Paramedic facts for kids

Paramedics of the Australian Capital Territory Ambulance Service during training
Quick facts for kids Occupation
Names	Paramedic
Profession
Activity sectors	Health care
Description
Fields of employment	Ambulance; Hospital; Pre-Hospital; Transport
Related jobs	Emergency medical technician

A paramedic is a healthcare professional trained in the medical model, whose main role has historically been to respond to emergency calls for medical help outside of a hospital. Paramedics work as part of the emergency medical services (EMS), most often in ambulances. They also have roles in emergency medicine, primary care, transfer medicine and remote/offshore medicine. The scope of practice of a paramedic varies between countries, but generally includes autonomous decision making around the emergency care of patients.

Not all ambulance personnel are paramedics, although the term is sometimes used informally to refer to any ambulance personnel. In some English-speaking countries, there is an official distinction between paramedics and emergency medical technicians (or emergency care assistants), in which paramedics have additional educational requirements and scope of practice.

Duties and functions

The paramedic role is closely related to other healthcare positions, especially the emergency medical technician, with paramedics often being at a higher grade with more responsibility and autonomy following substantially greater education and training. The primary role of a paramedic is to stabilize people with life-threatening injuries and transport these patients to a higher level of care (typically an emergency department). Due to the nature of their job, paramedics work in many environments, including roadways, people's homes, and depending on their qualifications, wilderness environments, hospitals, aircraft, and with SWAT teams during police operations. Paramedics also work in non-emergency situations, such as transporting chronically ill patients to and from treatment centers and in some areas, address social determinants of health and provide in-home care to ill patients at risk of hospitalization (a practice known as community paramedicine).

The role of a paramedic varies widely across the world, as EMS providers operate with many different models of care. In the Anglo-American model, paramedics are autonomous decision-makers. In some countries such as the United Kingdom and South Africa, the paramedic role has developed into an autonomous health profession. In the Franco-German model, ambulance care is led by physicians. In some versions of this model, such as France, there is no direct equivalent to a paramedic. Ambulance staff have either the more advanced qualifications of a physician or less advanced training in first aid. In other versions of the Franco-German model, such as Germany, paramedics do exist. Their role is to support a physician in the field, in a role more akin to a hospital nurse, rather than operating with clinical autonomy.

The development of the profession has been a gradual move from simply transporting patients to hospital, to more advanced treatments in the field. In some countries, the paramedic may take on the role as part of a system to prevent hospitalisation entirely and, through practitioners, are able to prescribe certain medications, or undertaking 'see and refer' visits, where the paramedic directly refers a patient to specialist services without taking them to hospital.

Occupational hazards

Paramedics are exposed to a variety of hazards such as lifting patients and equipment, treating those with infectious disease, handling hazardous substances, and transportation via ground or air vehicles. Employers can prevent occupational illness or injury by providing safe patient handling equipment, implementing a training program to educate paramedics on job hazards, and supplying PPE such as respirators, gloves, and isolation gowns when dealing with biological hazards.

Infectious disease has become a major concern, in light of the COVID-19 pandemic. In response, the U.S. Centers for Disease Control and Prevention and other agencies and organizations have issued guidance regarding workplace hazard controls for COVID-19. Some specific recommendations include modified call queries, symptom screening, universal PPE use, hand hygiene, physical distancing, and stringent disinfection protocols. Research on ambulance ventilation systems found that aerosols often recirculate throughout the compartment, creating a health hazard for paramedics when transporting sick patients capable of airborne transmission. Unidirectional airflow design can better protect workers.

