In the

United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...

, the

paramedic A paramedic is a registered healthcare professional who works autonomously across a range of health and care settings and may specialise in clinical practice, as well as in education, leadership, and research. Not all ambulance personnel are p ...

is a

professional A professional is a member of a profession or any person who works in a specified professional activity. The term also describes the standards of education and training that prepare members of the profession with the particular knowledge and skil ...

whose primary focus is to provide advanced emergency medical care for critical and emergency patients who access

Emergency Medical Services Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...

(EMS). This individual possesses the complex knowledge and skills necessary to provide patient care and transportation. Paramedics function as part of a comprehensive EMS response, under medical oversight. Paramedics perform interventions with the basic and advanced equipment typically found on an ambulance. The paramedic is a link from the scene into the

health care system Health, according to the World Health Organization, is "a state of complete physical, Mental health, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World H ...

. One of the eligibility requirements for state certification or licensure requires successful completion of a nationally accredited Paramedic program at the certificate or associate degree level. Each state varies in requirements to practice as a paramedic, and not all states require licensure.

History

Prior to 1970,

ambulance An ambulance is a medically equipped vehicle which transports patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport. Ambulances are used to respond to medi ...

s were staffed with advanced

first-aid First aid is the first and immediate assistance given to any person with either a minor or serious illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery. It includes initial int ...

level responders who were frequently referred to as "ambulance attendants." There was little regulation or standardized training for those staffing these early emergency response vehicles or the required equipment carried inside. Around 1966 in a published report entitled " Accidental Death and Disability: The Neglected Disease of Modern Society", (known in EMS trade as the White Paper) medical researchers began to reveal, to their astonishment, that soldiers who were seriously wounded on the battlefields of

Vietnam Vietnam or Viet Nam ( vi, Việt Nam, ), officially the Socialist Republic of Vietnam,., group="n" is a country in Southeast Asia, at the eastern edge of mainland Southeast Asia, with an area of and population of 96 million, making i ...

had a better survival rate than those individuals who were seriously injured in motor vehicle accidents on

California California is a U.S. state, state in the Western United States, located along the West Coast of the United States, Pacific Coast. With nearly 39.2million residents across a total area of approximately , it is the List of states and territori ...

freeways. Early research attributed these differences in outcome to a number of factors, including comprehensive

trauma Trauma most often refers to: *Major trauma, in physical medicine, severe physical injury caused by an external source *Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic inju ...

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 Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either cl ...

, which allowed the victim to survive the journey to definitive care. Paramedics in an ambulance

During the 1960s a Los Angeles cardiologist named

Walter S. Graf Walter Samuel Graf (July 15, 1917 – October 18, 2015) was an American cardiologist. He was a pioneer in establishing paramedic emergency care, "one of a handful of doctors who created the modern paramedic emergency system". Early life and educ ...

became concerned about the lack of actual medical care being given to coronary patients during emergency transportation to a hospital. In 1969, while serving as president of the Los Angeles Chapter of the

American Heart Association The American Heart Association (AHA) is a nonprofit organization in the United States that funds cardiovascular medical research, educates consumers on healthy living and fosters appropriate cardiac care in an effort to reduce disability and death ...

, he created a "mobile critical care unit", consisting of a Chevy van, a registered nurse, and a portable defibrillator. The same year his patient

Kenneth Hahn Kenneth Hahn (August 19, 1920 – October 12, 1997) was a member of the Los Angeles County Board of Supervisors for forty years, from 1952 to 1992. Hahn was on the Los Angeles City Council from 1947 to 1952. He was an ardent supporter of civil r ...

, a member of the Los Angeles County Board of Supervisors, persuaded the Supervisors to approve a pilot program to train county firefighters as "Mobile Intensive Care Paramedics". A change in state law was necessary to allow personnel other than doctors and nurses to render emergency medical care. Hahn recruited two state legislators who wrote the Wedworth-Townsend Paramedic Act of 1970, signed into law by

Governor A governor is an administrative leader and head of a polity or political region, ranking under the head of state and in some cases, such as governors-general, as the head of state's official representative. Depending on the type of political ...

