Paramedic - AbsoluteAstronomy.com

A paramedic is a healthcare professional that works in emergency medical

Emergency medicine

Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...

situations. Paramedics provide advanced levels of care for medical emergencies

Medical emergency

A medical emergency is an injury or illness that is acute and poses an immediate risk to a person's life or long term health. These emergencies may require assistance from another person, who should ideally be suitably qualified to do so, although some of these emergencies can be dealt with by the...

and trauma

Physical trauma

Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

. The majority of paramedics are based in the field in ambulance

Ambulance

An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...

s, emergency response vehicles, or in specialist mobile units such as cycle response

Cycle responder

A cycle responder is a medically trained responder, such as a paramedic or first aider that uses a bicycle to respond to a medical emergency. They are used by professional ambulance services to respond to emergency calls and also by private and voluntary providers of medical cover at events.Cycle...

. 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.

Early history

Throughout the evolution of paramedic care, there has been an ongoing association with military conflict. One of the first indications of a formal process for managing injured people dates from the Imperial Legions of Rome

Roman legion

A Roman legion normally indicates the basic ancient Roman army unit recruited specifically from Roman citizens. The organization of legions varied greatly over time but they were typically composed of perhaps 5,000 soldiers, divided into maniples and later into "cohorts"...

, where aging Centurion

Centurion

A centurion was a professional officer of the Roman army .Centurion may also refer to:-Military:* Centurion tank, British battle tank* HMS Centurion, name of several ships and a shore base of the British Royal Navy...

s, no longer able to fight, were given the task of organizing the removal of the wounded from the battlefield

Battlefield

A battlefield refers to the location of a battle.Battlefield may also refer to:-In music:*"Battlefield", a song by Diana Ross from her 1991 album The Force Behind the Power* Battlefield Band, a Scottish traditional music group...

and providing some form of care. Such individuals, although not physician

Physician

A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

s, were probably among the world's earliest surgeon

Surgeon

In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...

s by default, being required to suture wounds and complete amputation

Amputation

Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...

s. A similar situation existed in the Crusades

Crusades

The Crusades were a series of religious wars, blessed by the Pope and the Catholic Church with the main goal of restoring Christian access to the holy places in and near Jerusalem...

, with the Knights Hospitallers of the Order of St. John of Jerusalem filling a similar function; this organisation continued, and evolved into what is now known throughout the Commonwealth of Nations

Commonwealth of Nations

The Commonwealth of Nations, normally referred to as the Commonwealth and formerly known as the British Commonwealth, is an intergovernmental organisation of fifty-four independent member states...

as the St. John Ambulance

St. John Ambulance

St John Ambulance, branded as St John in some territories, is a common name used by a number of affiliated organisations in different countries dedicated to the teaching and practice of medical first aid and the provision of ambulance services, all of which derive their origins from the St John...

Early ambulance services

While civilian communities had organized ways to deal with the care and transportation of the sick and dying as far back as the bubonic plague

Bubonic plague

Plague is a deadly infectious disease that is caused by the enterobacteria Yersinia pestis, named after the French-Swiss bacteriologist Alexandre Yersin. Primarily carried by rodents and spread to humans via fleas, the disease is notorious throughout history, due to the unrivaled scale of death...

in London

London

London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...

between 1598 and 1665, such arrangements were typically temporary. In time, however, these arrangements began to formalize and become permanent. During the American Civil War

American Civil War

The American Civil War was a civil war fought in the United States of America. In response to the election of Abraham Lincoln as President of the United States, 11 southern slave states declared their secession from the United States and formed the Confederate States of America ; the other 25...

, Jonathan Letterman

Jonathan Letterman

Jonathan Letterman was an American surgeon credited as being the originator of the modern methods for medical organization in armies. Dr...

devised a system of mobile field hospital

Field hospital

A field hospital is a large mobile medical unit that temporarily takes care of casualties on-site before they can be safely transported to more permanent hospital facilities...

s employing the first uses of the principles of triage

Triage

Triage or ) is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate,...

. After returning home, some veterans began to attempt to apply what had they had seen on the battlefield to their own communities, and commenced the creation of volunteer life-saving squads and ambulance corps.
These early developments in formalised ambulance services were decided at local levels, and this led to services being provided by diverse operators such as the local hospital, police, fire brigade, or even funeral director

Funeral director

A funeral director , also known as a mortician or undertaker, is a professional involved in the business of funeral rites. These tasks often entail the embalming and burial or cremation of the dead, as well as the planning and arrangement of the actual funeral ceremony...

s who often possessed the only local transport allowing a passenger to lie down. In most cases these ambulances were operated by drivers and attendants with little or no medical training, and it was some time before formal training began to appear in some units. An early example was the members of the Toronto Police Ambulance Service

Toronto EMS

Toronto Emergency Medical Services is the statutory Emergency medical services provider for the city of Toronto, Ontario, Canada. The service is operated directly as a branch of the municipal government as an independent, third-service option provider, which means that the service is funded by...

receiving a mandatory five days of training from St. John as early as 1889.

Prior to World War I

World War I

World War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...

motorized ambulances started to be developed, but once they proved their effectiveness on the battlefield during the war the concept spread rapidly to civilian systems. In terms of advanced skills, once again the military led the way. During World War II

World War II

World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...

and the Korean War

Korean War

The Korean War was a conventional war between South Korea, supported by the United Nations, and North Korea, supported by the People's Republic of China , with military material aid from the Soviet Union...

battlefield medics administered painkilling narcotic

Narcotic

The term narcotic originally referred medically to any psychoactive compound with any sleep-inducing properties. In the United States of America it has since become associated with opioids, commonly morphine and heroin and their derivatives, such as hydrocodone. The term is, today, imprecisely...

s by injection in emergency situations, and pharmacists' mates on warships were permitted to do even more without the guidance of a physician. The Korean War also marked the first widespread use of helicopter

Helicopter

A helicopter is a type of rotorcraft in which lift and thrust are supplied by one or more engine-driven rotors. This allows the helicopter to take off and land vertically, to hover, and to fly forwards, backwards, and laterally...

s to evacuate the wounded from forward positions to medical units, leading to the rise of the term "medivac

Medivac

Medivac may refer to:* medical evacuation* Medivac , an Australian television series...

". These innovations would not find their way into the civilian sphere for nearly twenty more years.

