Guitars, Paramedics, Linux, and Me

About Paramedics®

Star of Life

par·a·med·ic

/ˌparəˈmedik/

Noun
A person who is trained to do medical work, esp. emergency first aid, but is not a fully qualified doctor.
Synonyms
medical orderly – medic

That is the result one gets if the Google the phrase: “What is a paramedic”

It’s a simplistic definition with absolutely no explanation of the scope of practice a paramedic utilizes. I will try to explain a little more but in reality everything one needs to learn about paramedics can be had with a little more effort and some scrolling on your favorite search engine.

A Better Definition of “Paramedic”

A certified and/or licensed healthcare provider who is educated to treat ill and injured people. Paramedics may work in the emergency department, fire department, private industry, but most importantly the certification is aimed at providing care in the pre-hospital setting.

The National Registry of Emergency Medical Technicians is a national certifying body that has worked closely with private and government entities since President Lyndon Johnson’s Committee on Highway Traffic Safety recommended the creation of a national certification agency to establish uniform standards for training and examination of personnel active in the delivery of emergency ambulance service. While not a government institution itself the result of Johnson’s recommendation was the inception of the National Registry of Emergency Medical  Technicians (NREMT) in 1970. One of the efforts the NREMT has been successful at is defining EMS practitioner “levels”.

Paramedics are also known as: EMT-Paramedic, EMT-P, Mobile Intensive Care Paramedic, MICP, Emergency Medical Technician-Paramedic, NRP, NREMT-P, or simply Medic.  The terms EMT and Paramedic are often mistaken as the same thing when in fact they are not the same.

None of the levels should ever be described as “Ambulance Driver”. It’s considered offensive to most in the profession.

What’s the Difference Between EMT and Paramedic and What Are the Different Levels?

The biggest differences between Paramedics and EMTs is the education, training, and the scope of practice (what they are allowed to do). Basic EMTs usually receive a minimum of 150 hours of training, while paramedics get anywhere from 1,200 hours to 1,800 hours of education and training. Paramedic programs often award two-year degrees or certificates.

The scope of practice differences between EMTs and paramedics can be summed up by the ability to break the skin. Most states do not allow basic emergency medical technicians to give shots or start intravenous lifelines. Paramedics, on the other hand, can give shots as well as use more advanced airway management devices to support breathing. Basic EMTs are usually restricted to using oxygen, glucose, asthma inhalers, and epinephrine auto-injectors (a common exception to the no-needles rule). Paramedics are trained in the use of 30-120 medications, depending on the state.

To gain a true understanding of what a Paramedic is, and does, one must first define and understand the differences of the various levels of EMS providers.

Levels of EMS Providers (excerpted from the NREMT website)

Emergency Medical personnel have designations or titles based upon the amount of education, training, and scope of care they provide to patients.  The National EMS Scope of Practice Model has four levels of EMS care (There currently are six levels but the two “Intermediate” designations are transitioning to either EMT, AEMT, or Paramedic).  Below is the  designations followed by the recommended amount of education required to reach that level of care (there may be some variation from state to state as some states do not recognize all levels):

Emergency Medical Responder (EMR), minimum of 58 hours of education.  An EMR provides front line EMS care, typically within a team but are not educated to take care of patients in the back of an ambulance.  Most EMRs are on rapid  response vehicles and help other EMS providers at a scene.

The Emergency Medical Responder’s scope of practice includes simple skills focused on lifesaving interventions for critical patients. Typically, the Emergency Medical Responder renders on-scene emergency care while  awaiting additional EMS response and may serve as part of the transporting crew, but not as the primary care giver.

In many communities, Emergency Medical Responders provide a mechanism to increase the likelihood that trained personnel and lifesaving equipment can be rapidly deployed to serious emergencies. In all cases,  Emergency Medical Responders are part of a tiered response system. Emergency Medical Responders work alongside other EMS and health care professionals as an integral part of the emergency care team.

The Emergency Medical Responder’s scope of practice includes simple, non-invasive interventions to reduce the morbidity and mortality associated with acute out-of-hospital medical and traumatic emergencies.  Emergency care is based on assessment findings.  Additionally, the Emergency Medical Responder provides care designed to minimize secondary injury and comfort the patient and family while awaiting additional EMS  resources.