Ronald Reagan Ronald Wilson Reagan ( ; February 6, 1911June 5, 2004) was an American politician, actor, and union leader who served as the 40th president of the United States from 1981 to 1989. He also served as the 33rd governor of California from 1967 ...

on July 15, 1970, despite opposition from doctors, nurses, and attorneys. Paramedic training began the next month at the Freeman Memorial Hospital under Graf's direction. It was the first nationally accredited paramedic training program in the United States. Other communities in the United States were also experimenting with advanced emergency medical care.

Pittsburgh Pittsburgh ( ) is a city in the Commonwealth (U.S. state), Commonwealth of Pennsylvania, United States, and the county seat of Allegheny County, Pennsylvania, Allegheny County. It is the most populous city in both Allegheny County and Wester ...

's branch of

Freedom House Freedom House is a non-profit, majority U.S. government funded organization in Washington, D.C., that conducts research and advocacy on democracy, political freedom, and human rights. Freedom House was founded in October 1941, and Wendell Wil ...

paramedics are credited as the first

emergency medical technician An emergency medical technician (EMT), also known as an ambulance technician, is a health professional that provides emergency medical services. EMTs are most commonly found working in ambulances. In English-speaking countries, paramedics are ...

(EMT) trainees in the United States. Pittsburgh's Peter Safar is referred to as the father of

CPR Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore sponta ...

. In 1967, he began training unemployed

African-American African Americans (also referred to as Black Americans and Afro-Americans) are an Race and ethnicity in the United States, ethnic group consisting of Americans with partial or total ancestry from sub-Saharan Africa. The term "African American ...

men in what later became Freedom House Ambulance Service, the first paramedic squadron 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 Seattle, the Medic One program at Harborview Medical Center and the

University of Washington Medical Center The University of Washington Medical Center (UWMC) is a hospital in the University District of Seattle, Washington. It is one of the teaching hospitals affiliated with the University of Washington School of Medicine.And is located in the War ...

, started by Leonard Cobb, M.D., began training firefighters in CPR in 1970. Dr. Eugene Nagel trained city of Miami firefighters as the first U.S. paramedics to use invasive techniques and portable defibrillators with telemetry in 1967. Dr. Jonathan Wasserberger helped actualize the teaching curriculum associated with this innovative training in 1973. Elsewhere, the novel approach to pre-hospital care was also evolving. Portland's Leonard Rose, M.D., in cooperation with Buck Ambulance Service, instituted a cardiac training program and began training other paramedics. Baltimore's R. Adams Cowley, the father of trauma medicine, devised the concept of integrated emergency care, designing the first civilian Medevac helicopter program and campaigning for a statewide EMS system. Other communities that were early participants in the development of paramedicine included

Jacksonville, Florida Jacksonville is a city located on the Atlantic coast of northeast Florida, the most populous city proper in the state and is the largest city by area in the contiguous United States as of 2020. It is the seat of Duval County, with which the ...

Pittsburgh, Pennsylvania Pittsburgh ( ) is a city in the Commonwealth (U.S. state), Commonwealth of Pennsylvania, United States, and the county seat of Allegheny County, Pennsylvania, Allegheny County. It is the most populous city in both Allegheny County and Wester ...

(in an expanded program), and

Seattle, Washington Seattle ( ) is a port, seaport city on the West Coast of the United States. It is the county seat, seat of King County, Washington, King County, Washington (state), Washington. With a 2020 population of 737,015, it is the largest city in bo ...