Pre-hospital emergency care

By the early 1960s experiments in improving care had begun in some civilian centres. One early experiment involved the provision of pre-hospital cardiac care by physicians in Belfast

Belfast

Belfast is the capital of and largest city in Northern Ireland. By population, it is the 14th biggest city in the United Kingdom and second biggest on the island of Ireland . It is the seat of the devolved government and legislative Northern Ireland Assembly...

, Northern Ireland, in 1966. This was repeated in Toronto

Toronto

Toronto is the provincial capital of Ontario and the largest city in Canada. It is located in Southern Ontario on the northwestern shore of Lake Ontario. A relatively modern city, Toronto's history dates back to the late-18th century, when its land was first purchased by the British monarchy from...

, Canada in 1968 using a single ambulance called Cardiac One, which was staffed by a regular ambulance crew, along with a hospital intern

Intern

Internship is a system of onthejob training for white-collar jobs, similar to an apprenticeship. Interns are usually college or university students, but they can also be high school students or post graduate adults seeking skills for a new career. They may also be as young as middle school or in...

to perform the advanced procedures. While both of these experiments had certain levels of success, the technology had not yet reached a sufficiently advanced level to be fully effective; for example, the Toronto portable defibrillator and heart monitor was powered by lead-acid car batteries, and weighed around 45 kilogram.

In 1966 a report called Accidental Death and Disability: The Neglected Disease of Modern Society—commonly known as The White Paper

The White Paper

Accidental Death and Disability: The Neglected Disease of Modern Society, more commonly known as The White Paper, was an influential report published in 1966 by the National Academy of Sciences that is considered a landmark in the development of the emergency medical services system in the United...

—was published in the United States. This paper presented data showing that soldiers who were seriously wounded on the battlefields during the Vietnam War

Vietnam War

The Vietnam War was a Cold War-era military conflict that occurred in Vietnam, Laos, and Cambodia from 1 November 1955 to the fall of Saigon on 30 April 1975. This war followed the First Indochina War and was fought between North Vietnam, supported by its communist allies, and the government of...

had a better survival rate than individuals who were seriously injured in motor vehicle accidents on California

California

California is a state located on the West Coast of the United States. It is by far the most populous U.S. state, and the third-largest by land area...

's freeways. Key factors allowing the victim to survive the journey to definitive care such as a hospital were stated to be comprehensive trauma care, rapid transport to designated trauma facilities, and the presence of medical corpsman who were trained to perform certain critical advanced medical procedures such as fluid replacement

Fluid replacement

Fluid replacement or fluid resuscitation is the medical practice of replenishing bodily fluid lost through sweating, bleeding, fluid shifts or other pathologic processes. Fluids can be replaced via oral administration , intravenous administration, rectally, or hypodermoclysis, the direct injection...

and airway management

Airway management

In cardiopulmonary resuscitation, anaesthesia, emergency medicine, intensive care medicine and first aid, airway management is the process of ensuring that:# there is an open pathway between a patient’s lungs and the outside world, and...

.

As a result of the The White Paper the Federal government moved to develop minimum standards for ambulance attendant training, ambulance equipment and vehicle design. These new standards were incorporated into Federal Highway Safety legislation and the state were advised to either adopt these standards into state laws or risk a reduction in Federal highway safety fundings. The "White Paper" also prompted the inception of of a number of emergency medical service (EMS)pilot units across the US including paramedic programs. The success of these units led to a rapid transition to make them fully operational, with the first paramedic program being in Miami, Florida.

New York City's Saint Vincent's Hospital developed America's first Mobile Coronary Care Unit (MCCU) under the medical direction of William Grace, MD and was based on Dr. Frank Pantridge's Belfast, Northern Ireland MCCU project. In 1967 Eugene Nagle, MD and Jim Hirschmann, MD helped pioneer America's first EKG telemetry transmission to a hospital and then in 1968, a functional paramedic program in conjunction with the City of Miami Fire Department. In 1969. the City of Columbus Fire Services joined together with the Ohio State University Medical Center and developed the "HEARTMOBILE" paramedic program under the medical direction of James Warren, MD and Richard Lewis, MD. In 1969. the Haywood County (NC) Volunteer Rescue Squad developed a paramedic program under the medical direction of Ralph Fleicher, MD. In 1969, the initial Los Angeles paramedic training program was instituted in conjunction with Harbor General Hospital under the medical direction of Michael Criley, MD and James Lewis, MD. In 1969, the Seattle "Medic 1" paramedic program was developed in conjunction with the Harborview Medical Center under the medical direction of Leonard, Cobb. The Marietta (GA) initial paramedic project was instituted in the Fall of 1970 in conjunction with Kennestone Hospital and Metro Ambulance Service, Inc. under the medical direction of Luther Fortson, MD. The Los Angeles county and city established paramedic programs following the passage of The Wedworth-Townsend Act in 1970. This was followed by other cities and states passing their own paramedic bills, leading to the formation of services across the US. Many other countries also followed suit, with paramedic units quickly being formed around the world.
In the military, however, the required telemetry

Telemetry

Telemetry is a technology that allows measurements to be made at a distance, usually via radio wave transmission and reception of the information. The word is derived from Greek roots: tele = remote, and metron = measure...

and miniaturization

Miniaturization

Miniaturization is the creation of ever-smaller scales for mechanical, optical, and electronic products and devices...

technologies were more advanced, particularly due to initiatives such as the space program, but it would take several more years before these technologies drifted through to civilian applications. In North America, physicians were judged to be too expensive to be used in the pre-hospital setting, although such initiatives were implemented, and sometimes still operate, in Europe

Europe

Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...

an countries and Latin America

Latin America

Latin America is a region of the Americas where Romance languages – particularly Spanish and Portuguese, and variably French – are primarily spoken. Latin America has an area of approximately 21,069,500 km² , almost 3.9% of the Earth's surface or 14.1% of its land surface area...

Public notability

While doing background research at Los Angeles' UCLA Harbor Medical Center for a proposed new show about doctors, television producer

Television producer

The primary role of a television Producer is to allow all aspects of video production, ranging from show idea development and cast hiring to shoot supervision and fact-checking...

Robert A. Cinader

Robert A. Cinader was an American television producer best known for his work on two NBC series packaged by actor/producer Jack Webb's Mark VII Limited, Adam-12 and Emergency!...

