Paramedic

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A paramedic is an Emergency medical technician certified to the highest level of training and responds to medical and trauma emergencies in the pre-hospital setting ("in-field") for the purpose of stabilizing a patient's condition before and during transportation to an appropriate medical facility, usually by ambulance. Paramedics also work in the inter-facility transport environment where a paramedic will continue or upgrade medical care to a higher level while transporting a patient from one healthcare facility to another. Paramedics most often will transport patients to an Emergency Department, but "Treat-and-Release" practice can occasionally occur, local protocols permitting. Paramedics work through standard written protocols from which they usually cannot deviate, but they may use their judgement in the best interest of the patient. Paramedics derive the legal ability to provide Basic Life Support, advanced life support and Pediatric Advanced Life Support care through a medical doctor's license, the Doctor acts as a Paramedics Medical Director. Paramedics can work for a city or municipality, a private company, or can be employees of a hospital. Because of the length and intensity of training, most paramedics are not volunteers.

1 Skills Performed by Paramedics
2 In the media
3 See also
4 References
5 External links

[edit] Skills Performed by Paramedics

Some of the many skills preformed (as permitted by local protocol):

Follow American Heart Association Advanced Cardiac Life Support (ACLS) Guidelines
Perform manual defibrillation
Perform synchronized cardioversion
Perform transcutaneous pacing
Perform ECG-Monitoring/Interpretation
Acquire and Interpret 12-lead ECG
Follow American Heart Association Pediatric Advanced Life support (PALS)
Perform needle cricothyrotomy/transtracheal jet insufflation
Perform intraosseous cannulation, a surgical needle placed into bone for emergent vascular access
Follow International Tauma Life Support Protocols (ITLS)
Follow Basic and Advanced Airway tequniques
Perform pulse oximetry
Visualize the airway by use of the laryngoscope and remove foreign bodies with Magill forceps
Perform endotracheal and nasotracheal intubation
Perform pulmonary ventilation by endotracheal intubation (incl. use of eschman catheter)
Perform surgical cricothyroidotomy (Adult)
Perform needle Decompression, or chest tube placement in some services for peumothorax
Perform Rapid Sequence Endotracheal Intubation, otherwise known as RSI
Perform nasogastric intubation and gastric suction
Paramedics Administer a variety of intravenous/intraosseous solutions and medications
Perform drug administration via intramuscular, subcutaneous, intravenous, sublingual, endotracheal, rectal, intraosseous and buccal routes
Use of Glucometry glucometer for diabetic patients
Obtain venous blood samples phlebotomy
Ventilator and IV pump management
Maintain the highest level of command of a situation until a medical command physician arrives on scene.

Paramedics administer a variety of emergency medications, ranging from calcium channel blockers that slow the heart rate to sympathomimetics like dopamine for severe hypotension (low blood pressure). They may also administer elective medications such as those which relieve pain or decrease nausea and vomiting. Nitroglycerine [1] may be administered for chest pain, and other medications used to treat cardiac conditions and arrythmia may also be administered.

Unlike most other health care providers, paramedics typically are not directly supervised by physicians. Rather, paramedics provide care under protocols written by physicians, which guide clinical decisions. In certain cases paramedics in the field may contact thier Medical Director to seek permission to perform certain uncommon procedures, administer certain medications, or discuss the appropriate treatment for a complicated situation. However, the paramedic, based on the patient's physical exam and history, decides which treatment protocol is most appropriate or if additional information/advice is needed from an emergency physician.

In some areas, paramedics are employed in emergency departments and critical care inpatient units. Paramedics may be beneficial to patient care in that setting due to their specialized knowledge and skills related to the management of acute emergencies. Experienced paramedics also can be found as the sole medical provider at remote industrial locations, such as oil rigs and platforms offshore. Their knowledge, skills, and resourcefulness are useful here as well; transport can take hours or days, without communication with a physician.

Paramedics usually work in shifts of eight, twelve, or twenty four hours.

While most paramedics work in an ambulance setting, many municipal fire departments employ combination firefighter paramedics. A fire medic must have the education to be both a firefighter and paramedic. Departments that employ such medics are referred to as ALS Fire Departments, or advanced life support fire departments. This can vary from region to region; however, some departments contract with BLS ambulance services (basic life support) to provide transport for non-life threateing calls. However the BLS ambulances are usually set up in a team of two, One Paramedic (EMT-P) and one EMT-B.

Firefighter/paramedics are in high demand. Most fire departments will hire a paramedic with no fire experience and train them to be a firefighter by sending them to a Public or Private Fire Acadamey as it is cheaper than sending an employee through paramedic school.

Most fire departments have a much larger percentage of medical calls than fire or other calls, thus, paramedics make sense in a customer service oriented modern fire department.

[edit] In the media

Paramedics is also the name of a show on the Discovery Health Channel, which details the life and work of emergency medical squads across the country. It is also the name of a 1988 Comedy which highlighted the lighter side of EMS.

[edit] See also

[edit] References

American Heart Association (Jan. 2006)
Meisel, Zachary (Nov. 8, 2005). "Ding-a-Ling-a-Ling". Slate.
UMMC. (n. d.). Tribute to R. Adams Cowley, MD. Retrieved December 30, 2005 from http://www.umm.edu/shocktrauma/history.html.