Scope of practice

Common skills

While there are varying degrees of training and expectations around the world, a set of skills practiced by paramedics in the pre-hospital setting commonly includes:

• Advanced cardiac life support, or ACLS, including cardiopulmonary resuscitation, defibrillation, cardioversion, transcutaneous pacing, and administration of cardiac drugs
• Patient assessment, including acquisition of vital signs, physical exam, chest auscultation, history taking, electrocardiogram acquisition and interpretation, capnography, pulse oximetry, point-of-care ultrasound and basic blood chemistry interpretation (glucose, lactate)
• Airway management techniques including tracheal intubation, cricothyrotomy, rapid sequence induction, supraglottic airway insertion, manual repositioning, sterile suctioning, use of oropharyngeal and nasopharyngeal airway adjuncts, and manual removal of obstructions via direct laryngoscopy and use of magill forceps
• Thorocostomy and pericardiocentesis to relieve pneumothorax and pericardial tamponade
• Intravenous (IV) and intraosseous (IO) cannulation
• Oxygen administration and positive pressure ventilation via bag-valve-mask, CPAP device, or ventilator
• Fluid resuscitation
• Administration of emergency drugs/medications (see section below)
• Bleeding control and management of shock
• Spinal injury management, including immobilization and safe transport
• Fracture management, including assessment, splinting, and dislocation reduction
• Obstetrics, including assessment, childbirth, and recognition of and procedures for obstetrical emergencies such as breech presentation, cord presentation, and placental abruption
• Management of burns, including classification, estimate of surface area, recognition of more serious burns, and treatment
• Triage of patients in a mass casualty incident
• Surgical procedures such as field amputation, escharotomy, or thorocotomy (if trained and credentialed)

Emergency Pharmacology

Paramedics carry and administer a wide array of emergency medications. The specific medications they are permitted to administer vary widely, based on local standards of care and protocols. For an accurate description of permitted drugs or procedures in a given location, it is necessary to contact that jurisdiction directly.

Medicolegal authority

The medicolegal framework for paramedics is highly dependent on the overall structure of emergency medical services in the territory where they are working.

Paramedics load an injured woman into an air ambulance after a head-on collision in the Kawartha Lakes region of Ontario, Canada.

In many localities, paramedics operate as a direct extension of a physician medical director and practice as an extension of the medical director's license. In the United States, a physician delegates authority under an individual state's Medical Practice Act. This gives a paramedic the ability to practice within limited scope of practice in law, along with state DOH guidelines and medical control oversight. The authority to practice in this manner is granted in the form of standing orders (protocols) (off-line medical control) and 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.

In places where paramedics are recognised 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 and Care Professions Council regulates 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 or advanced paramedic, which may allow them to administer a wider range of drugs and use a wider range of clinical skills.

In some areas, paramedics are only permitted to practice many advanced skills while assisting a physician who is physically present, except for immediately life-threatening emergencies.