, working for Jack Webb

Jack Webb

John Randolph "Jack" Webb , also known by the pseudonym John Randolph, was an American actor, television producer, director and screenwriter, who is most famous for his role as Sergeant Joe Friday in the radio and television series Dragnet...

, happened to encounter "firemen who spoke like doctors and worked with them". This concept developed into the television series Emergency!

Emergency!

Emergency! is an American television series that combines the medical drama and action-adventure genres. It was produced by Mark VII Limited and distributed by Universal Studios...

, which ran from 1972 to 1979, portraying the exploits of this new profession called paramedics. The show gained popularity with emergency services personnel, the medical community, and the general public. When the show first aired in 1972, there were just six paramedic units operating in three pilot programs in the whole of the US, and the term paramedic was essentially unknown. By the time the program ended in 1979, there were paramedics operating in all fifty states. The show's technical advisor

Technical advisor

A technical advisor is an individual who is expert in a particular field of knowledge, hired to provide detailed information and advice to people working in that field...

, James O. Page

James O. Page

James O. Page, JD , was recognized as a leading authority on United States emergency medical services . Page served in the Los Angeles County Fire Department for 16 years rising to the rank of Battalion Chief. In 1973 he was appointed as the first director of North Carolina's statewide EMS system...

, was a pioneer of paramedicine and responsible for the UCLA paramedic program; he would go on to help establish paramedic programs throughout the US, and was the founding publisher of the Journal of Emergency Medical Services (JEMS). The JEMS magazine creation resulted from Page's previous purchase of the "PARAMEDICS International" magazine.

Evolution and growth

Throughout the 1970s and 80s, the paramedic field continued to evolve, with a shift in emphasis from patient transport to treatment both on scene and en-route to hospitals. This led to some services changing their descriptions from "ambulance services" to "emergency medical services

Emergency medical services

Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...

The training, knowledge-base, and skill sets of both paramedics and emergency medical technicians (EMTs) were typically determined by local medical directors, what it was felt the community needed, and what was affordable. There were also large differences between localities in the amount and type of training required, and how it would be provided. This ranged from in-service training in local systems, through community colleges, and up to university level education. This emphasis on increasing qualifications has followed the progression of other health professions such as nursing, which also progressed from on the job training to university level qualifications.

The variations in educational approaches and standards required for paramedics has led to large differences in the required qualifications between locations—both within individual countries and from country to country. This has led to many countries passing laws to protect the title of "paramedic" (or its local equivalent) from use by anyone except those qualified and experienced to a defined standard. This usually means that paramedics must be registered with the appropriate body in their country, for example all paramedics in the United Kingdom must by registered with the Health Professions Council

Health Professions Council

The Health Professions Council is a statutory regulator of 210,000 health professionals from 15 professions in the United Kingdom. It was set up in 2003 under the National Health Service Reform and Health Care Professions Act 2002, to replace the Council for Professions Supplementary to Medicine ....

in order to call themselves a paramedic. In the United States, a similar system is operated by the National Registry of Emergency Medical Technicians (NREMT)

National Registry of Emergency Medical Technicians

The National Registry of Emergency Medical Technicians is a US certification agency covering prehospital medical providers.- History :NREMT was established in 1970 in response to President Lyndon Johnson's Committee on Highway Traffic Safety recommended a national certifying agency for Emergency...

, although this is only accepted by forty of the fifty states.

As paramedicine has evolved a great deal of both the curriculum

Curriculum

See also Syllabus.In formal education, a curriculum is the set of courses, and their content, offered at a school or university. As an idea, curriculum stems from the Latin word for race course, referring to the course of deeds and experiences through which children grow to become mature adults...

and skill set has existed in a state of flux. Requirements often originated and evolved at the local level, and were based upon the preferences of physician advisers and medical directors. Recommended treatments would change regularly, often changing more like a fashion

Fashion

Fashion, a general term for a currently popular style or practice, especially in clothing, foot wear, or accessories. Fashion references to anything that is the current trend in look and dress up of a person...

than a scientific discipline. Associated technologies also rapidly evolved and changed, with medical equipment manufacturers having to adapt equipment that worked adequately the hospital environment to be able to cope with the less controlled pre-hospital environment.

Physicians began to take more interest in paramedics from a research perspective as well. By about 1990, the fluctuating trends began to diminish, being replaced by outcomes-based research. This research then drove further evolution of the practice of both paramedics and the emergency physicians who oversaw their work, with changes to procedures and protocols

Guideline (medical)

A medical guideline is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of healthcare...

occurring only after significant research demonstrated their need and effectiveness. Such changes affected everything from simple procedures, such as CPR, to changes in drug protocols. As the profession grew, some paramedics went on to become not just research participants, but researchers in their own right, with their own projects and journal publications.

Changes in procedures also included the manner in which the work of paramedics was overseen and managed. In the early days medical control and oversight was direct and immediate, with paramedics calling into a local hospital and receiving orders for every individual procedure or drug. While this still occurs in some jurisdictions, it has become increasingly rare, with physicians building an increasing confidence and trust in the work of paramedics. Day-to-day operations largely moved from direct and immediate medical control to pre-written protocols or standing orders, with the paramedic typically seeking advice after the options in the standing orders had been exhausted.

Canada

While the evolution of paramedicine described above is focussed largely on the US, many other countries followed a similar pattern, although often with significant variations. Canada, for example, attempted a pilot paramedic training program at Queen's University

Queen's University

Queen's University, , is a public research university located in Kingston, Ontario, Canada. Founded on 16 October 1841, the university pre-dates the founding of Canada by 26 years. Queen's holds more more than of land throughout Ontario as well as Herstmonceux Castle in East Sussex, England...

, Kingston, Ontario

Kingston, Ontario

Kingston, Ontario is a Canadian city located in Eastern Ontario where the St. Lawrence River flows out of Lake Ontario. Originally a First Nations settlement called "Katarowki," , growing European exploration in the 17th Century made it an important trading post...

