Talk:Paramedic

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Cleanup

This article has long sections on Germany and Canada. As discussed above, as a layperson I have a hard time determining if and how a paramedic differs from an EMT. Doubtless this varies from country to country, but this article does not explain those differences adequately. This needs attention from a subject-matter expert. Cleduc 2 July 2005 21:19 (UTC)

Now, there is a very profound difference between Paramedics (EMT-P) and the typical EMT. Of course this article is somewhat lacking, and following some other things I will make an effort to revise this article to explain this difference. As it stands, Paramedic does need its own section, because it is a lot more complicated than EMT.WASTREL 09:55, 23 March 2006 (UTC)

Please be aware that the terminology "EMT-P" as referring to a paramedic is outdated. See ems.gov for additional information. New provider levels are now EMT, AEMT (advanced EMT), and Paramedic. EMT was dropped from the paramedic title to signify that paramedics are allied health professionals, not technicians. EMTs and AEMTs remain the lower level certifications.

List?

Does anyone think a list of famous paramedics would be useful? Just a quick bit of research on Wikipedia shows Ernest Hemingway, E. E. Cummings, John Dos Passos, John Howard Lawson, and Archibald MacLeish (to list only the American writers born in the 1890s) were all "ambulance drivers". The list could be interesting. LizardWizard 21:52, July 10, 2005 (UTC)

---

There's a difference between "ambulance driver" and modern paramedic, and while this might have been a term given to figures such as Ernest Hemingway in their time, their role would more appropriately be termed "ambulance driver" or "emt", as they were not trained (even for lack of technology) in most of the applications in which EMT-P are trained.

-LoL WASTREL 09:55, 23 March 2006 (UTC)

and you can add Walt Disney and Walt Whitman to the list of wartime "ambulance drivers"

---

Someone's added a new list of possible skills, which is fine, but it needs a lot of cleanup and needs to be better described as possibilities for skills a paramedic MAY be allowed to perform. If this is going to be a main page with links to descriptions of the roles paramedics have in various countries, it may even be useful in generating some interest in which options are common in different places. Still, at the moment, it reads like a resume. catseyes 10:42, 26 November 2006 (UTC)

International bias

This article is very US-centric, what a paramedic does in the US should not be listed in this "paramedic" area. --jbignell 16:35, 20 February 2007

This article is very US-centric, and this should be pointed out, or preferably corrected to include information about other countries. For example, I think no other country calls it's paramedics "NREMT-P"s, and in France, ambulance drivers are just that -- they have no/minimal medical training, even in urban environments. --me_and 16:35, 31 July 2005 (UTC)

They are called "NREMT-P"s because they are certified through the National Registry of Emergency Medical Technicans as Paramedics. Now, be aware that not all Paramedics are certified through the NREMT-P. For example, many of the Paramedics in King County are not NREMT-Ps, although they are EMT-Ps through what is typically considered the best paramedic program in the world. -LoL

Actually, in much of Europe, there are doctors and nurses on the ambulances. I've seen literature (but can't quote it directly off the top of my head) that says that American paramedics (including Canadians) have much better patient outcomes than most or all of those systems. --catseyes 03:56, 1 November 2005 (UTC)

In Canada (at least Alberta) a paramedic is a technologist one level above the technician, we have 3 levels for pre-hospital care emergency workers, Emergency Medical Responder (EMR), Emergency Medical Technician "Ambulance" (EMT-A), and Emergency Medical TECHNOLOGIST "Paramedic" (EMT-P) depending on level of training, now common usage does use "EMR" "EMT" "Paramedic" but technically Paramedic is an "EMT-P", but the term and protected title 'Medic' or 'Paramedic' is used to distinguish the technician from the technologist as the abbreviation 'EMT'-a vs 'EMT-p' can at times seem ambiguous due to 'technician' and 'technologist' both beginning with the letter 'T'. Green1 23:33, 15 December 2005 (UTC)

All depends on perspective really. In Australia a Paramedic can have the most basic of skills, Semi-automatic defibrillation, S/l GTN, and the like or the most advanced skills such as rapid sequence intubation, cricothyrotomy, Decompress Tension Pneumothorax, etc. So the term in Australia is almost meaningless, especially as private providers with dubious qualifications can call themselves a paramedic. Add in the out of date references, and parochial dialgue this is not a very good article. Long story short...this article should be removed, my humble opinion of course.--Paradimn 09:35, 19 December 2005 (UTC)

Perhaps the majority of this article should be under the title of 'Paramedic in the US' and then 'Paramedic' should be a page with a brief description of what a Paramedic generally does, and links to country-specific pages. (Iburneditdown 11:32, 5 January 2006 (UTC))

I agree. See Paramedics_in_Canada. Andrewjuren 23:26, 12 January 2006 (UTC)

I've removed the External links, since they were all specific to paramedics in Canada and already linked on the Paramedics in Canada page. Also, removed the {{cleanup-date}} and {{globalize}} tags, since they are no longer applicable. Andrewjuren 19:33, 8 March 2006 (UTC)

I think that recent changes and the branching of pages for paramedics of different nationalities has actually done quite a lot to make this page more internationally oriented. Perhaps with the addition of comments that explain just how restricted the skills of paramedics are in some places (from what I understand, very minimal skills are required to be called a paramedic in parts of Canada and Australia, to give examples) we could remove the national bias tag? --catseyes 22:08, 19 February 2007 (UTC)

I added the section on South Africa to promote the diversity, eventhough South Africa operates much as the UK with clinicians (ECP) rather than technicians (Paramedics). Princeattractive (talk) 05:16, 21 January 2008 (UTC)

It should be pointed out that the term "Paramedic" does not get used quite the same way in Canada. There are many jurisdictions (Ontario for example)in which ALL ambulance staff are called "Paramedics" and are differentiated by levels (I,II,III,CCTU). This is not an unfair description, since an ENTRY level Paramedic in this jurisdiction requires some 1,400 hours of post secondary education before they can write certification exams and then practice. This ranges to as high as another 1,000 hours of training at the upper end of the scale. Even at the low end of the scale, the skill set and knowledge are typically considerably beyond those of the U.S. EMT designation, which rarely has more than 200 hours of training, and seldom that much. Emrgmgmtca (talk) 14:09, 20 August 2008 (UTC)

Paramedics in Canada and worldwide

As a so called "paramedic" in the province of manitoba i have something i would like to add, the term paramedic has been used quite liberaly although it is supposed to mean the highest level of care and traning availible in pre-hospital care. if going by the standards of say texas department of state health services manitoba has no paramedics even though my skill level EMR (Emergency Medical Responder) is considerd to be a paramedic in manitoba. skill levels as low as this should not be considerd paramedics. ambulance officers or ambulance attendants, yes. paramedics no. the term paramedic should only apply to EMT3-P's or EMT-P's. the paramedic page on wikipedia should only deal with the EMT3-P or EMT-P levels. anything else should be called what it is. EMT's whether it be a EMT-1,2,3 or EMT-A,B,I or whatever you call them should have their own catagories and it should be made clear that the lower levels are NOT paramedics. since laypeople are not neccesarily familiar with the different standards it might be adivsable to simply have a paramedic wiki with links to the other skill levels making it clear there is a differance. infact, not every province in canada even calls themselves paramedics, and alberta is not the only one. ontario has AEMCA's[i am making a minor correction] Paradimn, you are partily correct, as i am partily wrong. the A-EMCA testing standatd is a reletivly new advent. older ontario EMCA's were exactly that EMCA's. the term EMT or Paramedic was not part of their title, indeed, their uniforms used to have their service patch and the title EMCA emergency medical care attendant. no paramedic or EMT patch

TheRenaissanceMan 06:54, 18 January 2006 (UTC)L James EMR (not 

paramedic)

- not true(above - statements written by Manitoba EMR)) a-emca in ontario is merely the testing level and the certifications through base hospital are primary care, advanced care and critical care paramedics. Critical care paramedic falls in a level above all of these including EMT-P

The article does a good job of discribing paramedics in the US. I agree with the comments that it should be balanced with international material.

