A paramedic is a healthcare professional that works in emergency medical situations. Paramedics provide advanced levels of care for medical emergencies and trauma. The majority of paramedics are based in the field inambulances, emergency response vehicles, or in specialist mobile units such as cycle response. Paramedics provide out-of-hospital treatment and some diagnostic services, although some may undertake hospital-based roles, such as in the treatment of minor injuries.
Structure of employment
Firefighter paramedics assist a simulated burn victim during a US Navy mass casualty drill Paramedics are employed by a variety of different organizations, and the services provided by paramedics may occur under differing organizational structures, depending on the part of the world. A new and evolving role for paramedics involves the expansion of their practice into the provision of relatively basic primary health care and assessment services.
Some paramedics have begun to specialize their practice, frequently in association with the environment in which they will work. Some early examples of this involved aviation medicine and the use of helicopters, and the transfer of critical care patients between facilities. While some jurisdictions still use physicians, nurses, and technicians for transporting patients, increasingly this role falls to specialized senior and experienced paramedics. Other areas of specialization include such roles as tactical paramedics working in police units, marine paramedics, hazardous materials (Hazmat) teams, Heavy Urban Search and Rescue, and paramedics on offshore oil platforms, oil and mineral exploration teams, and in the military.
The majority of paramedics are employed by the municipal emergency medical service for their area, although this employer could be itself be working under a number of models, including a specific autonomous public ambulance service, a fire department, a hospital based service or a private company working under contract. There are also legions of paramedics who volunteer for backcountry rescue teams, small town rescue squads, and the like.
The provision of municipal ambulance services, and paramedics, can vary by area, even within the same country or state. For instance, in Canada, the province of British Columbia operates a province-wide service (the British Columbia Ambulance Service) whereas in Ontario, the service is provided by each municipality, either as a disctinct service, linked to the fire brigade, or contracted out to a third party.
While there are varying degrees of training and expectations around the world, a general set of skills shared by essentially all paramedics and EMTs includes:
Paramedics in most jurisdictions administer a variety of emergency medications. The specific medications they are permitted to administer vary widely, based on local standards of care and legal restrictions, and physician or medical director preferences. For an accurate description of permitted drugs or procedures in a given location, it is necessary to contact that jurisdiction directly. A representative list of medications may commonly include:
Skills by certification level
As described above, many jurisdictions have different levels of paramedic training, leading to variations in what procedures different paramedics may perform depending upon their qualifications. Three common general divisions of paramedic training are the basic technician, general paramedic or advanced technician, and advanced paramedic. Common skills that these three certification levels may practice are summarized in the table below. The skills for the higher levels automatically also assume those listed for lower levels.
The medicolegal framework for paramedics is highly dependant on the overall structure of emergency medical services in the territory where they are working.
In places where paramedics are recognized health care professionals registered with an appropriate body, they can conduct all procedures authorised for their profession, including the administration of prescription medication, and are personally answerable to a regulator. For example, in the United Kingdom, the Health Professions Councilregulates paramedics and can censure or strike a paramedic from the register. In some cases paramedics may gain further qualifications to extend their status to that of a paramedic practitioner, which provides the right to prescribe, rather than just administer, medication.
In other places paramedics operate as a direct extension of a physician medical director, and practice as an extension of the medical director’s license to practice medicine. 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 some locations paramedics are only permitted to practice many advanced skills while assisting a physician who is physically present, except for immediately life-threatening emergencies.