, in 1972. The program, which intended to upgrade the then mandatory 160 hours of training for ambulance attendants, was found to be too costly and premature. The program was abandoned after two years, and it was more than a decade before the legislative authority for its graduates to practice was put into place. An alternative program which provided 1,400 hours of training at the community college

Community college

A community college is a type of educational institution. The term can have different meanings in different countries.-Australia:Community colleges carry on the tradition of adult education, which was established in Australia around mid 19th century when evening classes were held to help adults...

level prior to commencing employment was then tried, and made mandatory in 1977, with formal certification examinations being introduced in 1978. Similar programs occurred at roughly the same time in Alberta

Alberta

Alberta is a province of Canada. It had an estimated population of 3.7 million in 2010 making it the most populous of Canada's three prairie provinces...

and British Columbia

British Columbia

British Columbia is the westernmost of Canada's provinces and is known for its natural beauty, as reflected in its Latin motto, Splendor sine occasu . Its name was chosen by Queen Victoria in 1858...

, with other Canadian provinces gradually following, but with their own education and certification requirements. Advanced Care Paramedics were not introduced until 1984, when Toronto

Toronto

trained its first group internally, before the process spread across the country. By 2010 the Ontario system involved a two year community college based program, including both hospital and field clinical components, prior to designation as a Primary Care Paramedic, although it is starting to head towards a university degree-based program. Some services, such as Toronto EMS

Toronto EMS

, continue to train advnaced care paramedics internally.

United Kingdom

In the United Kingdom, ambulances became largely municipal services shortly after the end of World War II. Training was frequently conducted internally, although national levels of coordination led to more standardization of staff training. As of 2010 public ambulance services were operated by regional entities, most often trusts, under the authority of the National Health Service

National Health Service

The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...

, with significant standardization of training and skills. The UK model utilizes two levels of ambulance staff, internally trained Ambulance Technicians, which are similar to EMTs in the US, and paramedics with advanced life support skills. Initially paramedics were mainly trained internally, with experienced ambulance technicians often progressing to the role of paramedic. Increasingly, however, university qualifications are being expected for paramedics, with the entry level being an Honours Bachelor of Science

Bachelor of Science

A Bachelor of Science is an undergraduate academic degree awarded for completed courses that generally last three to five years .-Australia:In Australia, the BSc is a 3 year degree, offered from 1st year on...

degree in Pre-Hospital or Paramedic Care. Some British paramedics have gone on to become Paramedic Practitioners, a role that practices independently in the pre-hospital environment in a capacity similar to that of a nurse practitioner

Nurse practitioner

A Nurse Practitioner is an Advanced practice registered nurse who has completed graduate-level education . Additional APRN roles include the Certified Registered Nurse Anesthetist s, CNMs, and CNSs...

, but with more of an acute care orientation.

Current practice

Paramedicine continues to grow and evolve into a formal profession in its own right, complete with its own standards and body of knowledge, and in many locations paramedics have formed their own professional bodies. The early technicians with limited training, performing a small and specific set of procedures, has become a profession requiring a university qualification in countries such as Australia, South Africa, and the UK, and increasingly so in the US and Canada. In some locations paramedics are evolving into a second tier medical practitioner and being granted the legal status of self-regulated health professionals. This requires them to meet set standards of education and proficiency, deals with complaints regarding individual practitioners, and will usually involve government regulation.

Structure of employment

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

Aviation medicine

Aviation medicine, also called flight medicine or aerospace medicine, is a preventive or occupational medicine in which the patients/subjects are pilots, aircrews, or persons involved in spaceflight...

and the use of helicopter

Helicopter

s, 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

Dangerous goods

Dangerous goods are solids, liquids, or gases that can harm people, other living organisms, property, or the environment. They are often subject to chemical regulations. "HazMat teams" are personnel specially trained to handle dangerous goods...

) teams, Heavy Urban Search and Rescue, and paramedics on offshore oil platforms

Oil platform

An oil platform, also referred to as an offshore platform or, somewhat incorrectly, oil rig, is a lаrge structure with facilities to drill wells, to extract and process oil and natural gas, and to temporarily store product until it can be brought to shore for refining and marketing...

, oil and mineral exploration teams, and in the military

Military

A military is an organization authorized by its greater society to use lethal force, usually including use of weapons, in defending its country by combating actual or perceived threats. The military may have additional functions of use to its greater society, such as advancing a political agenda e.g...

.

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

British Columbia Ambulance Service

The British Columbia Ambulance Service is the sole ambulance service and provider of pre-hospital emergency care in the province of British Columbia, Canada. It operates under the Emergency and Health Services Commission and the Provincial Health Services Authority, and is tasked with the...

) 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.

Common skills

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:

Spinal injury management, including immobilization and safe transport
Fracture
Fracture
A fracture is the separation of an object or material into two, or more, pieces under the action of stress.The word fracture is often applied to bones of living creatures , or to crystals or crystalline materials, such as gemstones or metal...

management, including assessment, splinting, and use of traction splints where appropriate
Obstetrics
Obstetrics
Obstetrics is the medical specialty dealing with the care of all women's reproductive tracts and their children during pregnancy , childbirth and the postnatal period...

, including assessment, assisting with uncomplicated childbirth, and recognition of and procedures for obstetrical emergencies such as breech presentation, cord presentation, and placental abruption
Placental abruption
Placental abruption is a complication of pregnancy, wherein the placental lining has separated from the uterus of the mother. It is the most common pathological cause of late pregnancy bleeding. In humans, it refers to the abnormal separation after 20 weeks of gestation and prior to birth...
Management of burn
Burn
A burn is an injury to flesh caused by heat, electricity, chemicals, light, radiation, or friction.Burn may also refer to:*Combustion*Burn , type of watercourses so named in Scotland and north-eastern England...

s, including classification, estimate of surface area, recognition of more serious burns, and treatment
Triage
Triage
Triage or ) is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate,...

of patients in a mass casualty incident
Assessment and evaluation of general incident scene safety
Effective verbal and written reporting skills (charting)
Routine medical equipment maintenance procedures
Routine radio operating procedures
Emergency vehicle operation

Medications administered

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:

Analgesic
Analgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....

medications such as aspirin
Aspirin
Aspirin , also known as acetylsalicylic acid , is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. It was discovered by Arthur Eichengrun, a chemist with the German company Bayer...

, ketorolac
Ketorolac
Ketorolac or ketorolac tromethamine is a non-steroidal anti-inflammatory drug in the family of heterocyclic acetic acid derivative, often used as an analgesic...