A major difference between the lay person and the Emergency Medical Responder is the “duty to act” as part of an organized EMS response.  In some systems, Emergency Medical Responders serve as a part of the crew  on transporting EMS units; however, the EMR is not intended to be the highest level caregiver in such situations. They must function with an EMT or higher level personnel during the transportation of emergency  patients. The scope of practice model of an EMR is limited to simple skills that are effective and can be performed safely in an out-of hospital setting with medical oversight.

After initiating care, the Emergency Medical Responder transfers care to higher level personnel. The Emergency Medical Responder serves as part of an EMS response system that ensures a progressive increase in  the level of assessment and care.

EMR Psychomotor Skills The following are the minimum psychomotor skills of the EMR:

  • Airway and Breathing
    • Insertion of airway adjuncts intended to go into the oropharynx
    • Use of positive pressure ventilation devices such as the bag-valve-mask
    • Suction of the upper airway
    • Supplemental oxygen therapy
  • Pharmacological Interventions
    • Use of unit dose auto-injectors for the administration of life saving medications intended for self or peer rescue in hazardous materials situations (MARK I, etc.)
  • Medical/Cardiac Care
    • Use of an automated external defibrillator
  • Trauma Care
    • Manual stabilization of suspected cervical spine injuries
    • Manual stabilization of extremity fractures
    • Bleeding control
    • Emergency moves

Emergency Medical Technician (EMT), minimum of 150 hours of education.  An EMT can serve in the patient compartment of an ambulance.   EMTs use medical equipment such as automatic defibrillators, deliver trauma care and are educated  in a simple way over all injuries and diseases.  EMTs form the backbone of EMS delivery in the United States.  Most work in a team with more advanced providers and/or typically work in inter-facility transport of hospital patients. Some jurisdictions allow specific advanced procedures at the EMT level.

The Emergency Medical Technician’s scope of practice includes basic skills focused on the acute management and transportation of critical and emergent patients. This may occur at an emergency scene until  transportation resources arrive, from an emergency scene to a health care facility, between health care facilities, or in other health care settings.

In many communities Emergency Medical Technicians provide a large portion of the out-of-hospital care. In some jurisdictions, especially rural areas, Emergency Medical Technicians provide the highest level  of out-of-hospital care. Emergency Medical Technicians work alongside other EMS and health care professionals as an integral part of the emergency care team.

Emergency Medical Technicians’ scope of practice includes basic, non-invasive interventions to reduce the morbidity and mortality associated with acute out-of-hospital medical and traumatic emergencies.  Emergency care is based on assessment findings.  Additionally, Emergency Medical Technicians provide care to minimize secondary injury and provide comfort to the patient and family while transporting the patient  to an emergency care facility.

An Emergency Medical Technician’s knowledge, skills, and abilities are acquired through formal education and training. The Emergency Medical Technician has the knowledge of, and is expected to be competent in,  all of the skills of the EMR. A major difference between the Emergency Medical Responder and the Emergency Medical Technician is the knowledge and skills necessary to provide medical transportation of emergency patients.

The Emergency Medical Technician level is the minimum licensure level for personnel transporting patients in ambulances. The scope of practice is limited to basic skills that are effective and can be performed safely  in an out-of-hospital setting with medical oversight and limited training.

The Emergency Medical Technician transports all emergency patients to an appropriate medical facility. The Emergency Medical Technician is not prepared to make decisions independently regarding the appropriate disposition  of patients. The Emergency Medical Technician serves as part of an EMS response system, assuring a progressive increase in the level of assessment and care. The Emergency Medical Technician may make destination  decisions in collaboration with medical oversight. The principal disposition of the patient encounter will result in the direct delivery of the patient to an acute care facility.

In addition to emergency response, Emergency Medical Technicians often perform medical transport services of patients requiring care within their scope of practice.

