Paramedics

Paramedics are medical professionals trained to provide lifesaving, advanced prehospital care at the scene of a disaster or other emergency as part of a comprehensive emergency medical services (EMS) system. Working under the authority of a supervising medical control physician, paramedics provide advanced emergency medical and trauma care in the field, where early assessment and treatment have the greatest impact on patient outcomes if delivered within the “platinum 10 minutes” immediately following an injury. The diverse requirements of providing emergency medical care outside the hospital call for paramedics to cultivate a range of skills and expertise in addition to their medical training. Competencies in rescue practices, hazardous materials response, patient transportation, communications, logistics, interagency operations, documentation and reporting, and other disciplines are directly relevant to providing patient care in the aftermath of disasters and other emergencies.

People often use the term paramedic in reference to any EMS professional, despite the fact that in the United States and numerous other countries, the title refers specifically to someone who has successfully completed the training and certification required to practice the highest level of advanced prehospital care. Most paramedics work on ambulances as part of a team; however, by its nature, paramedic training adds an important set of lifesaving capabilities to firefighting, law enforcement, and other emergency services, which brings paramedics into frequent contact with patients outside of a hospital emergency department—and thus into disaster zones.

Though regulations governing the training and certification of EMS professionals vary, most areas have adopted a tiered system of qualifications. Tiered levels of certification are characteristic of the overall structure of most modern EMS systems in the developed world, which rely on the careful coordination of personnel and agencies to maximize capabilities, resources, and types of specialization. While it would be ideal to train all EMS professionals to practice at the paramedic level, financial and organizational realities often make this impossible. In the United States, for example, the National Registry of Emergency Medical Technicians, an organization that provides EMS testing and registration in 46 states and the District of Columbia, employs a certification scheme that begins with basic qualification as an emergency medical technician (EMT-B) and culminates with paramedic (EMT-P) certification.

Paramedic training generally consists of one to two years of classroom and clinical instruction in advanced prehospital care techniques in addition to the training required to become a basic EMT. Paramedic students complete extensive coursework in anatomy and physiology, pathophysiology, pharmacology, trauma and burn life support, advanced cardiac and pediatric care, [Page 465]and other aspects of emergency medicine, in addition to instruction on the use of diagnostic and treatment equipment such as electrocardiogram (EKG) monitors and artificial ventilators. Once they have completed training and have passed rigorous cognitive and psychomotor examinations, paramedics may employ a wide array of treatments, tools, and medications that include the administration of an expanded list of medications and access to some invasive surgical procedures such as needle thoracostomy (incising the chest wall for drainage). In short, paramedic education prepares practitioners to treat the full range of possible illnesses and injuries that may be found in the field, as well as to stabilize patients during transportation.

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