In entertainment

• Emergency! was a popular 1970s television 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 acted as an inspiration for many individuals to enter the fields of emergency medicine. The show rated well for its entire production run (1972–77), as well as in syndicated reruns, and inspired a related cartoon series.
• Mother, Jugs & Speed is a 1976 comedy film, starring Bill Cosby, Raquel Welch, and Harvey Keitel. The film depicts a private ambulance company struggling to survive in Los Angeles, and gives an indication of the state of the ambulance industry just prior to its increased professionalism.
• Trauma Center is a 1983 American television medical drama focussing on the McKee Hospital Trauma Center, and two paramedics who had to rescue or save injured people before delivering them to the trauma center.
• Casualty is a long-running British BBC television series (1986–present), depicting the fictional Holby City Hospital's Accident and Emergency Department, and the related paramedics. Casualty has inspired the spin-off series, Holby City, and a number of made-for-television films.
• Paramedics is a 1988 American comedy film focusing on a group of paramedics in a US city.
• Paramedic: On the Front Lines of Medicine, is a 1988 autobiographical account of a paramedic's first year on the job by Peter Canning. A sequel, Rescue 471: A Paramedic's Stories was released in 2000.
• Bringing Out the Dead is a 1999 American drama film, directed by Martin Scorsese and starring Nicolas Cage, showing forty-eight hours in the life of a burnt-out hospital paramedic in New York's Hell's Kitchen. The film is based on the novel of the same name by Joe Connelly, a former New York City paramedic.
• Paramedics is an American reality television show that originally screened from 1999 to 2001, and now runs intermittently on the Discovery Health Channel. The show features the life and work of emergency medical squads in major urban centers in the United States.
• Third Watch (1999–2005) is an American television drama, parts of which focused on the firefighters and paramedics of the New York City Fire Department.
• Shinjuku Punk Rescue Ambulance is a 2000 Japanese comedy drama TV series which aired on Nippon Television in Japan. The story is about two young Tokyo Fire Department ambulance technicians at Shinjuku West District and working with medical staff of Juniso Hospital. The show is also demonstrating how to deal with various emergency scenarios with first aid techniques at the ending of each episode.
• Into the Breach: A Year of Life and Death with EMS is a 2002 book written by J. A. Karam, focussing on real-life stories of paramedics, emergency medical technicians, and heavy-rescue specialists fighting to control trauma and medical emergencies.
• Saved is a 2006 medical television drama centered on a fictional paramedic, his partner, and their chaotic lives on and off the job.
• Black Flies is a 2008 American novel written by Shannon Burke, based on his experiences working as a paramedic in Harlem, New York.
• In NBC's sci fi drama Heroes (2006, 2010), the character Peter Petrelli uses his abilities to save 53 people while working as a paramedic.
• Code Blue: Doctor-Heli (2008, 2010) is a Japanese television medical drama which aired on Fuji TV Network. It is centered on the lives and work of flight physician trainees with the air ambulance program of the fictional Shoyo University Hokubu Hospital Emergency Center.
• Trauma is a 2009–10 American television drama series focusing on a group of San Francisco Fire Department paramedics working in conjunction with the fictional trauma center of San Francisco City Hospital.
• Recruits: Paramedics is an Australian television series airing on Network Ten, depicting the work of trainee paramedics recently employed with the Ambulance Service of New South Wales.
• Denise Sherwood on Army Wives was a paramedic, having been a nurse beforehand and a 911 dispatcher later.
• F.S.D. is a 2011 Hong Kong action-drama TV series which was co-produced by RTHK and the Hong Kong Fire Service Department. It is focused on the work and lives of ambulancemen and firemen in the Hong Kong Fire Service Department. The second episode, "Caring with Love", and fifth episode, "Call for Duty", are centered on the ambulancemen and paramedics particularly.
• Sofia's Last Ambulance (2012) is a feature-length documentary by Ilian Metev about a dedicated ambulance crew in Sofia, Bulgaria. The film premiered at Cannes in 2012.
• Elite Brigade is a 2012 Hong Kong action-drama TV series co-produced by RTHK and the Hong Kong Fire Service Department after the previous series F.S.D. succeeded in 2011. The story carries on to tell the work of ambulancemen and firemen in the Hong Kong Fire Service Department. The third episode, "First Responders", is centered on the ambulancemen and paramedics who face a double-decker bus crash during rush hour, with mass victims on scene.
• Trauma Team, a surgery video game for the Nintendo Wii, features a playable paramedic named Maria Torres whose playstyle centers around managing and stabilizing multiple accident victims at once.
• In the game Metal Gear Solid 3, Dr. Clark, nicknamed Para-Medic, dreams of creating a unit of medics able to parachute down to an emergency location.
• Junior Paramedics is a British television series that was first broadcast on BBC Three on 27 February 2014. The series follows paramedics on a six-week placement with East Midlands Ambulance Service.
• Boston EMS is a medical documentary series which premiered on ABC on July 25, 2015. It follows one of America's most seasoned teams of first responders in Boston, Massachusetts.
• Nightwatch is a 2015 American reality television show that airs on the A&E channel that focuses on the EMTs and paramedics of the New Orleans Emergency Medical Services, as well as the firefighters of the New Orleans Fire Department, and the police officers on the New Orleans Police Department.
• Ambulance, a BBC documentary which first aired in 2016, originally followed paramedics in the London Ambulance Service, and since 2017 has followed paramedics in the West Midlands Ambulance Service.
• Synchronic is a 2019 science-fiction horror film directed by Justin Benson and Aaron Moorhead that follows two New Orleans paramedics whose lives are ripped apart after a series of horrific deaths are caused by a new designer drug.

See also

In Spanish: Paramédico para niños