EMT Psychomotor Skills The following are the minimum psychomotor skills of the EMT:

  • Airway and Breathing
    • Insertion of airway adjuncts intended to go into the oropharynx or nasopharynx
    • Use of positive pressure ventilation devices such as manually triggered ventilators and automatic transport ventilators
  • Pharmacological Interventions
    • Assist patients in taking their own prescribed medications
    • o Administration of the following over-the-counter medications with appropriate medical oversight:
      • Oral glucose for suspected hypoglycemia
      • Aspirin for chest pain of suspected ischemic origin
  • Trauma Care
    • Application and inflation of the pneumatic anti-shock garment (PASG) for fracture stabilization

Emergency Medical Technician – Intermediate/85

All NREMT-Intermediate/85s will have two registration cycles (four years) to complete a state approved Intermediate/85 to Advanced Emergency Medical Technician (AEMT) transition course in order to be eligible for National EMS Certification as an Advanced Emergency Medical Technician (NRAEMT).  To be awarded National EMS Certification as an NRAEMT all NREMT-Intermediate/85s after completing the approved transition course must successfully complete the NRAEMT computer delivered cognitive examination and a transition course-ending practical examination within the past two years that validates competency over the following skills:

  • Patient Assessment/Management – Medical
  • Airway Ventilation and Oxygenation of an Infant/Child in Respiratory Distress/Failure
  • Cardiac Arrest Management /AED
  • Intravenous Bolus Medications
  • Pediatric Intraosseous Infusion
  • Completion of a transition course that is state approved must be validated by attending and successfully completing a course that issues a certificate that has within its title:
    • NREMT-Intermediate/85’s name
    • transition course completion date
    • The certificate must contain the following statement: “has completed a state approved EMT-Intermediate/85 to Advanced Emergency Medical Technician (AEMT) transition course including successful completion of a course-ending practical examination.”  The individual skills below should also be listed on the certificate:
      • Patient Assessment/Management – Medical
      • Airway Ventilation and Oxygenation of an Infant/Child in Respiratory Distress/Failure
      • Cardiac Arrest Management /AED
      • Intravenous Bolus Medications
      • Pediatric Intraosseous Infusion”
    • name of the sponsoring agency
    • signature of the individual responsible for the training
  • NREMT-Intermediate/85s must complete an online application, including submission of a $70.00 application fee and successfully complete the NRAEMT cognitive examination prior to their Intermediate/85 expiration date.
  • Intermediate/85s who are unable to successfully complete the NRAEMT cognitive exam by their expiration date will be issued a NREMT certification and have 2 years from date of lapse to obtain NRAEMT certification provided they meet all NREMT requirements currently in effect.
  • All Intermediate/85s transitioning will have a maximum of six attempts to successfully complete the NRAEMT cognitive exam.
  • Any Intermediate/85 transitioning who fails six attempts will be required to successfully complete an entire AEMT education program to regain eligibility to apply for NRAEMT.
  • NREMT-Intermediate/85s who submit an acceptable recertification application but do not include successful completion of a state-approved transition course from EMT-Intermediate/85 to AEMT will be issued National EMS Certification as an Emergency Medical Technician (NREMT) upon reaching their expiration date of March 31, 2016 or 2017.
    NREMT-Intermediate/85 expires: Complete AEMT Transition by:
    March 31, 2011 March 31, 2015
    March 31, 2012 March 31, 2016
    March 31, 2013 March 31, 2017

Emergency Medical Technician – Intermediate/99

All NREMT-Intermediate/99s will have three registration cycles (six years) to complete a state approved Intermediate/99 to Paramedic transition course in order to be eligible for National EMS Certification as a Paramedic (NRP).  To be awarded National EMS Certification as an NRP all NREMT-Intermediate/99s after completing the approved transition course must successfully complete the NRP computer delivered cognitive examination.

  • Completion of a transition course that is state approved must be validated by attending and successfully completing a course that issues a certificate that has within its title:
    • NREMT-Intermediate/99’s name
    • transition course completion date
    • The certificate must contain the following statement: “has completed a state approved EMT-Intermediate/99 to Paramedic transition course.
    • name of the sponsoring agency
    • signature of the individual responsible for the training
  • NREMT-Intermediate/99s must submit an online application, including submission of the application fee (currently $110) and successfully complete the NRP cognitive examination prior to the Intermediate/99 expiration date.
  • Intermediate/99s who are unable to successfully complete the NRP cognitive exam by their expiration date will be issued a NRAEMT certification and have 2 years from date of lapse to obtain NRP certification provided they meet all NREMT requirements currently in effect.
  • All Intermediate/99s transitioning will have a maximum of six attempts to successfully complete the NRP cognitive exam.
  • Any Intermediate/99 transitioning who fails six attempts will be required to successfully complete an entire CAAHEP-accredited Paramedic education program to regain eligibility to apply for NRP certification.
  • NREMT-Intermediate/99s who submit an acceptable recertification application but do not include successful completion of a state-approved transition course from EMT-Intermediate/99 to Paramedic will be issued National EMS Certification as an Advanced Emergency Medical Technician (NRAEMT) upon reaching their expiration date of March 31, 2018 or 2019.
    NREMT-Intermediate/99 expires: Complete Paramedic Transition by:
    March 31, 2011 March 31, 2017
    March 31, 2012 March 31, 2018
    March 31, 2013 March 31, 2019

