A paramedic is a trained medical professional who responds to medical and trauma emergencies in the pre-hospital setting ("in-field") for the purpose of stabilizing a patient's condition before and during transportation to an appropriate medical facility, usually by ambulance. Paramedics also work in the inter-facility transport environment where a paramedic will continue or upgrade medical care to a higher level while transporting a patient from one healthcare facility to another. Paramedics most often will transport patients to an Emergency Department, but "Treat-and-Release" practice can occasionally occur, local protocols permitting. Paramedics work through "protocols" from which they cannot deviate but may use judgment. Paramedics derive the legal ability to provide advanced life support care through a medical doctor's license. Paramedics can work for a city or municipality, a private company, or can be employees of a hospital. Some are volunteers.
Skills Performed by Paramedics
* Perform manual defibrillation
* Perform synchronized cardioversion
* Perform transcutaneous pacing
* Perform Valsalva's Maneuver and Carotid Sinus Massage
* Perform EKG-Monitoring
* Acquire and Interpret 12-lead EKG
* Perform pulse oximetry
* Visualize the airway by use of the laryngoscope and remove foreign body(ies) with forceps
* Perform pulmonary ventilation by endotracheal intubation (incl. use of eschman catheter)
* Perform needle cricothyrotomy/transtracheal jet insufflation
* Perform surgical cricothyroidotomy in patients > 12 years of age
* Perform needle thoracostomy
* Perform Rapid Sequence Endotracheal Intubation
* Perform intraosseous cannulation (a surgical needle placed into bone for emergent vascular access)
* Administer a variety of intravenous solutions
* Obtain venous blood samples
* Perform phlebotomy
* Perform pericardiocentesis
* Perform nasogastric intubation and gastric suction
* Perform drug administration via intramuscular, subcutaneous, intravenous, sublingual, endotracheal, rectal, and buccal routes
* Ventilator and IV pump management
The skill set of a paramedic varies by jurisdiction and may include monitoring and interpreting electrocardiograms (EKGs or ECGs), inserting intravenous lines, performing endotracheal intubation (a breathing tube into the trachea), and defibrillation. Paramedics administer a variety of emergency medications, ranging from calcium channel blockers that slow the heart rate to sympathomimetics like dopamine for severe hypotension (low blood pressure). They may also administer elective medications such as those which relieve pain or decrease nausea and vomiting.
Unlike most other health care providers, paramedics provide care that is not directly supervised by physicians. Rather, paramedics provide care under protocols written by physicians, which guide clinical decisions. In certain cases, paramedics in the field may contact an emergency physician to seek permission to perform certain uncommon procedures, administer certain medications, or discuss the appropriate treatment for a complicated situation. However, the paramedic, based on the patient's physical exam and history, decides which treatment protocol is most appropriate or if additional information/advice is needed from an emergency physician.
In some areas, paramedics are employed in emergency departments. Paramedics may be beneficial to patient care in that setting due to their specialized knowledge and skills related to the management of acute emergencies. Experienced paramedics also can be found as the sole medical provider at remote industrial locations, such as oil rigs and platforms offshore. Their knowledge, skills, and resourcefulness are useful here as well; transport can take hours or days, without communication with a physician. 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. Paramedics usually go to anywhere from 0 - 10 emergency incidents a shift, depending on location and the length of their shifts. Paramedics have shifts, which are usually eight, twelve, or twenty four hours long.