, paracetamol
Paracetamol
Paracetamol INN , or acetaminophen USAN , is a widely used over-the-counter analgesic and antipyretic . It is commonly used for the relief of headaches and other minor aches and pains and is a major ingredient in numerous cold and flu remedies...

and Tylenol
Tylenol
Tylenol is a North American brand of drugs advertised for reducing pain, reducing fever, and relieving the symptoms of allergies, cold, cough, and flu. The active ingredient of its original, flagship product, paracetamol , is marketed as an analgesic and antipyretic...

used to relieve pain or decrease nausea and vomiting
Narcotic
Narcotic
The term narcotic originally referred medically to any psychoactive compound with any sleep-inducing properties. In the United States of America it has since become associated with opioids, commonly morphine and heroin and their derivatives, such as hydrocodone. The term is, today, imprecisely...

s like morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...

, pethidine
Pethidine
Pethidine or meperidine Pethidine (INN) or meperidine (USAN) Pethidine (INN) or meperidine (USAN) (commonly referred to as Demerol but also referred to as: isonipecaine; lidol; pethanol; piridosal; Algil; Alodan; Centralgin; Dispadol; Dolantin; Mialgin (in Indonesia); Petidin Dolargan (in Poland);...

, fentanyl, and dilaudid, used to treat severe pain, such as with burns and fractures
Adenosine, calcium channel blockers Diltiazem
Diltiazem
Diltiazem is a non-dihydropyridine member of the class of drugs known as calcium channel blockers, used in the treatment of hypertension, angina pectoris, and some types of arrhythmia....

and Verapamil
Verapamil
Verapamil is an L-type calcium channel blocker of the phenylalkylamine class. It has been used in the treatment of hypertension, angina pectoris, cardiac arrhythmia, and most recently, cluster headaches. It is also an effective preventive medication for migraine...

used to slow down excessively high heart rate
Heart rate
Heart rate is the number of heartbeats per unit of time, typically expressed as beats per minute . Heart rate can vary as the body's need to absorb oxygen and excrete carbon dioxide changes, such as during exercise or sleep....

s
Parasympatholytic
Parasympatholytic
A parasympatholytic agent is a substance or activity that reduces the activity of the parasympathetic nervous system. A parasympatholytic agent is a substance or activity that reduces the activity of the parasympathetic nervous system. A parasympatholytic agent is a substance or activity that...

drug such as Atropine
Atropine
Atropine is a naturally occurring tropane alkaloid extracted from deadly nightshade , Jimson weed , mandrake and other plants of the family Solanaceae. It is a secondary metabolite of these plants and serves as a drug with a wide variety of effects...

, used to speed up slow bradycardia
Bradycardia
Bradycardia , in the context of adult medicine, is the resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min. It may cause cardiac arrest in some patients, because those with bradycardia may not be pumping enough oxygen to their heart...

heart rates
Sympathomimetics such as dopamine
Dopamine
Dopamine is a catecholamine neurotransmitter present in a wide variety of animals, including both vertebrates and invertebrates. In the brain, this substituted phenethylamine functions as a neurotransmitter, activating the five known types of dopamine receptors—D1, D2, D3, D4, and D5—and their...

, dobutamine
Dobutamine
Dobutamine is a sympathomimetic drug used in the treatment of heart failure and cardiogenic shock. Its primary mechanism is direct stimulation of β1 receptors of the sympathetic nervous system. Dobutamine was developed by a laboratory led by Drs...

used for severe hypotension
Hypotension
In physiology and medicine, hypotension is abnormally low blood pressure, especially in the arteries of the systemic circulation. It is best understood as a physiologic state, rather than a disease. It is often associated with shock, though not necessarily indicative of it. Hypotension is the...

(low blood pressure) and cardiogenic shock
Cardiogenic shock
Cardiogenic shock is based upon an inadequate circulation of blood due to primary failure of the ventricles of the heart to function effectively....
D50W (a solution of 50% dextrose in water), used to treat hypoglycemia
Hypoglycemia
Hypoglycemia or hypoglycæmia is the medical term for a state produced by a lower than normal level of blood glucose. The term literally means "under-sweet blood"...

(low blood sugar)
Sedative
Sedative
A sedative or tranquilizer is a substance that induces sedation by reducing irritability or excitement....

s like midazolam
Midazolam
Midazolam is a short-acting drug in the benzodiazepine class developed by Hoffmann-La Roche in the 1970s. The drug is used for treatment of acute seizures, moderate to severe insomnia, and for inducing sedation and amnesia before medical procedures. It possesses profoundly potent anxiolytic,...

, lorazepam
Lorazepam
Lorazepam is a high-potency short-to-intermediate-acting 3-hydroxy benzodiazepine drug that has all five intrinsic benzodiazepine effects: anxiolytic, amnesic, sedative/hypnotic, anticonvulsant, antiemetic and muscle relaxant...

, and etomidate
Etomidate
Etomidate is a short acting intravenous anaesthetic agent used for the induction of general anaesthesia and for sedation for short procedures such as reduction of dislocated joints, tracheal intubation and cardioversion...

, used to reduce the irritability or agitation of patients
Paralytics such as succinylcholine, rocuronium
Rocuronium
Rocuronium is an aminosteroid non-depolarizing neuromuscular blocker or muscle relaxant used in modern anaesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.Introduced in 1994, rocuronium has...

, and vecuronium
Vecuronium
Vecuronium is a muscle relaxant in the category of non-depolarizing blocking agents. Vecuronium bromide is indicated as an adjunct to general anesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation...

, used when an emergency procedure such as rapid sequence induction (RSI)
Rapid sequence induction
Rapid Sequence Induction is a medical procedure involving the expeditious induction of general anesthesia and subsequent intubation of the trachea. RSI is generally used in an emergency setting or for patients who have an increased risk of aspirating stomach contents into the lungs...

is required
Antipsychotic
Antipsychotic
An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...

s like haloperidol
Haloperidol
Haloperidol is a typical antipsychotic. It is in the butyrophenone class of antipsychotic medications and has pharmacological effects similar to the phenothiazines....

or ziprasidone
Ziprasidone
Ziprasidone was the fifth atypical antipsychotic to gain FDA approval . In the United States, Ziprasidone is Food and Drug Administration approved for the treatment of schizophrenia, and the intramuscular injection form of ziprasidone is approved for acute agitation in schizophrenic patients...

, used to sedate combative patients
Respiratory medications such as salbutamol
Salbutamol
Salbutamol or albuterol is a short-acting β2-adrenergic receptor agonist used for the relief of bronchospasm in conditions such as asthma and chronic obstructive pulmonary disease. It is marketed as Ventolin among other brand names....