Advanced Emergency Medical Technician (AEMT), minimum of 150 additional hours of education.  To be an AEMT requires a person to first be an EMT, then take the advanced education course.  Some states combine EMT and AEMT education in  300 minimum hour courses.  AEMTs provide interventions to patients that if done improperly can cause harm.  The AEMT level of care is new in the United States as of Jan 1, 2013.

The Advanced Emergency Medical Technician’s scope of practice includes basic and limited advanced skills focused on the acute management and transportation of critical and emergent patients. This may occur at  an emergency scene until transportation resources arrive, from an emergency scene to a health care facility, between health care facilities, or in other health care settings.

For many communities, Advanced Emergency Medical Technicians provide an option to provide high benefit, lower risk advanced skills for systems that cannot support or justify Paramedic level care. This is frequently  the case in rural and volunteer systems. In some jurisdictions, Advanced Emergency Medical Technicians are the highest level of out-of-hospital care. In communities which utilize emergency medical dispatch systems, Advanced Emergency Medical Technicians may function as part of a tiered response system. In all cases, Advanced Emergency Medical Technicians work alongside other EMS and health care professionals as an integral  part of the emergency care team.

The Advanced Emergency Medical Technician’s scope of practice includes basic, limited advanced and pharmacological interventions to reduce the morbidity and mortality associated with acute out-of-hospital medical  and traumatic emergencies. Emergency care is based on assessment findings. Additionally, Advanced Emergency Medical Technicians provide care to minimize secondary injury and provide comfort to the patient and  family while transporting the patient to an emergency care facility.

The Advanced Emergency Medical Technician’s knowledge, skills, and abilities are acquired through formal education and training. The Advanced Emergency Medical Technician has the knowledge associated with, and  is expected to be competent in, all of the skills of the EMR and EMT. The major difference between the Advanced Emergency Medical Technician and the Emergency Medical Technician is the ability to perform limited  advanced skills and provide pharmacological interventions to emergency patients.

The Advanced Emergency Medical Technician is the minimum licensure level for patients requiring limited advanced care at the scene or during transportation. The scope of practice model is limited to lower risk,  high benefit advanced skills that are effective and can be performed safely in an out-of-hospital setting with medical oversight and limited training.
The Advanced Emergency Medical Technician transports all emergency patients to an appropriate medical facility. The Advanced Emergency Medical Technician is not prepared to independently make decisions regarding  the disposition of patients. The Advanced Emergency Medical Technician serves as part of an EMS response system assuring a progressive increase in the level of assessment and care. The Advanced Emergency Medical  Technician may make destination decisions in collaboration with medical oversight. The principal disposition of the patient encounter will result in the direct delivery of the patient to an acute care facility.

In addition to emergency response, Advanced Emergency Medical Technicians often perform medical transport services of patients requiring care within their scope of practice.

AEMT Psychomotor Skills The following are the minimum psychomotor skills of the AEMT:

  • Airway and Breathing
    • Insertion of airways that are NOT intended to be placed into the trachea
    • Tracheobronchial suctioning of an already intubated patient
  • Assessment
  • Pharmacological Interventions
    • Establish and maintain peripheral intravenous access
    • Establish and maintain intraosseous access in a pediatric patient
    • Administer (nonmedicated) intravenous fluid therapy
    • Administer sublingual nitroglycerine to a patient experiencing chest pain of suspected ischemic origin
    • Administer subcutaneous or intramuscular epinephrine to a patient in anaphylaxis
    • Administer glucagon to a hypoglycemic patient
    • Administer intravenous D50 to a hypoglycemic patient
    • Administer inhaled beta agonists to a patient experiencing difficulty breathing and wheezing
    • Administer a narcotic antagonist to a patient suspected of narcotic overdose
    • Administer nitrous oxide for pain relief