The additional comments in the article do little to aid clarification. In Australia it is not usual practice to start out as an "EMT-B" we don't use that term. In fact it is possible to commence day one as a "paramedic" after gaining a degree from a university this is not a reflection on north American paramedics (with whom I have worked) simply a different way of labelling the people who work on and in ambulances. The term paramedic in the international context does not describe the level of care able to be provided by the caregiver..--Paradimn 10:40, 17 February 2006 (UTC)

In Ontario we use the following classification. PCP -Primary Care Paramedic, ACP - Advanced Care Paramedic , and CCP - Critical Care Paramedic. We do not call ourselves A-EMCA's... —Preceding unsigned comment added by 192.234.223.100 (talk) 17:30, 29 March 2008 (UTC)

The Manitoba EMR is very wrong. First in Manitoba there are three levels of care EMR, paramedic and advance paramedics and EMRs cannot say they are paramedics. Second in Ontario AEMCA is the name of the licences needed to get a job as a paramedic. —Preceding unsigned comment added by MedicPCP (talk • contribs) 21:22, 5 March 2009 (UTC)

Removed some stuff

I removed this list and the following text. The list was unneccisary and the text read like a child's book and wasn't too useful.

Dependent on local protocol and medical director approval, paramedics can administer most of the following medications: - *adenosine - *albuterol - *aminophylline - *amyl nitrite - *acetylsalicylic acid - *atropine - *calcium chloride - *dextrose 50% - *diazepam - *diltiazem - *diphenhydramine - *epinephrine - *etomidate - *furosemide - *glucagon - *glyceryl trinitrate - *isoetharine - *isoproterenol - *lidocaine - *magnesium sulfate - *metoprolol - *morphine - *naloxone - *norepinephrine - *oxytocin - *pancuronium - *phenobarbital - *procainamide - *promethazine - *sodium bicarbonate - *sodium nitrite - *sodium thiosulfate - *succinylcholine

Unencyclopedic section, feel free to cleanup and reinsert - A Paramedic isn’t just an ordinary doctor it’s much much more!

- Paramedics are the first people at the scene of an accident. They are like ‘mini doctors’ that drive ambulances, boats and fly helicopters! - - A paramedic is also called a ‘medical technician’, which means a person who may be called to any number of settings in an emergency situation. - - Being a paramedic is not all exciting and good. A paramedic must be brave and strong having to put up with some pretty tough stuff. - For example, they see people who are very sad or people who have damaged body parts but apart from that it must be great! - A paramedic has a huge responsibility. People trust paramedics with their lives! - In other words, dealing with life and death! - - When a paramedic gets to the emergency scene he/she must treat the patient first. Then the paramedic will keep looking after the patient until they reach hospital. After that they must tell a doctor about the condition/s of the patient. - A paramedic must be prepared for any emergency situation. - - A paramedic always works with a partner. They take turns of driving the ambulance. Another part of a paramedic’s job is to check if they have the right medicine in the ambulance. They also keep in touch with an ambulance communication centre. An ambulance communication centre is where a more experienced paramedic gives medical advice over the phone. - - Paramedics have to go through lots of training to get to the level where you can drive ambulances at over 100kph when the speed limit is 80kph. Landing in helicopters in snow or in tight spaces or most importantly knowing how to help other people is a major responsibility. - - There are many different types of paramedics. - These include: - Emergency Preparedness Coordinator - (EPC’s) are paramedics that have more training than other normal paramedics, which gives them the ability to handle more dangerous situations and very bad injuries. - Patient Transport Services Staff (PTS’s) are people who are training to become a paramedic. PTS’s have first aid training, they also have specialist driving skills and are able to handle basic life support. - - The highest level of being a paramedic is being an EMT. EMT stands for Emergence Medical Treatment. - An EMT can get to the level where the lead missions or become an Instructor! - An EMT has more levels than one, there can be up to four levels called: EMT, EMT-2, EMT-3 and EMT-4! - - An EMT trained paramedic needs excellent eye-sight and be able to carry heavy loads, such as a patient in a stretcher. - - The lowest level of being a paramedic is called a ‘first responder’ they know all the basic medical stuff so all the pro’s don’t get called out to the easy emergencies where if a major injury happens, they can help. - All emergency services (Fire, Police and Rescue) have the first responder level. - - - A paramedic gets special passes to go places where you can’t go. For example, going in the mine where the trapped miners in Tasmania or standing at the side of a race track and much, much more! - - Paramedics go to about 5- 10 accidents a day. - - Paramedics have ‘shifts’ which means paramedic might work from 12:00am-12:00pm and then another paramedic might come and take over and go from 12:00pm-12:00am and then switch over in a cycle. - - A paramedic not only helps people but also educates the community by visiting schools and doing first aid courses. - - A paramedic is a very important person who never gives up!

If you want to salvage some of that and put it back in feel free --Crucible Guardian 22:44, 9 June 2006 (UTC)

I'm removing this

"an example would be usually going to Krispy Kreme but instead going to Dunkin Donuts because they have a coupon."

I'm removing this as it is obviously stupid. 172.191.102.217 21:03, 2 July 2006 (UTC)

In the U.K. ...

... paramedics on the whole do not:

• "derive the legal ability to provide advanced life support care through a medical doctor's license", they are legally autonomous practitioners, registered with the state,
• perform "synchronized cardioversion", "transcutaneous pacing", "transtracheal jet insufflation", "surgical cricothyroidotomy", "rapid sequence endotracheal intubation", "IV pump management", and "gastric suction",
• administer "calcium channel blockers" or "dopamine",
• "provide care under protocols written by physicians, which guide clinical decisions," rather they follow guidelines derived from best practice as agreed by a national clinical committee,
• do not work in "critical care inpatient units".

but they do

• Administer thrombolitic drugs to reduce the effects of myocardial infarctions.

And that's just one country's differences. I agree that this article needs a complete review to ensure it reflects the international nature of the role. The entry for ambulance has lots of useful bits of info for the task at hand.

Here's my entry...

Paramedics in the UK

In the United Kingdom the term paramedic is protected by law and only applies ambulance practitioners who are able to achieve and maintain strict standards established by a statutory body. The Health Professions Council (H.P.C) requires paramedics to enter on to a register before being allowed to work autonomously. It sets the profession’s standards of proficiency and expects registrants to work by codes of ethics, conduct and performance.

Paramedics are expected to work using the clinical standards set by their employers. These vary throughout the country but increasingly are being brought into line with national guidelines. The Joint Royal Colleges Ambulance Liaison Committee, a collection of professionals from the U.K.’s medical, nursing, and ambulance communities, have produced these guidelines bi-annually since 2000. This group reviews its advice based on the principles of evidence based medicine and best practice.

Unlike other countries, there is only one legal level of practitioner. However, many paramedics have undertaken further training or higher educational programmes in order to work as advanced practitioners. Community paramedics and emergency care practitioners vary in the scope of their practice throughout the country but can be found offering unscheduled care in the community in lieu of G.P. visits.

Qualifications

Traditionally the only route to becoming a paramedic was to join an NHS ambulance service and work towards the position from non-emergency patient transport roles through to the emergency division. After qualifying and working as an ambulance technician for a period, it was possible to internally apply for paramedic training. Although offered at ambulance service training departments, the curriculum and certification were awarded by a private company called IHCD. Such paramedic training was usually a 10 week course with some of this time spent in a hospital operating theatre, assisting the anaesthetist. Completion of the course allowed the paramedic to register with the then legislative body (state registration).

It was nearly impossible for non-NHS employees to access such courses, and many private ambulance companies provided their own training. However, lack of recognition by the regulatory body for such training created a problem. This was compounded by paramedical staff leaving the armed forces found their training unrecognised. Eventually the term paramedic was used by variety of people with varying levels of ability. After the incorporation of the H.P.C. the paramedic became legally defined and private and military ambulance staff were given an opportunity to have their training and experience reviewed (grand parenting) against the new standards. This allowed many to register.