, Ipratropium bromide and methylprednisolone
Methylprednisolone
Methylprednisolone is a synthetic glucocorticoid or corticosteroid drug. It is marketed in the USA and Canada under the brand names Medrol and Solu-Medrol. It is also available as a generic drug....

, used to treat conditions such as asthma and acute bronchitis
Cardiac medications such as nitroglycerin, aspirin, and morphine, fentanyl used to treat cardiac ailments such as angina and heart attacks
Antiarrhythmics such as amiodarone
Amiodarone
Amiodarone is an antiarrhythmic agent used for various types of tachyarrhythmias , both ventricular and supraventricular arrhythmias. Discovered in 1961, it was not approved for use in the United States until 1985...

, lidocaine
Lidocaine
Lidocaine , Xylocaine, or lignocaine is a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery.- History :Lidocaine, the first amino...

and magnesium sulfate
Magnesium sulfate
Magnesium sulfate is a chemical compound containing magnesium, sulfur and oxygen, with the formula MgSO4. It is often encountered as the heptahydrate epsomite , commonly called Epsom salt, from the town of Epsom in Surrey, England, where the salt was distilled from the springs that arise where the...

used to treat cardiac arrhythmias such as ventricular tachycardia
Ventricular tachycardia
Ventricular tachycardia is a tachycardia, or fast heart rhythm, that originates in one of the ventricles of the heart...

and ventricular fibrillation
Ventricular fibrillation
Ventricular fibrillation is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them quiver rather than contract properly. Ventricular fibrillation is a medical emergency and most commonly identified arrythmia in cardiac arrest...
Ondansetron
Ondansetron
Ondansetron is a serotonin 5-HT3 receptor antagonist used mainly as an antiemetic , often following chemotherapy. Its effects are thought to be on both peripheral and central nerves...

used for nausea and vomiting
Naloxone
Naloxone
Naloxone is an opioid antagonist drug developed by Sankyo in the 1960s. Naloxone is a drug used to counter the effects of opiate overdose, for example heroin or morphine overdose. Naloxone is specifically used to counteract life-threatening depression of the central nervous system and respiratory...

used to treat opioid
Opioid
An opioid is a psychoactive chemical that works by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract...

drug overdose

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.


