Typical view of the defibrillator operator. The leader is at the head of the patient, administrating oxygen. Note how the head of the patient in secured between the leader's knees. The defibrilation patches are on.

A paramedic is a trained and licensed or certified medical professional. Most commonly, paramedics are those who respond to medical emergencies out in the field for the purpose of stabilizing the victim's condition so s/he can be transported to medical facilities.

The paramedic is a type of emergency medical technician (EMT). In the United States, emergency medical technicians are classified according to their level of training. The National Registry of EMTs is a central certifying entity, and individual states usually set their own standards of licensure. All EMTs must meet the minimum requirements as set forth in the Department of Transportation's standards for EMT curriculum. The National Registry recognizes three levels of EMT: EMT-B (Basic), EMT-I (Intermediate) and EMT-P (Paramedic). The paramedic level is the highest level of nationally registered positions. In addition to the basic-level skills of CPR, first aid, airway management, oxygen administration, spinal immobilization, traction splinting, bleeding control and splinting, as well as the intermediate skills of IV therapy, endotracheal intubation and initial cardiac drug therapy, the paramedic is also educated in EKG interpretation, advanced airway skills to include RSI, pharmacology, trauma resuscitation, pediatric life support and advanced cardiac life support.

Paramedics are employed by various public and private emergency services providers. These include ambulance services, fire suppression agencies (as firefighters), hospitals, law enforcement services, the military, or various multi-service agencies. Paramedics may respond to medical incidents in an ambulance, rescue vehicle, helicopter, fixed-wing aircraft, and increasingly in fire suppression apparatus.

As nursing shortages become more and more prevalent, paramedics are increasingly used in Emergency Departments and Intensive Care Units of hospitals. Often, paramedics operate with greater lattitude and autonomy than many nurses. In addition, paramedics are often used as chief medical personnel on offshore drilling platforms and on MEDEVACs and airplanes. However, paramedics may be employed in many different medical fields that do not necessarily involve transportation of patients. Such positions may include phlebotomy, blood banks, research labs and educational fields.

In the U.S., paramedic salaries can range anywhere from unpaid, volunteer positions to around $60,000 a year, depending on location and experience. It should be noted that volunteer paramedics can provide the same level of care as those at the upper end of the pay scale. Currently, in the United States, the busiest EMS service per ambulance is New Orleans' Health Department EMS, which responds to approximately 4,000 "911" calls per month, utilizing six ambulances for the entire city of about 500,000 people.

History

Prior to the 1970s, ambulances were staffed with advanced first-aiders and were frequently referred to as "ambulance drivers." There was little regulation or standardized training for those staffing these early emergency response vehicles. However, after the release of the National Highway Traffic Safety Administration's "White Paper" on motor vehicle fatalities, a concentrated effort was undertaken to improve emergency medical care in the prehospital setting.

Pittsburgh, Pennsylvania, Portland, Oregon and Seattle, Washington were early pioneers in prehospital emergency medical training. Pittsburgh's Freedom House paramedics are credited as the first EMT trainees in America. Portland's Leonard Rose, M.D., in cooperation with Buck Ambulance Service, instituted a cardiac training program and began to train other paramedics. In Seattle, the Medic One program at Harborview Medical Center and the University of Washington Medical Center, started by Leonard Cobb, M.D., began training firefighters in CPR in 1970. At the same time, the City of Los Angelas Fire Department also began training some of their firefighters in emergency care. This was vividly portrayed in the television show, Emergency!.

The first paramedics began operating in 1970 and there has been a steady decrease in cardiac related deaths and traffic fatalities ever since.

A few years later, emergency medical helicopters or MEDEVACs were put into service in the Denver area. It is now routine to have paramedic and nurse staffed EMS helicopters in most major metropolitan areas.

The employment of paramedics depends on the organizations that operate the ambulances and other emergency vehicles which they are deployed in. Paramedics responding to a typical emergency may work for the local fire department and arrive in a fire truck or an ambulance bearing the department's insignia, or work for a private corporation like American Medical Response and arrive in one of their brightly painted ambulances.

Training

Paramedics receive at least two years of intensive training. Many universities now offer four-year degrees in emergency medical services, but as a relatively young industry, professional standards and training levels are still evolving.

Paramedics are trained to deal with a broad range of emergency medical situations. These include: obstetrics, cardiac, airway and breathing, a vast array of medical emergencies, orthopedics, psychological and mental health emergencies, pediatrics, trauma, vehicle extrication, communications, intravenous therapy, pharmacology, and advanced cardiac life support. In addition, most locales require paramedics to attend an ongoing schedule of refresher courses in order to maintain their license and/or certification.

Specifically, paramedics are trained in intubation, including pharmacologically assisted intubation and increasingly in rapid sequence intubation, advanced cardiac life support, including cardiac monitoring, 12-lead electrocardiograms, synchronized cardioversion and transcutaneous pacing; pediatric advanced life support, intravenous cannulation, needle chest decompression, needle cricothyroidotomy, and the administration of a wide range of medications such as nitroglycerin, benzodiazepines such as lorazepam, opioids and dextrose.

The National Registry requires significant continuing educational requirements and professional standards, as does the American Heart Association and other regulatory and standards boards.

The Future

Gone are the days, at least in the urban setting, of untrained ambulance drivers. Those in need of emergency medical care have come to expect highly trained medical professionals within four to six minutes of the onset of their emergency. Rapid treatment and transport to a qualified medical facility follow the care given by paramedics in the field.

Paramedics may arrive by fire truck or ambulance and may be involved in initial care and/or transportation, depending on local response strategies and funding levels.

In the future, we will see fire agencies provide increasing levels of emergency medical services. Granted, even now, due to the success of fire prevention activities, 80% of the services provided by most fire departments is medical. Nontraditional agencies such as the Highway Patrol may also increase their involvement in providing paramedic-level emergency medical services, which is now mostly limited to aeromedical transportation.

Paramedics in France

Until very recently, the French pre-hospital care strategy was based on either first responders (firemen) or prehospital medical teams (MD + nurse + ambulance driver) called Smur (service mobile d'urgence et de réanimation, emergency resuscitation mobile unit). With this organisation, any situation requiring a paramedic is handled by a physician who specialises in pre-hospital emergencies.

Due to a lack of physicians, interhospital transportation requiring intensive care was often performed by an ambulance driver and a nurse working on protocol, although it was not entirely legal (the nurses are allowed to apply a medical protocol, but the definition of a Smur necessarily includes a MD). In any case, the protocols had to be written specifically for a patient, so such protocols could not be used for pre-hospital emergencies (the patient was not seen by the MD who wrote the protocol). The situation is evolving, and nurses belonging to a fire department (or ISP–infirmier sapeur-pompier) can now apply emergency protocols in pre-hospital situations, in the same way as paramedics. They can also receive oral prescriptions by phone or radio and thus provide specialised care.

Therefore, there is no specific paramedic profession in France, but the existing nursing profession have evolved to meet the needs of pre-hospital care.