Eventually the IHCD began to accredit non-NHS training establishments, alowing them to teach their ciriculum. In the mid 1990s some universities started to offer paramedicine diplomas and degrees, in association with local Ambulance Trusts. These incorporated the IHCD ciriculum and allowed registration. Later, the HPC and British Paramedic Association defined the educational standards required to register, removing the requirement for the IHCD material to be the core of such programmes. Only recognised courses will lead to registration however.

The higher educational route is still considered controversial, with some more experienced ambulance staff arguing that such a fast-track approach misses the experience of PTS where recruits learn vital interpersonal skills.

Employment

The NHS employs the majority of paramedics, usually in the role of clinical lead on accident and emergency ambulances. However, some are employed by the NHS in providing other services such as G.P. practice based roles, community unscheduled care provision, and within minor injury units. Private sector paramedics are often found providing medical services at large public events, at remote industrial sites, as lectuers and trainers, or increasingly as contractors working on behalf of the NHS in accident and emergency work.

Professional Organizations

The British Paramedic Association is the paramedic's professional body in the U.K. It was formed relatively soon after the H.P.C.'s incorporation but only due to Government pressure rather than peer demand. It was the only profession regulated by the H.P.C. without such a body and this situation was deemed unallowable. It was important the profession could maintain self regulation responsibilities for standards and education. At the time paramedics were still struggling with what it mean to be a professional rather than a vocational worker and the B.P.A. was eyed with some suspicion. As a consequence membership is still relatively small compared to the body of the profession as a whole. It does not offer industrial relations or other services normally associated with trade unions.

Sources

HPC http://www.hpc-uk.org/aboutregistration/professions/paramedics/

IHCD http://www.edexcel.org.uk/subjects/a-z/ihcd/

Ambulance Service Association http://www.asa.uk.net/document_archive/073-049_amb_careers_broch.pdf

British Paramedic Association http://www.britishparamedic.org/

Acts Allowed

Scope2776 07:37, 30 December 2006 (UTC) I'm pretty sure retrograde intubation is not an act allowed by paramedics here in the united states, this should be removed if unsupported and erroneous.

There are a FEW jurisdictions that allow it. Not many, but someone was obviously making a list of everything they could find. I'm trying to think of ways to emphasize the fact that many jurisdictions allow very few of the things in the sample list, and in places like Australia, you can be called a paramedic with essentially no training (as compared to many other countries). If you have any suggestions, please let me know.--catseyes 19:47, 16 April 2007 (UTC)

In my humble opinion, the entire skills list needs to be cleaned up. At the moment it appears to be almost obsessed with medications, and with trying to make sharp distinctions between ALS and BLS (almost as a form of classism!). In some senses it almost seems like someone was trying to score as many points as possible by listing as much as they could. The result has been a whole range of inaccuracies. There is a whole list of procedures, beginning with Rapid Sequence Induction, which are not typically performed by British paramedics, for example. There are also examples of procedures being listed as ALS procedures, such as glucometry, when they are in fact BLS procedures in a great many jurisdictions. Perhaps someone is just assuming that the way things work in their system is common throughout EMS throughout the world (and you would be astonished at how common that particular belief is sometimes!). At any rate, I would propose that the entire section be reworked and reconfigured. To begin with, eliminate ALL of the drug names! This isn't an article for the exclusive use of paramedics, nurses or physicians, but an education effort and reference source for ALL Wiki users. As a result, the names of the medications are far less important to the average reader than a brief description of what they can do when used properly. It is far more useful to the average reader to read that 'paramedics may be able to administer drugs to relieve pain' than to provide a list of analgesics, narcotic and otherwise, which would be identical in virtually NO TWO systems. The first provides a general statement to the reader of what their local paramedic can be expected to do, the second may actually mislead the reader by describing medications and procedures not used in that jurisdiction, and which the reader doesn't really understand in any case. The other thing that I would propose is that the skills be listed as follows:

1) General Skills/Procedures Performed by All EMTs and Paramedics 2) Common Skills/Procedures Performed by MOST Paramedics 3) Special Skills/Procedures Performed by SOME Paramedics

These changes would greatly improve the access to information for the average reader, and their understanding of what is being said. I welcome your comments before proceeding.

Emrgmgmtca (talk) 12:22, 22 August 2008 (UTC)

Based on the lack of any objections, I am going to proceed. I will set this up in as straightforward a manner as I can, posting it in here first, and then moving it to the main page once I'm satisfied with it. By all means feel free to jump in and help.

Examples of Skills Performed by Paramedics

Although there is a great deal of variation in what paramedics are trained and permitted to do from region to region, some skills performed by paramedics include:

Treatment Issue	Common Technician Skills	Paramedic/Advanced Technician Skills	Advanced Paramedic Skills
Airway Management	Manual and repositioning, Oro- and Nasopharyngeal airway adjuncts, manual removal of obstructions, xuctioning	Endotracheal intubation (in some cases, naso as well), advanced airway management, ETT, LMA, ETOA, and Combitube, deep suctioning, use of Magill forceps	Rapid sequence induction, surgical airways (including needle cricothyrotomy and others)
Breathing	Initial assessment (rate, effort, symmetry, skin color), obstructed airway maneuver, passive Oxygen administration by nasal canula, rebreathing and non-rebreathing mask, active Oxygen administration by Bag-Valve-Mask (BVM) device.	pulse oximetry, active Oxygen administration by endotracheal tube or other device using BVM	Use of mechanical transport ventilators, active Oxygen administration by surgical airway, decompression of chest cavity using needle/valve device (needle thoracotomy)
Circulation	Assessment of pulse (rate, rhythm, volume), blood pressure and capillary refill, patient positioning to enhance circulation, recognition and control of hemorrhage of all types using direct and indirect pressure and tourniquets	Ability to interpret assessment findings in terms of levels of perfusion, intravenous fluid replacement, vasoconstricting drugs	intravenous plasma volume expanders, blood transfusion, Intraosseous (IO) cannulation (placement of needle into marrow space of a large bone), central venous access (central venous catheter by way of external jugular or subclavian)
Cardiac Arrest	Cardiopulmonary resuscitation, airway management, manual ventilation with BVM, automatic external defibrillator	Dynamic resuscitation including intubation, drug administration (includes anti-arrhythmics), ECG interpretation (may be limited to Lead II) Semi-automatic or manual defibrillator	Expanded drug therapy options, ECG interpretation (12 Lead), manual defibrillator, synchronized mechanical or chemical cardioversion, external pacing of the heart
Cardiac Monitoring	Cardiac monitoring and interpretation of ECGs	12-lead ECG monitoring and interpretation	18-lead ECG monitoring and interpretation
Drug Administration	Limited Oral, Limited Aerosol, Limited Injection	Intramuscular, subcutaneous, intravenous injection (bolus), IV drip	per ETT, per rectal tube, per infusion pump
Drug Types Permitted	Low-risk/immediate requirements (e.g. ASA (Chest Pain), Nitroglycerin (Chest Pain), Oral Glucose (Diabetes), Glucagon (Diabetes), Epinephrine (Allergic Reaction), Ventolin (Asthma)). Note: Some jurisdictions also permit Naloxone (Narcotic Overdose), Nitrous Oxide (for pain); considerable variation by jurisdiction	Considerable expansion of permitted drugs, but still typically limited to about 20, including analgesics (narcotic or otherwise) (for pain), antiarrhythmics (irregularities in heartbeat), major cardiac resuscitation drugs, bronchodilators (for breathing), vasoconstrictors (to improve circulation), sedatives	Dramatically expanded (up to 60) drug list, Note: In some jurisdictions advanced levels of paramedics are permitted to administer any drug, as long as they are familiar with it. Note: In some jurisdictions certain types of advanced paramedics have limited authority to prescribe.
Patient Assessment	Basic physical assessment, 'vital' signs, history of general and current condition	More detailed physical assessment and history, auscultation, interpretation of assessment findings, ECG interpretation, glucometry, capnography, pulse oximetry	Interpretation of lab results, interpretation of chest x-rays, interpretation of cranial CT scan, limited diagnosis (e.g. rule out fracture using Ottawa Ankle Rules)
Wound Management	Assessment, control of bleeding, application of pressure dressings and other types of dressings		Wound cleansing, wound closure with Steri-strips, suturing

Skills Common to All EMTs and Paramedics

Spinal injury management, including immobilization and safe transport.