Treatment issue	Common technician skills	Paramedic/advanced technician skills	Advanced paramedic skills
Airway management	Assessment, manual repositioning, oropharyngeal and nasopharyngeal airway adjuncts, manual removal of obstructions, suctioning	Tracheal intubation Tracheal intubation Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs... , and sometimes nasopharyngeal intubation, advanced airway management, ETT, LMA Laryngeal mask airway The laryngeal mask airway is a supraglottic airway device invented by Archie Brain, a British anaesthetist.-Description:Laryngeal masks consist of a tube with an inflatable cuff that is inserted into the pharynx. Laryngeal mask airways come in a variety of sizes ranging from large adult to infant... , and combitube Combitube The Combitube is a blind insertion airway device often used in the pre-hospital, emergency setting. It is designed to facilitate the tracheal intubation of a patient in respiratory distress. It consists of a cuffed, double-lumen tube that is inserted into a the patient's airway facilitating... , deep suctioning, use of Magill forceps	Rapid sequence induction Rapid sequence induction Rapid Sequence Induction is a medical procedure involving the expeditious induction of general anesthesia and subsequent intubation of the trachea. RSI is generally used in an emergency setting or for patients who have an increased risk of aspirating stomach contents into the lungs... , surgical airway procedures including needle cricothyrotomy and surgical cricothyrotomy
Breathing	Assessment (rate, effort, symmetry, skin color), obstructed airway maneuver, passive oxygen Oxygen Oxygen is the element with atomic number 8 and represented by the symbol O. Its name derives from the Greek roots ὀξύς and -γενής , because at the time of naming, it was mistakenly thought that all acids required oxygen in their composition... administration by nasal canula, rebreathing and non-rebreathing mask, active oxygen administration by bag valve mask (BVM) Bag valve mask A bag valve mask is a hand-held device used to provide positive pressure ventilation to a patient who is not breathing or who is breathing inadequately. The device is a normal part of a resuscitation kit for trained professionals, such as ambulance crew...	Pulse oximetry Pulse oximetry Pulse oximetry is a non-invasive method allowing the monitoring of the oxygenation of a patient's hemoglobin.A sensor is placed on a thin part of the patient's body, usually a fingertip or earlobe, or in the case of an infant, across a foot.... , active oxygen administration by endotracheal tube or other device using BVM, side stream, or inline end tidal carbon dioxide, capnography Capnography Capnography is the monitoring of the concentration or partial pressure of carbon dioxide in the respiratory gases. Its main development has been as a monitoring tool for use during anaesthesia and intensive care. It is usually presented as a graph of expiratory plotted against time, or, less...	Use of mechanical transport ventilators, active oxygen administration by surgical airway, decompression of chest cavity using needle or valve device (needle thoracotomy Thoracotomy Thoracotomy is an incision into the pleural space of the chest. It is performed by a surgeon, and, rarely, by emergency physicians, to gain access to the thoracic organs, most commonly the heart, the lungs, the esophagus or thoracic aorta, or for access to the anterior spine such as is necessary... )
Circulation	Assessment of pulse (rate, rhythm, volume), blood pressure Blood pressure Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies... , skin color, and capillary refill, patient positioning to enhance circulation, recognition and control of hemorrhage of all types using direct and indirect pressure, tourniquets, and obtaining intravenous access	Ability to interpret assessment findings in terms of levels of perfusion Perfusion In physiology, perfusion is the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue. The word is derived from the French verb "perfuser" meaning to "pour over or through."... , intravenous fluid replacement, use of vasoconstriction Vasoconstriction Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, particularly the large arteries, small arterioles and veins. The process is the opposite of vasodilation, the widening of blood vessels. The process is particularly important in... drugs	Intravenous plasma volume expanders, blood transfusion Blood transfusion Blood transfusion is the process of receiving blood products into one's circulation intravenously. Transfusions are used in a variety of medical conditions to replace lost components of the blood... , intraosseous (IO) cannulation (placement of needle into marrow space of a large bone), central venous access (using central venous catheter by way of external jugular or subclavian)
Cardiac arrest Cardiac arrest Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...	Cardiopulmonary resuscitation Cardiopulmonary resuscitation Cardiopulmonary resuscitation is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive... , airway management, manual ventilation with BVM, automatic external defibrillator	Dynamic resuscitation including intubation, drug administration (includes antiarrhythmics), ECG interpretation (may be limited to three-lead), semi-automatic and/or manual defibrillator, cardioversion Cardioversion Cardioversion is a medical procedure by which an abnormally fast heart rate or cardiac arrhythmia is converted to a normal rhythm, using electricity or drugs. Synchronized electrical cardioversion uses a therapeutic dose of electric current to the heart, at a specific moment in the cardiac cycle... , and external cardiac pacing	Expanded drug therapy options, ECG interpretation (twelve-lead), manual defibrillator, synchronized mechanical or chemical cardioversion, external pacing of the heart
Cardiac Monitoring	Cardiac monitoring Cardiac monitoring The phrase cardiac monitoring generally refers to continuous monitoring with electrocardiography with assessment of the patients condition relative to their cardiac rhythm. It is different from hemodynamic monitoring, which monitors the pressure and flow of blood within the circulatory system. The... and interpretation of ECGs Electrocardiogram Electrocardiography is a transthoracic interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached to the outer surface of the skin and recorded by a device external to the body...	Twelve-lead ECG monitoring and interpretation	Eighteen-lead ECG monitoring and interpretation
Drug administration	Oral, nebulized, and intramuscular injection	Intramuscular, subcutaneous, intravenous injection (bolus Bolus (medicine) In medicine, a bolus is the administration of a medication, drug or other compound that is given to raise its concentration in blood to an effective level... ), intravenous drip Intravenous therapy Intravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals... , transdermal Transdermal Transdermal is a route of administration wherein active ingredients are delivered across the skin for systemic distribution. Examples include transdermal patches used for medicine delivery, and transdermal implants used for medical or aesthetic purposes.... and intraosseous	endotracheal tube, rectal tube, infusion pump Infusion pump An infusion pump infuses fluids, medication or nutrients into a patient's circulatory system. It is generally used intravenously, although subcutaneous, arterial and epidural infusions are occasionally used....
Drug types permitted	Low-risk and immediate requirements, e.g., aspirin and nitroglycerin (chest pain), oral glucose and glucagon Glucagon Glucagon, a hormone secreted by the pancreas, raises blood glucose levels. Its effect is opposite that of insulin, which lowers blood glucose levels. The pancreas releases glucagon when blood sugar levels fall too low. Glucagon causes the liver to convert stored glycogen into glucose, which is... (diabetes), epinephrine Epinephrine Epinephrine is a hormone and a neurotransmitter. It increases heart rate, constricts blood vessels, dilates air passages and participates in the fight-or-flight response of the sympathetic nervous system. In chemical terms, adrenaline is one of a group of monoamines called the catecholamines... (allergic reaction), salbutamol Salbutamol Salbutamol or albuterol is a short-acting β2-adrenergic receptor agonist used for the relief of bronchospasm in conditions such as asthma and chronic obstructive pulmonary disease. It is marketed as Ventolin among other brand names.... (asthma), sometimes naloxone Naloxone Naloxone is an opioid antagonist drug developed by Sankyo in the 1960s. Naloxone is a drug used to counter the effects of opiate overdose, for example heroin or morphine overdose. Naloxone is specifically used to counteract life-threatening depression of the central nervous system and respiratory... (narcotic overdose)	Considerable expansion of permitted drugs, but still typically limited to about twenty, including analgesics (may include narcotics), antiarrhythmics, major cardiac resuscitation drugs, bronchodilators, vasoconstrictors, sedatives	Significantly expanded drug list (up to sixty); in some jurisdictions advanced levels of paramedics are permitted to administer any drug, as long as they are familiar with it, and may have limited authority to prescribe Medical prescription A prescription is a health-care program implemented by a physician or other medical practitioner in the form of instructions that govern the plan of care for an individual patient. Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist....
Patient assessment	Basic physical assessment, vital signs Vital signs Vital signs are measures of various physiological statistics, often taken by health professionals, in order to assess the most basic body functions. Vital signs are an essential part of a case presentation. The act of taking vital signs normally entails recording body temperature, pulse rate ,... , history of general and current condition	More detailed physical assessment and history, auscultation Auscultation Auscultation is the term for listening to the internal sounds of the body, usually using a stethoscope... , interpretation of assessment findings, ECG interpretation, glucometry Glucose meter A glucose meter is a medical device for determining the approximate concentration of glucose in the blood. It is a key element of home blood glucose monitoring by people with diabetes mellitus or hypoglycemia... , capnography, pulse oximetry	Interpretation of lab results, interpretation of chest x-rays, interpretation of cranial CT scan, limited diagnosis Medical diagnosis Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process... (e.g. rule out fracture using Ottawa ankle rules Ottawa ankle rules In medicine, the Ottawa ankle rules are a set of guidelines for doctors to aid them in deciding if a patient with foot or ankle pain should be offered X-rays to diagnose a possible bone fracture. Before the introduction of the rules most patients with ankle injuries would have been X-rayed... ), ultrasonography
Wound management	Assessment, control of bleeding Bleeding Bleeding, technically known as hemorrhaging or haemorrhaging is the loss of blood or blood escape from the circulatory system... , application of pressure dressings and other types of dressings		Wound cleansing, wound closure with butterfly stitches Butterfly stitches Butterfly stitches are generally thin adhesive strips which can be used to close small wounds. They are applied across the laceration in a manner which pulls the skin on either side of the wound together. They are not true sutures, but can often be used in addition to, or in place of real sutures... , suturing

Medicolegal authority

The medicolegal

Medical law

Medical law is the branch of law which concerns the prerogatives and responsibilities of medical professionals and the rights of the patient. It should not be confused with medical jurisprudence, which is a branch of medicine, rather than a branch of law....

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 Council

Health 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, 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

Guideline (medical)

A medical guideline is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of healthcare...

(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 with immediately life-threatening emergencies.

In entertainment

Emergency!
Emergency!
Emergency! is an American television series that combines the medical drama and action-adventure genres. It was produced by Mark VII Limited and distributed by Universal Studios...

was a popular 1970s television series which centered on the work of paramedics in the Los Angeles County Fire Department
Los Angeles County Fire Department
The Los Angeles County Fire Department , serves unincorporated parts of Los Angeles County, as well as 58 cities and towns that choose to have the county provide fire and EMS services, including La Habra. It should not be confused with the Los Angeles City Fire Department, which serves the city of...