Paramedic, minimum of 1,200 hours of accredited education, including college level Anatomy & Physiology. Paramedic education also includes Basic Life Support, Pharmacology, Advanced Life Support, Pediatric Advanced Life Support, Trauma, and Advanced Medical Life Support. Paramedics provide the most advanced care of all EMS professionals.

The Paramedic’s scope of practice includes basic and advanced skills focused on the acute management and transportation of the broad range of patients who access the emergency medical system. This may occur at an  emergency scene until transportation resources arrive, from an emergency scene to a health care facility, between health care facilities, or in other health care settings.
In some communities, Paramedics provide a large portion of the out-of-hospital care and represent the highest level of out-of-hospital care. In communities that use emergency medical dispatch systems, Paramedics may  be part of a tiered response system. In all cases, Paramedics work alongside other EMS and health care professionals as an integral part of the emergency care team.

The Paramedic’s scope of practice includes invasive and pharmacological interventions to reduce the morbidity and mortality associated with acute out-of-hospital medical and traumatic emergencies. Emergency care is  based on an advanced assessment and the formulation of a field impression. The Paramedic provides care designed to minimize secondary injury and provide comfort to the patient and family while transporting the patient  to an appropriate health care facility.

The Paramedic has knowledge, skills, and abilities developed by appropriate formal education and training. The Paramedic has the knowledge associated with, and is expected to be competent in, all of the skills of the  EMR, EMT, and AEMT. The major difference between the Paramedic and the Advanced Emergency Medical Technician is the ability to perform a broader range of advanced skills. These skills carry a greater risk for the  patient if improperly or inappropriately performed, are more difficult to attain and maintain competency in, and require significant background knowledge in basic and applied sciences.

The Paramedic is the minimum licensure level for patients requiring the full range of advanced out-of-hospital care. The scope of practice is limited to advanced skills that are effective and can be performed safely in  an out-of-hospital setting with medical oversight.

The Paramedic transports all emergency patients to an appropriate medical facility. The Paramedic serves as part of an EMS response system, ensuring a progressive increase in the level of assessment and care. The  Paramedic may make destination decisions in collaboration with medical oversight. The principal disposition of the patient encounter will result in the direct delivery of the patient to an acute care facility.

In addition to emergency response, Paramedics often perform medical transport services of patients requiring care within their scope of practice.

Paramedic Psychomotor Skills The following are the minimum psychomotor skills of the Paramedic:

  • Airway and Breathing
    • Perform endotracheal intubation
    • Perform percutaneous cricothyrotomy
    • Decompress the pleural space
    • Perform gastric decompression
  • Pharmacological Interventions
    • Insert an intraosseous cannula
    • Enteral and parenteral administration of approved prescription medications
    • Access indwelling catheters and implanted central IV ports for fluid and medication administration
    • Administer medications by IV infusion
    • Maintain an infusion of blood or blood products
  • Medical/Cardiac Care
    • Perform cardioversion, manual defibrillation, and transcutaneous pacing

This information is primarily based on definitions and descriptions outlined by the National Registry of Emergency Medical Technicians and is specific to EMS in the United States.

State EMS Offices issue licenses to EMS professionals and ambulance service providers, along with a variety of other tasks. Currently 46 states require their  EMS professionals to be certified by the National Registry of EMTs in order to obtain a license to practice as an EMS professional in their state. Some states  require their EMS professionals to maintain certification with the NREMT as part of the continued license; others have their own license renewal process. All  EMS professionals are required to complete continuing education.  The Continuing Education Coordinating  Board for Emergency Medical Services establishes guidelines for approval of courses and helps assure that EMS professionals receive a quality educational  experience.

The National Highway Traffic Safety Administration of the US Department of  Transportation (DOT) sets the lead in establishing EMS education standards. The Congress has not designated or funded an EMS lead agency at the federal level,  so EMS works with many federal agencies to help guide some national EMS agendas and issues.

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