Fracture management, including assessment, splinting, traction splints where appropriate.

Obstetrics, assessment, assisting with uncomplicated childbirth, recognition of and procedures for obstetrical emergencies, such as breech presentation, cord presentation, placental abruption.

Management of Burns, including classification, estimate of surface area, recognition of more serious burns, treatment.

Assessment and evaluation of general incident scene safety.

Effective verbal and written reporting skills (Charting).

Routine medical equipment maintenance procedures.

Routine radio operating procedures.

Triage of patients in a mass casualty incident.

Emergency vehicle operation.

Medications Administered

Paramedics in most jurisdictions administer a variety of emergency medications; the individual medications vary widely, based on physician medical director preference, local standard of care, and law. These drugs may include Adenocard (Adenosine), which will slow the heart for a short period of time, and Atropine, which will speed a heartbeat that is too slow. The list may include sympathomimetics like dopamine for severe hypotension (low blood pressure) and cardiogenic shock. Diabetics often benefit from the fact that paramedics are able to give D50W (Dextrose 50%) to treat hypoglycemia (low blood sugar). They can treat crisis and anxiety conditions; some may also be permitted to perform rapid sequence inductionRSI, a rapid way of obtaining an advanced airway with the use of paralytics and sedatives, using such medications as Versed, Ativan, or Etomidate, and paralytics such as succinylcholine, rocuronium, or vecuronium. Paramedics in some jurisdictions may also be permitted to sedate combative patients using antipsychotics like Haldol or Geodon. The use of medications for treating respiratory conditions such as, albuterol, atrovent, and methylprednisolone is common. Paramedics may also be permitted to administer medications such as those which relieve pain or decrease nausea and vomiting. Nitroglycerin, baby aspirin, and morphine sulfate may be administered for chest pain. Paramedics may also use other medications and antiarrhythmics like amiodarone to treat cardiac arrhythmias such as ventricular tachycardia and ventricular fibrillation not responding to defibrillation. Paramedics also treat for severe pain, i.e. burns or fractures, with narcotics like morphine sulfate, pethidine, fentanyl and in some jurisdictions, ketorolac. This list is not representative of all jurisdictions, and EMS jurisdictions may vary greatly in what is permitted. Some jurisdictions may not permit administration of certain classes of drugs, or may use drugs other than the ones listed for the same purposes. For an accurate description of permitted drugs or procedures in a given location, it is necessary to contact that jurisdiction directly. The material included here is, however, fairly typical and representative. Emrgmgmtca (talk) 14:16, 27 August 2008 (UTC)

Okay folks, as far as I'm concerned, that's pretty much it. My thanks to whoever was working in the background making little adjustments and amendments along the way; it really helped! At this point, I am moving this material over to the main page. I hope you're all happy with it. Emrgmgmtca (talk) 14:16, 27 August 2008 (UTC)

Difference Between an EMT and Paramedic

Scope2776 08:44, 9 January 2007 (UTC)I was also wondering if we should add a section about the differences between an EMT and Paramedic, the public may be confused about this and may be looking to wikipedia for an answer!

Since this is the parent, worldwide article, I think the sentence lumping EMTs together with Ambulance Drivers and Ambulance Attendents and "other lesser trained personel" should cover it, since we only use call them EMTs here in North America. I think that the Paramedics in the United States of America article does have a good explanation of the difference. --Elipongo ^{(Talk|contribs)} 08:52, 9 January 2007 (UTC)

Have a look at how I've dealt with this in the History of Paramedicine section, and let me know if you think this explains the discrepancies better. I don't think that 'lesser trained' works as an explanation, and certainly not a universal one; we have people working as Primary Care Paramedics in some places in Canada, which is what you would probably describe as your EMT level in terms of skills, but who have more than twice as much training as some U.S. paramedics. Emrgmgmtca (talk) 16:34, 22 August 2008 (UTC)

This should deserve it's own section.You might like to here [1] for more info.--Kelvin_HO^{Wiknerd(talk)} 06:16, 9 March 2009 (UTC)

More U.S. centrisism

"Paramedics are employed by a variety of EMS systems, which may be fire-based (a part of the fire department), private, or municipal third-service (city or county). "

How about regional too... and municipal could be changed to public sector to reflect other country's ways of service provision.

Don't forget 'Third Watch' from the media section: http://www.imdb.com/title/tt0197182/?fr=c2l0ZT1kZnx0dD0xfGZiPXV8cG49MHxrdz0xfHE9dGhpcmQgd2F0Y2h8ZnQ9MXxteD0yMHxsbT01MDB8Y289MXxodG1sPTF8bm09MQ__;fc=1;ft=21

Or Trauma http://www.imdb.com/title/tt0405602/?fr=c2l0ZT1kZnx0dD0xfGZiPXV8cG49MHxrdz0xfHE9dHJhdW1hfGZ0PTF8bXg9MjB8bG09NTAwfGNvPTF8aHRtbD0xfG5tPTE_;fc=13;ft=45;fm=1 http://www.bartsandthelondon.org.uk/news/story.asp?id=132&section_id

I think the problem is that this article doesn't make it clear that it is for the international meaning of Paramedic and not for just the USA or elsewhere. That should be clearly stated somehow in the opening of the article. Also, instead of simple links under *See also* I think each country should get a short paragraph headed by the *Main* template linked to the main article on that country. That should clear up confusion and keep this article in a proper worldview. I'll put it on my list of project to do, if no one else gets to it first! --Elipongo ^{(Talk|contribs)} 16:34, 5 January 2007 (UTC)

Golden Rod of Asclepius

In Denmark paramedics have started to use a special version of the classic Star of Life, where the Rod of Asclepius has been added a golden color. But is this only a national phenomenon or has it been seen other places?

See commons:Image:Roskilde I2 right.jpg and commons:Image:Star of life gold.svg. --|EPO| ^da: 20:21, 11 July 2007 (UTC)

It's not unprecedented. The NREMT has a golden Rod of Asclepius on some of the pins they sell to registrants [2]. Cheers! —Elipongo (Talk contribs) 22:02, 20 July 2007 (UTC)

Cool to know. The "paramedic" concept is still relative new in Denmark and is starting to grow during these years. But would like know if you have seen it on e.g. vehicles, clothes or papers rather than pins, which strictly spoken are merely ornaments. --|EPO| ^da: 08:56, 21 July 2007 (UTC)

I spotted a golden snake on the Rod of Asclepius of a local ambulance and I took a snapshot of it... Image:South Windsor Connecticut ambulance.JPG. So I guess it's not just a phenomenon of Denmark. Cheers! —Elipongo (Talk contribs) 20:23, 10 August 2007 (UTC)

Cool to know it is actually being used "out there" - thanks for the image. --|EPO| ^da: 10:32, 11 August 2007 (UTC)

History of Paramedicine

I recommend some sort of historical section. Remember not to limit it to United States...unless that is where it truly started. —Preceding unsigned comment added by AnthonyM83 (talk • contribs) 04:38, 6 December 2007 (UTC)

This really isn't a bad idea! The average non-paramedic reader (and for that matter, many of our younger 'medics') may have no idea how all of this got started! What I am going to attempt to do here is to work on this, a little at a time, recounting the history as I understand it. Anybody can and should jump in at any time, if they have something to add, or something that they feel that I've gotten wrong. When it's all done, we can edit it and post the page in public. I do think that it is important though, to talk in general terms...there really isn't much point to "the way it all evolved where I work was..."; what we should be striving to create is a good, solid, general history. When an innovation occurred in one place, by all means mention it, and give credit where it's due...the evolution of paramedicine is the culmination of a lot of good ideas from a lot of good people and places, and I think that we should really try to ensure that we honour all of them if we can. I'll look forward to working with all of you on this project. Emrgmgmtca (talk) 16:43, 20 August 2008 (UTC)

"Throughout the evolution of what we now call paramedicine, 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, where aging Centurions, no longer able to fight, were tasked with organizing the removal of the wounded from the battlefield and providing some form of care. Such individuals, although not physicians, were probably among the world's earliest surgeons, suturing wounds, completing amputations, and not through training, but by default. This trend would continue throughout the Crusades, with the Knights Hospitallers of the Order of St. John of Jerusalem, known throughout the British Commonwealth today as St. John Ambulance, filling a similar function.

