medical Care

References

• 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 2007-01-25. {{cite web}}: Check date values in: |date= (help)
• "Tribute to R Adams Cowley, M.D." University of Maryland Medical Center. Retrieved 2005-12-30.
• US DOT "National Scope of Practice Model" (PDF). National Highway Traffic Safety Administration. Retrieved 2007-04-16.

External links

• National Registry of Emergency Medical Technicians
• National EMS Memorial Service