, 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 (1972–79), as well as in syndicated rerun
Rerun
A rerun or repeat is a re-airing of an episode of a radio or television broadcast. The invention of the rerun is generally credited to Desi Arnaz. There are two types of reruns—those that occur during a hiatus, and those that occur when a program is syndicated. Reruns can also be, as the...

s, and inspired a related cartoon
Cartoon
A cartoon is a form of two-dimensional illustrated visual art. While the specific definition has changed over time, modern usage refers to a typically non-realistic or semi-realistic drawing or painting intended for satire, caricature, or humor, or to the artistic style of such works...

series.
Mother, Jugs & Speed
Mother, Jugs & Speed
Mother, Jugs & Speed is a 1976 black comedy film directed by Peter Yates. It stars Bill Cosby , Raquel Welch , Harvey Keitel , and Larry Hagman as employees of an independent ambulance service trying to survive in Los Angeles.-Plot:...

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
Trauma Center (TV series)
Trauma Center is an American medical drama that aired on ABC from September 22, 1983 to December 8, 1983.-Premise:The series followed the staff at the McKee Hospital Trauma Center who dealt with numerous traumas in each episode...

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
Trauma center
A trauma center is a hospital equipped to provide comprehensive emergency medical services to patients suffering traumatic injuries. Trauma centers grew into existence out of the realization that traumatic injury is a disease process unto itself requiring specialized and experienced...

.
Casualty
Casualty (TV series)
Casualty, stylised as Casual+y, is a British weekly television show broadcast on BBC One, and the longest-running emergency medical drama television series in the world. Created by Jeremy Brock and Paul Unwin, it was first broadcast on 6 September 1986, and transmitted in the UK on BBC One. The...

is a long-running British BBC
BBC
The British Broadcasting Corporation is a British public service broadcaster. Its headquarters is at Broadcasting House in the City of Westminster, London. It is the largest broadcaster in the world, with about 23,000 staff...

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
Spin-off (media)
In media, a spin-off is a radio program, television program, video game, or any narrative work, derived from one or more already existing works, that focuses, in particular, in more detail on one aspect of that original work...

series, Holby City
Holby City
Holby City, stylised as Holby Ci+y, is a British medical drama television series that airs weekly on BBC One.The series was created by Tony McHale and Mal Young as a spin-off from the established BBC medical drama Casualty, and premiered on 12 January 1999...

, and a number of made-for-television films.
Paramedics
Paramedics (film)
Paramedics is a 1988 comedy film starring George Newbern and Christopher McDonald.-Plot:When this group of rowdy and raunchy, laid-back medics are transferred from their cushy uptown district to the rough south-end, they find plenty of trouble when they discover the tough guys are playing a...

is a 1988 American comedy film focussing 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
Bringing Out the Dead
Bringing Out the Dead is a 1999 drama film directed by Martin Scorsese, and based on the novel by Joe Connelly with the screenplay by Paul Schrader...

is a 1999 American drama film, directed by Martin Scorsese
Martin Scorsese
Martin Charles Scorsese is an American film director, screenwriter, producer, actor, and film historian. In 1990 he founded The Film Foundation, a nonprofit organization dedicated to film preservation, and in 2007 he founded the World Cinema Foundation...

and starring Nicolas Cage
Nicolas Cage
Nicolas Cage is an American actor, producer and director, having appeared in over 60 films including Raising Arizona , The Rock , Face/Off , Gone in 60 Seconds , Adaptation , National Treasure , Ghost Rider , Bad Lieutenant: Port of Call New Orleans , and...

, showing forty-eight hours in the life of a burnt-out paramedic in New York's Hell's Kitchen
Hell's Kitchen, Manhattan
Hell's Kitchen, also known as Clinton and Midtown West, is a neighborhood of Manhattan in New York City between 34th Street and 59th Street, from 8th Avenue to the Hudson River....

. The film is based on the novel of the same name by Joe Connelly
Joe Connelly (writer)
Joe Connelly is an American writer. Connelly is best known for his first novel, Bringing Out the Dead. Connelly grew up in a working class family in Warwick, New York. He dropped out of Colgate University and, before publishing his first novel, worked as a paramedic at St. Clare's Hospital in...

, a former New York City paramedic.
Paramedics is an American reality television
Reality television
Reality television is a genre of television programming that presents purportedly unscripted dramatic or humorous situations, documents actual events, and usually features ordinary people instead of professional actors, sometimes in a contest or other situation where a prize is awarded...

show that originally screened from 1999 to 2001, and now runs intermittently on the Discovery Health Channel
Discovery Health Channel
Discovery Health Channel is a website owned by Discovery Communications, created for people interested in health and wellness. Until December 31, 2010, it was a U.S. cable television specialty channel dedicated to television programming that highlights various aspects of health and wellness...

. The show features the life and work of emergency medical squads in major urban centers in the United States.
Third Watch
Third Watch
Third Watch is an American television drama series which first aired on NBC from 1999 to 2005 for a total of 132 episodes, broadcast in 6 seasons of 22 episodes each....

(1999–2005) is an American television drama, parts of which focussed on the firefighters and paramedics of the New York City Fire Department
New York City Fire Department
The New York City Fire Department or the Fire Department of the City of New York has the responsibility for protecting the citizens and property of New York City's five boroughs from fires and fire hazards, providing emergency medical services, technical rescue as well as providing first response...

.
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
Saved (TV series)
Saved is a medical drama television series, which was broadcast on Turner Network Television in 2006. The series was created by David Manson....

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.
Trauma
Trauma (TV series)
Trauma is a television series which originally ran on NBC from September 28, 2009 to April 28, 2010 and focused on a group of paramedics in San Francisco, California....

is a 2009–10 American television drama series focussing on a group of San Francisco Fire Department paramedics working in conjunction with the fictional trauma center of San Francisco City Hospital.

Denise Sherwood, from "Army Wives
Army Wives
Army Wives is an American drama series that follows the lives of four army wives, their families, and an army husband whose wife is in the army. The series, shot at ABC Studios, premiered on Lifetime on June 3, 2007...

" was a paramedic, having been a nurse beforehand and a 911 dispatcher later on.

External links

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