The first vehicle that was specifically designed as an ambulance was created during the Napoleonic War. Created by Napoleon's Chief Surgeon, Baron Dominique Larry, this new horse-drawn contrivance was intended to rapidly (and jarringly...they had no springs)transport the wounded to surgeons, waiting at the rear. If they survived their wounds and the trip in the ambulance, given the level of surgical skill and sepsis in the early 19th century, their nightmare was just beginning! Such vehicles were seen by the military as a general resource and care of the wounded was not given much priority; it was not uncommon for such vehicles to be tasked with carrying fresh ammunition to the battlefront, before they transported the wounded back. The basic design of such vehicles remained unchanged for nearly 100 years.

While communities had organized to deal with the care and transportation of the sick and dying as far back as the plague in London, England (1598, 1665), such arrangements were typically temporary. In time, however, such arrangements began to formalize and become permanent. In the United States, following the American Civil War, some veterans began to attempt to apply what had they had seen on the battlefield to their own communities, through the creation of volunteer life-saving squads and ambulance corps. This translation to civilian use did not occur in the same way everywhere; in Britain, early civilian ambulances were often operated by the local hospital or the police, while in some parts of Canada, it was common for the local undertaker (having the only transport in town in which one could lie down) to operate both the local furniture store (making coffins as a sideline) and the local ambulance service. In larger centers in various countries, such services might fall to the local Health Department, the Police, the Fire Department, or some combination of all of the above. Once again, the civilian model followed the lead of the military; although there were a handful of motorized ambulances just prior to the First World War (1914-1918), the concept of motorized ambulances was proven first on the battlefield, and spread rapidly to civilian systems immediately following the war." Emrgmgmtca (talk) 17:11, 20 August 2008 (UTC)

"There is some debate as to when the first formal training of "ambulance attendants" began. The generally accepted belief is that this occurred in the United States, at Roanoke, Virginia, during the 1920s (citation needed). While this may have been true of the U.S., Canadian records indicate the members of the Toronto Police Ambulance Service received a mandatory five days of training, conducted by St. John, as early as 1889 (Toronto EMS Website: http://torontoems.ca), and well developed printed manuals, clearly beyond the scope of simple first aid, were present in England even earlier. In terms of advanced skills, it is known that, once again, the military led the way. During the Second World War (1939-1945) and the Korean Conflict, battlefield 'medics' were administering painkilling narcotics by injection, as emergency procedures, and 'pharmacists' mates' on warships without physicians were permitted to do even more. Korea also marked the first widespread use of helicopters to evacuate the wounded from forward positions to medical units. These innovations would not find their way into the civilian sphere for nearly twenty more years.

By the early 1960s experiments in improving care had begun in some civilian centres. The first such experiment involved the provision of pre-hospital cardiac care by physicians in Belfast, Northern Ireland, in 1962 (citation needed). This was repeated in Toronto, Canada in 1968, using a single ambulance called Cardiac One, staffed by a regular ambulance crew, plus a hospital intern, who was tasked with performing the advanced procedures. While both of these experiments had certain levels of success, technology had not yet reached the required level (the Toronto 'portable' defibrillator/heart monitor was powered by lead-acid car batteries and weighed nearly 100 lbs.). The required telemetry and miniaturization technologies already existed in the military, and particularly in the space program, but it would take several more years before they found their way to civilian applications. In North America, physicians were judged to be too expensive to be used in the pre-hospital setting, although such intiatives were implemented, and in some cases still operate, in the United Kingdom, Europe, and Latin America." Emrgmgmtca (talk) 17:58, 20 August 2008 (UTC)

"Around 1969 (citation needed) medical researchers began to discover, to their astonishment, that soldiers who were seriously wounded on the battlefields of Vietnam had a better survival rate than those individuals who were seriously injured in motor vehicle accidents on California freeways. Early research attributed these differences in outcome to a number of factors, including comprehensive trauma care, rapid transport to designated trauma facilities, and a new type of medical corpsman, one who was trained to perform certain critical advanced medical procedures such as fluid replacement and airway management, which allowed the victim to survive the journey to definitive care. As a result, a series of grand experiments began in the United States. Almost simultaneously, and completely independent from one another, experimental programs began in three U.S. centers; Miami, Florida, Seattle, Washington, and Los Angeles, California. Each was aimed at determining the effectiveness of using firefighters to perform many of these same advanced medical skills in the pre-hospital setting in the civilian world. Many in the senior administration of the Fire Departments were initially quite opposed to this concept of 'firemen giving needles', and actively resisted and attempted to cancel pilot programs more than once.

In a curious example of 'life imitating art' a television producer, working for producer Jack Webb, of Dragnet and Adam-12 fame, happened to be in Los Angeles' UCLA Harbor Medical Center, doing background research for a proposed new TV show about doctors, when he happened to encounter these 'firemen who spoke like doctors and worked with them'. This novel idea would eventually evolve into the Emergency! television series, which ran from 1972-1977, portraying the exploits of a new group called 'paramedics'. The show captured the imagination of emergency services personnel, the medical community, and the general public. When the show first aired in 1972, there were exactly 6 paramedic units operating in 3 pilot programs (Miami, Los Angeles, Seattle) in the whole of the United States. No one had ever heard the term 'paramedic'; indeed, it is reported that one of the show's actors was initially concerned that the 'para' part of the term might involve jumping out of airplanes! By the time the program ended production in 1977, there were paramedics operating in every state. The show's technical advisor was a pioneer of paramedicine, James O. Page, then a Battalion Chief responsible for the Los Angeles County Fire Department 'paramedic' program, but who would go on to help establish other paramedic programs in the U.S., and to become the founding publisher of the Journal of Emergency Medical Services (JEMS)." Emrgmgmtca (talk) 09:59, 21 August 2008 (UTC)

"Throughout the 1970s and 80s, the field continued to evolve, although in large measure, on a local level. In the broader scheme of things the term 'ambulance service' was replaced by 'emergency medical service' in order to reflect the change from a transportation system to a system which provided actual medical care. The training, knowledge base, and skill sets of both Paramedics and Emergency Medical Technicians (both competed for the job title, and 'EMT-Paramedic' was a common compromise) were typically determined by what local medical directors were comfortable with, what it was felt that the community needed, and what could actually be afforded. There were also tremendous local differences in the amount and type of training required, and how it would be provided. This ranged from inservice training in local systems, through community colleges, and ultimately even to universities. In the U.S. the community college training model remains the most common, although university-based paramedic education models continue to evolve. These variations in both educational approaches and standards led to tremendous differences from one location to another, and at its worst, created a situation in which a group of people with 120 hours of training, and another group (in another jurisdiction) with university degrees, both calling themselves 'paramedics'. There were some efforts made to resolve these discrepancies. The National Association of Emergency Medical Technicians (NAEMT) along with National Registry of Emergency Medical Technicians ((NREMT) attempted to create a national standard by means of a common licensing examination, but to this day, this has never been universally accepted by U.S. States, and issues of licensing reciprocity for paramedics continue, although if a EMT obtains certification through NREMT (NREMT-P, NREMT-I, NREMT-B), this is accepted by 40 of the 50 states in the United States. This confusion was further complicated by the introduction of complex systems of gradation of certification, reflecting levels of training and skill, but these too were, for the most part, purely local. The only truly common trend that would evolve was the relatively universal acceptance of the term 'Emergency Medical Technician' being used to denote a lower lever of training and skill than a 'Paramedic'." Emrgmgmtca (talk) 16:42, 21 August 2008 (UTC)

"During the evolution of paramedicine, a great deal of both curriculum and skill set was in a state of constant flux. Permissible skills evolved in many cases at the local level, and were based upon the preferences of physician advisors and medical directors. Treatments would go in and out of fashion, and sometimes, back in again. The use of certain drugs, Bretyllium for example, illustrate this. In some respects, the development seemed almost faddish. Technologies also evolved and changed, and as medical equipment manufacturers quickly learned, the pre-hospital environment was not the same as the hospital environment; equipment standards which worked fine in hospitals could not cope well with the less controlled pre-hospital environment. Physicians began to take more interest in Paramedics from a research perspective as well. By about 1990, most of the 'trendiness' in pre-hospital emergency care had begun to disappear, and was replaced by outcome-based research; the gold standard for the rest of medicine. This research began to drive the evolution of the practice of both paramedics and the emergency physicians who oversaw their work; changes to procedures and protocols began to occur only after significant outcome-based research demonstrated their need. Such changes affected everything from simple procedures, such as CPR, to changes in drug protocols. As the profession of paramedic grew, some of its members actually went on to become not just research participants, but researchers in their own right, with their own projects and journal publicatons.

Changes in procedures also included the manner in which the work of paramedics was overseen and managed. In the earliest days of the field, medical control and oversight was direct and immediate, with paramedics calling into a local hospital and receiving orders for every individual procedure or drug. This still occurs in some jurisdictions, but is becoming very rare. As physicians began to build a bond of trust with paramedics, and experience in working with them, their confidence levels also rose. Increasingly, in many jurisdictions day to day operations moved from direct and immediate medical control to pre-written protocols or 'standing orders', with the paramedic typically only calling in for direction after the options in the standing orders had been exhausted. Medical oversight became driven more by chart review or rounds, than by step by step control during each call." Emrgmgmtca (talk) 16:42, 21 August 2008 (UTC)

In other places, the evolution of paramedicine occurred somewhat differently. In Canada, for example, there was an early, but unsuccessful attempt to introduce paramedicine. In 1972, a pilot paramedic training program occurred at Queen's University, located in Kingston, Ontario. The program, intended to upgrade the mandatory 160 hours of training then required for 'ambulance attendants', was found to be too costly and premature. While the program operated for two years and produced a number of graduates, it would be more than a decade before the legislative authority for them to practice was put into place. The program then moved in another direction, providing 1,400 hours of training at the community college level, prior to commencing employment. This change was made mandatory in 1977, with formal certification examinations being introduced for the first time in 1978. Similar, but not identical, programs occurred at roughly the same time in the Province of Alberta, and in British Columbia, through its Justice Institute. Other Canadian provinces gradually followed, but with their own education and certification requirements. Advanced Care Paramedics were not introduced until 1984, when Toronto trained its' first group internally, and the process continued to spread across the country. The current model in Ontario calls for a two year community college based program, including both hospital and field clinical components, prior to designation as an Advanced Care Paramedic, although this is gradually evolving in the direction of a university degree-based program. Some services, such as Toronto EMS, continue to train paramedics internally (indeed, Toronto EMS is accredited in its own right by the Canadian Medical Association as an Advance Care Paramedic training academy).

In the United Kingdom, ambulance services became largely municipal services, with some exceptions, shortly after the end of World War Two. Training was frequently conducted internally, although national levels of coordination led to better standardization of staff training. All public ambulance services are currently operated by regional entities, most often 'trusts', under the authority of the National Health Service. Tremendous standardization of training and permitted skills has also occurred. The English model utilizes, two levels of ambulance staff. The first of these is 'Ambulance Technician'. This role is not a paramedic, but more closely corresponds to the EMT role in the United States. Most services train these individuals internally, using a common curriculum. The second role is that of 'Paramedic'. These are practitioners of advanced life support skills, similar to U.S. paramedics. Initially, many of these individuals were trained internally by the services that employed them, with the step to Paramedic being a logical career path progression for an experienced Ambulance Technician. Increasingly, this trend has moved toward training in the University system, with the entry level for Paramedics being an Honours Bachelor of Science degree in Pre-Hospital or Paramedic Care. Some British Paramedics have been further elevated, into the role of Paramedic Practitioner, a role that practices independently in the pre-hospital environment, in a capacity similar to that of a nurse practitioner, but with more of an acute care orientation. Some Paramedic Practitioners in the U.K. hold M.Sc. degrees." Emrgmgmtca (talk) 12:16, 21 August 2008 (UTC)

I'm pretty sure SAIT in Calgary had an paramedic (ACP) program as early as '79, and NAIT in Edmonton in '81. Systemet (talk) 11:00, 13 February 2012 (UTC)

I would love to see some information contributed by Paramedics from other countries, particularly Australia, New Zealand, and the European Union. I think the readers would find the differences in how your systems evolved very interesting, particularly when described by those with first hand experience with them. Feel free to jump in...I am hoping that together we can create a very high quality article! Emrgmgmtca (talk) 12:16, 21 August 2008 (UTC)

"Today, the field of paramedicine continues to grow and evolve into a formal profession in its' own right, complete with its own standards and body of knowledge. What began as a concept of simple 'technicians' with a couple of weeks of training, performing procedures that they didn't fully understand, has evolved into a career that in many cases (U.K., Australia, increasingly U.S. and Canada)requires a university education, and which is, in some locations actually evolving into a second tier medical practitioner. In many places, the practice of paramedics began as an extension of the supervising physician's license to practise medicine. As such, they were absolutely subject to every condition that the physician placed on their practice. More recently, however, paramedics in both the U.K. and some Canadian provinces have been granted the legal status of self-regulated health professions. When this occurs, the individual paramedics are certified and licensed by a College of Paramedicine, created by legislation but run by the paramedics themselves. This body sets standards, conducts licensing exams, deals with complaints regarding individual practitioners, and consults the government with respect to legislation, policy, and regulations. Paramedics are governing and regulating themselves; the true measure of a profession. In the U.S., paramedics are subject to regulation by individual states, and the degree and type of regulation, as well as paramedic participation in that process, varies from state to state.

In some centers, some paramedics have begun to specialize their practice. One of the earliest examples of this involved aviation medicine, and the use of helicopters. Another was the transfer of critical care patients between facilities. While some jurisdictions still use physicians, nurses and technicians for this purpose, increasingly, this role falls to specially-trained, very senior and experienced paramedics, who perform this role as their primary job function. Other areas of specialization include such roles as tactical paramedics working in police tactical units, marine paramedics, hazardous materials teams, and Heavy Urban Search and Rescue. Still others work in physical isolation, on offshore oil platforms, oil and mineral exploration teams, and in the military. In some cases, one can even find paramedics working on cruise ships! A new and evolving role for paramedics involves the expansion of their practice into the provision of relatively simple primary health care and assessment services." Emrgmgmtca (talk) 10:04, 22 August 2008 (UTC)

(((I'm going to pop this stuff over to the main article page now. I will continue to look for additions and suggested edits. I hope that you will find this useful.))) Emrgmgmtca (talk) 10:09, 22 August 2008 (UTC)

Canada section citation tags

1. If your going to reference a journal such as New England Journal of Medicine, please provide a full citation.

2. I would be willing to place money that there are American paramedic services that are allowed to reroute to a cardiac center without going to online medical control. Hospital notification [e.g. "We're 10 minutes out from your facility with a STEMI"] doesn't count. JPINFV (talk) 05:15, 27 March 2008 (UTC)

Actually no. Ottawa was the first Paramedic Service to have a STEMI protocol( where the medics interrupt the 12-Lead, diagnose the STEMI, and decide on their own to transport to a Heart institute to a cath lab. It is slowly being implemented around the world. Its saving lives and I hope all services can get it.

Heres your reference NEGM article.:

http://content.nejm.org/cgi/content/short/358/3/231

http://cardiology.jwatch.org/cgi/content/full/2008/116/1 —Preceding unsigned comment added by 99.241.180.108 (talk) 14:13, 27 March 2008 (UTC)

I'm pretty sure the paramedics in the UK have been doing this for longer than since 2005. City of Edmonton was thrombolysing patients with physician telemetry oversight in 2001. The original MITI prehospital trials in Seattle (King County?)happened in the mid 90's. I don't think this is particularly unique to Ottawa. Other places have been doing similar things for longer. Systemet (talk) 11:08, 13 February 2012 (UTC)

Reply to deleted comment: I am not deleting them, only changing them to reference tags. It is the preferred style over inline links as they had been put in. If you look at the bottom under the References heading they are still there Jons63 (talk) 14:27, 27 March 2008 (UTC)

Thanks, :) —Preceding unsigned comment added by 1972MGB72 (talk • contribs) 14:31, 27 March 2008 (UTC)

I have no problem if Ottawa was the first, but the current edition states that they are the only service in the world. Actually, New York City's EMS region allows paramedics to reroute to the nearest cath lab (http://www.nycremsco.org/images/articlesserver/General%20Operating%20Procedures%20January%202008%20v010108b.pdf) page 11. Again, it's one thing to say "first" and a complete other thing to say "only." Either way, it doesn't belong on Wikipedia without a reference. Furthermore, plenty of American paramedics operate under standing orders. The sentence "...unlike American Paramedics [sic]" is patently false. Also, paramedic is not capitalized when used in this sense. JPINFV (talk) 17:28, 27 March 2008 (UTC)

But do NYC Paramedics need to talk to a physician first and send the 12-Lead for interuptation by a physician? —Preceding unsigned comment added by 1972MGB72 (talk • contribs) 18:16, 27 March 2008 (UTC)

Not according to the protocol I posted. Admittedly I don't work in New York. This still does not solve the problem with there being no reference for Ottawa being the first service to do prehospital 12-leads with medic interpretation. JPINFV (talk) 18:27, 27 March 2008 (UTC)

There are still alot of American services that have to contact a physician before giving any medications. I know Florida still runs like this, so I am not patently false.

Yes. Implying that ALL US paramedics need to call for orders is patently false. Even LA County is no longer working under the same situation shown in "Emergency!" JPINFV (talk) 18:28, 27 March 2008 (UTC)

I stand by what I have stated, alot of services still run like this. Heck there are still volunteer medics in the US, not sure if they have any medical backgrounds. —Preceding unsigned comment added by 1972MGB72 (talk • contribs) 19:10, 27 March 2008 (UTC)

It doesn't matter what you stand by, it matters what you can verify. You can hold any beliefs that you want, but that doesn't mean it gets included onto Wikipedia. The simple fact is that there are services in the US that use 12 leads based on the medic's judgment (avoid the fire based EMS systems) and there are plenty of services that either use either complete standing orders or a combination of standing/online orders. JPINFV (talk) 19:17, 27 March 2008 (UTC)

I am not doubting what you are stating, but you are not proving me wrong :). I know that US medics have full ACLS, and CCP's and have 12-lead training. Never once did I say that the US didnt. I didnt know that Fire base medic programs arent as advanced as pure medic based programs in the US. Is that true ? —Preceding unsigned comment added by 1972MGB72 (talk • contribs) 19:43, 27 March 2008 (UTC)

My point was that the original phrasing used the "only" and the section about "US Paramedics call for orders" (without any qualifications such as "some") was false. As far as fire-based, I'll contact you via talk page since it's starting to get a bit off topic. JPINFV (talk) 20:02, 27 March 2008 (UTC)

In my service, which is hospital based, paramedics are required to interpret their 12-leads and make the judgement as to where the patient should be transported, afterwhich the ECG is transmitted to the on duty cardiologist. As a paramedic I only have to contact a physician if I declare death in the field, not for permission but for notification of the coronor. —Preceding unsigned comment added by 67.98.222.15 (talk) 06:23, 23 September 2008 (UTC)

Quebec prehosipital setup

The section about Quebec is wrong in the article. It says "In many parts of Europe and in the Canadian province of Quebec (which follows the French system), a different paradigm is used for prehospital care in which doctors, nurses and occasionally medical students function as prehospital providers, either in conjunction with or instead of paramedics." The Quebec system only provides level 1 paramedics on the field. As stated here http://www.spll.ca/ambufonctions.htm here http://www.paramedicduquebec.org/node/33 and here http://www.urgences-sante.qc.ca/indexx.asp?page=58 . The actual Quebec system is not based on the french system in no way. That would be a misunderstanding. The presence of doctor in prehospital set is only a byproduct of the level 2 paramedic project in Montreal. It is an exeption and it is not permenant but it is a educationnal purpose until the student achives automnomy. I think the paragraph speaking about Quebec should be simply taken out since it is unaccurate.

--Arkar1984 (talk) 04:25, 15 April 2008 (UTC)

Cool. I suggest you be bold and edit it. Just include any references you have. -JPINFV (talk) 04:57, 15 April 2008 (UTC)

In so I was. I took out the part and if I get the time I will suggest a more accurate comment for Quebec. --Arkar1984 (talk) 00:17, 16 April 2008 (UTC)

Its too bad Quebec is so far behind in pre hospital medicine, when the rest of the country is making great grounds. Hopefully your system will change. —Preceding unsigned comment added by 99.241.180.108 (talk) 17:07, 24 April 2008 (UTC)

Lead

Ok, an anonymous/IP address editor keeps adding the following to the lead. "Furthermore, they often express frustration at being prejudiced by their phyisican colleagues who, due to higher degree of training and clinical expertese, are less inclined to take into significant consideration the medical advice provided by the paramedic." In doing so, he keeps removing a citation needed tag. I have numerous problems with it.

1. The lead is the wrong place to add the information. things like this need to be in it's own category, not integrated into the lead. See wp:lead.

2. The wording is highly POV. I highly doubt that doctors are highly "prejudiced" (a word that carries a very negative connotation) against paramedics. Are some? Sure. As a whole? No. It's like saying a teacher is prejudiced against her pupils because the teacher has more training and education.

3. It is something that is sweeping and needs to be sourced, per WP:verify.

4. The removal of a citation needed without addressing the need for a citation (stand alone issue).

Comments? JPINFV (talk) 23:24, 18 May 2008 (UTC)

CCEMTP

• I have expanded the CCEMPT section, this is a very well known and extensive course developed at UMBC, added external link. I also suggest that we create a wiki page for the CCEMPT Medicellis (talk) 02:01, 23 June 2008 (UTC)\

"Beignet" removal of "beignets tremper"

A beignet ([bεn.je] pronounced ben–YAY, from the Middle French word for "bump"), in American English, refers to a French doughnut being a pastry made from deep-fried dough and sprinkled with confectioner's sugar.[3]

• I'm pretty sure that someone was calling paramedics donut eaters Medicellis (talk) 11:12, 26 July 2008 (UTC)

Advanced Life Support vs Advanced Advanced Life Support (Advaced ALS)

Ok, ignoring for a moment that no other medical field breaks down procedures and interventions between ALS and BLS (e.g. physicians are physicians. There aren't ALS physicians and BLS physicians), what exactly is the difference between Advanced ALS and ALS? Some of the things are preformed by EMT-Intermediates are listed under "advanced ALS" and some of those are even preformed by EMT-B (defibrillation via AEDs, for example). Furthermore, should there even be a "skills" section? Could you imagine if the emergency physician or the emergency nursing article decided to list the skills that the articles respective providers performed? JPINFV (talk) 03:48, 30 July 2008 (UTC)

That isn't strictly true; not all nurses are RNs. There are also Registered Practical Nurses, with a different level of training, knowledge and skill set. Furthermore, in an effort to maintain control over the system in order to 'protect the public', physicians have succeeded in creating a huge patchwork of medical treatment models, few of which are precisely the same. The intent was good, but the result was not. The skill set permitted to a Paramedic in the Canadian province of Ontario can vary from community to community, depending on which Base Hospital supervises them, and can differ completely from the so-called 'same' level of Paramedic in N.Y. or Michigan, right next door! If you want to see this at its' worst, there is a First Nations reserve with its' own EMS system, which straddles the provinces of Ontario and Quebec, and also New York State, and what they can do depends on where they are going to end up taking their patient!!! If you were going to have a section on "Skills", it would pretty much have to be jurisdiction-specific. Emrgmgmtca (talk) 14:10, 20 August 2008 (UTC)

JPINFV, I attempted to clarify the section which was a mess when I got to it. The sections were divided into BLS/ALS/ACLS. Which we all know ACLS "protocols" or algorithms included pretty much all ALS skills. What I attempted to do is divide up the skills and make it more readable in regards to ALS and advanced standing protocols (what I named advanced ALS, which now reading it does read 'advanced' 'advanced'). Now this is were my bias comes in, and were I disagree. In regards to US related EMS we do have 'standard' BLS and ALS protocols so to speak in regards to National Highway Traffic Safety Administration and DOT national curriculum, see here [4] and here for EMT-P [5]. These "standards" of care apply to all EMT-B and EMT-P programs taught in the United States. Can a local or regional EMS council make more "advanced" protocols, and the answer is yes. But all ALS agency now must meet a 'minimum' standard. This minimum standard includes a skill set. When I was creating the table this is what I had in mind. With that said, each state creates there own state-wide BLS protocols (wholly based on the national Curriculum), and then regionally each system develops there own ALS protocols based on what the MD or medical director or "directors" feel they can extend there license and to what scope of practice s/he will allow. Take for example flight paramedics and flight nurses. In this environment (in the US) usually includes very advanced set of skills not usually scene in the ground ambulance protocols. These paramedics are usually very trained (with most flight programs have a min of 5 years experience as a ground medic). So with that long winded write up , can this section be improved , absolutely and should be. I do feel that we do need a sections on skills , as again this is a hugh part of what we do. Medicellis (talk) 15:37, 21 August 2008 (UTC)

Where did I mention standards? I'm simply asking for the definition between "advanced" ALS and regular old ALS because they seem pretty arbitrary. Does defibrillation really need to be included when ACLS is already listed? What criteria makes defib an "Advanced ALS" while ACLS is just plain "ALS." Defibrillation is something that all paramedics should be able to preform (automatic or manual depending on the area/designation [trying to be inclusive for PCPs since I don't think they get to manually defib, but I may be wrong), but CPAP, which all areas definitely do not have, is listed as regular ALS. Is this an arbitrary list? If not, what "standards" are used to determine ALS v Advanced ALS? Also, looking on it now, some things are listed twice, like ETT and advanced airway management.

My second question is whether listing a bunch of skills is even something that should be in an article. I wonder how long the lists for nurses (LVN, LPN, etc. Heck, let's even throw in CRNAs, NPs, and midwives while we're at it) or physicians would be.JPINFV (talk) 04:04, 22 August 2008 (UTC)

Not to put down LVN's, I'm sure that our skill set is much larger, besides IV's (which come to think of it most states wont allow LPN and LVN's to do) and medication admin. what other skills do they perform? But I diverge. I really am agreeing with you on this, I'm just saying that there is a standard set of skills that a paramedic is able to perform. The advanced protocol procedures are arbitrary as they differ state to state, agency to agency and I'm not sure how to divide those up.

As for physicians they absolute have a skill set based on there area of "expertise". This is very evident when MD's and DO's are credentialed at a hospital. They absolutely have skills they can and can't perform (and this is a actually document that is produced and signed by the physicians when s/he is given privileges to practice) based on there board certifications. A board cert. OBGYN wont be performing neurosurgery and so forth. Just like a doctor we have a area of expertise and that is emergency medicine. That includes a skill set that is important to what we do, should it be included I'm not sure, would like to see a consensuses Medicellis (talk) 18:12, 22 August 2008 (UTC)

Shorten Tag

I was a little surprised when I checked the page today and discovered that someone had added a 'shorten' tag to it. In my opinion, there is nothing on this page which should not be there or is not necessary. The attempt has been to provide a fairly comprehensive overview of a fairly large topic. Admittedly, the history section is long, but why shouldn't paramedics be as entitled to post a comprehensive history of their profession as anyone else at Wikipedia? The fact is that in a great many cases, the history and evolution of the profession directly explains how some of our current situations occurred in the first place. Should the training and skills sections be shortened? The fact remains that, once again, there is a tremendous degree of regional variation in how paramedics are trained and become paramedics, the skills that they are permitted to perform, how they operate, and how medical oversight is conducted. One need look no further than this discussion page to see the broad degree of variation which needs to be covered, if the article is to be comprehensive. There are other articles about both paramedics and EMS in other countries, including the United States, but before this article was expanded and the international content added, it was specifically criticized as being 'too US-centric', was rated as 'Start' and of low importance. Following the work that was done, the article was independently evaluated and ranked by both Wikiproject Medicine and the Emergency Medicine and EMS Task Force. It was reevaluated to be of Mid to Top importance, and given a 'B' rating. I understand what you're attempting here, but I am at a loss to see what might be removed without making the article less than what it is.Emrgmgmtca (talk) 11:23, 12 November 2008 (UTC)

Why don't paramedics have parachutes? It seems like it would be only natural. Also, paragraphs, paragons, parapsychologists? —Preceding unsigned comment added by 128.113.138.46 (talk) 09:22, 9 December 2009 (UTC)

First paragraph

I refocused the first paragraph to be more inline with the expansion of the education and roles of the paramedic as described in the EMS Agenda for the Future. See ems.gov for the documents. -Ian —Preceding unsigned comment added by Slider1 (talk • contribs) 09:30, 2 June 2010 (UTC)

EMT vs paramedic

I know the question has been asked before on this page, but we didn't seem to get an answer, so I'm asking it again. What is the difference between an EMT and paramedic? Why do we have two separate articles for each? To avoid duplicating the discussion, rather than answer here, please take the discussion to Talk:Emergency_medical_technician#EMT_vs_paramedic. Thanks. SJK (talk) 11:19, 16 January 2013 (UTC)

In many countries an EMT is a person who had been trained in emergency medicine, A Paramedic is specific type of EMT (commenly the highest training level). EMT can be anyone from an Ambulance team member to a first responder to a Critical care transport paramedic (Emergency_medical_technician#Levels5.144.59.224 (talk) 11:36, 22 April 2018 (UTC)

Paramedic not being a professional

The first sentence of this Paramedic article contradicts with the Paraprofessional article, which says that paraprofessionals are trained in a certain field, but only work alongside a professional, not being professionals themselves. Therefore the Paramedic article would be better off starting with "The paramedic is a healthcare paraprofessional who works in emergency medical situations". If professional here is not used in the sense of a person doing something for pay, of course. 93.74.15.183 (talk) 19:02, 29 April 2013 (UTC)

I have edited the introductory paragraph based on this discussion. A paramedic is most often (eg commonly) under orders by a hospitalist, ambulatory care director, or hospital director. These are positions that require a medical license, a medical degree. They provide the orders, direction and policy for paramedics to follow. Additionally, patients are formally treated by a licensed professional at the medical facility. There is a sharp seperation between scope of practice and disctinction between roles. This is precisely the reason why paramedics (in English) are called para-medics (ie one who is a paraprofessional that practices under the supervision of a licensed professional whether in the field or not). There is some POV in this article that has an asipirational tone that is not necessarily fact. 70.39.231.100 (talk) 21:43, 12 February 2015 (UTC)

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Wiki Education assignment: Epidemiology of Occupations

This article was the subject of a Wiki Education Foundation-supported course assignment, between 11 January 2024 and 18 April 2024. Further details are available on the course page. Student editor(s): AmakIdris (article contribs). Peer reviewers: Clark3ei.

— Assignment last updated by Clark3ei (talk) 22:14, 22 February 2024 (UTC)

AI generated images?

Hello, first time editor here. A user named "Sachindu Nawanjana" added a fairly obviously AI generated image captioned "Mental Health and Burnout" to this article and I don't know how to report it or have it taken down. Sorry if I'm doing this wrong. 129.2.192.207 (talk) 02:24, 16 April 2024 (UTC)