(in an expanded program). In 1972 the first civilian emergency medical helicopter transport service,

Flight for Life Flight for Life is a prehospital care service with many bases of operation across the United States. Flight for Life is primarily known for its emergency medical helicopter transport, but also operates a fleet of land vehicles and fixed-wing airc ...

opened in Denver, Colorado. Emergency medical

helicopter A helicopter is a type of rotorcraft in which lift and thrust are supplied by horizontally spinning rotors. This allows the helicopter to take off and land vertically, to hover, and to fly forward, backward and laterally. These attributes ...

s were soon put into service elsewhere in the United States. It is now routine to have paramedic and nurse-staffed EMS helicopters in most major metropolitan areas. The vast majority of these aeromedical services are utilized for critical care air transport (inter-hospital) in addition to emergency medical services (pre-hospital). A

television producer A television producer is a person who oversees one or more aspects of video production on a television show, television program. Some producers take more of an executive role, in that they conceive new programs and pitch them to the television net ...

, working for producer

Jack Webb John Randolph Webb (April 2, 1920 – December 23, 1982) was an American actor, television producer, Television director, director, and screenwriter, who is most famous for his role as Joe Friday, Sgt. Joe Friday in the Dragnet (franchise) ...

, of '' Dragnet'' and ''

Adam-12 ''Adam-12'' is an American television police procedural crime drama television series created by Robert A. Cinader and Jack Webb. The series follows Los Angeles Police Department (LAPD) officers Pete Malloy and Jim Reed as they patrol the stre ...

'' fame, was 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 only 6 full-fledged 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 James O. Page JD (August 7, 1936 – September 4, 2004) was recognized as a leading authorityLos 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 Publishing is the activity of making information, literature, music, software and other content available to the public for sale or for free. Traditionally, the term refers to the creation and distribution of printed works, such as books, newsp ...

of the Journal of Emergency Medical Services. Throughout the 1970s and 1980s, 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' to reflect the change from a transportation system to a system that provides 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 in-service training in local systems, through community colleges, and ultimately even to

universities A university () is an institution of higher (or tertiary) education and research which awards academic degrees in several academic disciplines. Universities typically offer both undergraduate and postgraduate programs. In the United States, t ...

. 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 advisers and medical directors. Treatments would go in and out of fashion, and sometimes, back in again. The use of certain drugs,

Bretylium Bretylium (also bretylium tosylate) is an antiarrhythmic agent. It blocks the release of noradrenaline from nerve terminals. In effect, it decreases output from the peripheral sympathetic nervous system. It also acts by blocking K+ channels and is ...

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 that 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 and

evidence-based medicine Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients". The aim of EBM is to integrate the experience of the clinician, the values of t ...

; 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. Paramedics became increasingly accountable for their errors as well, and these too led to changes in procedure. Such changes affected everything from simple procedures, such as CPR, to changes in drug protocols and other advanced procedures. 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 publications.

Education

The education and skills required of paramedics vary by state. The U.S.

National Highway Traffic Safety Administration The National Highway Traffic Safety Administration (NHTSA ) is an agency of the U.S. federal government, part of the Department of Transportation. It describes its mission as "Save lives, prevent injuries, reduce vehicle-related crashes" rela ...

(NHTSA) designs and specifies a National Standard Curriculum for EMT training. Most paramedic education and certifying programs require that a student is at a minimum educated and trained to the National Standard Curriculum for a particular skill level. The National Registry of Emergency Medical Technicians (NREMT) is a private, central certifying entity whose primary purpose is to maintain a national standard. NREMT also provides certification information for paramedics who relocate to another state. Paramedics in Training

Paramedic education programs can be as short as six months or as long as four years. An associate degree program is two years, often administered through a

community college A community college is a type of educational institution. The term can have different meanings in different countries: many community colleges have an "open enrollment" for students who have graduated from high school (also known as senior sec ...

. Degree programs are an option, with two-year associate degree programs being most common, although four-year bachelor's degree programs exist. In contrast to commonwealth countries such as Canada, the United Kingdom, Australia and New Zealand, generally the minimum education is a two- to three-year degree at an accredited college or university for the entry-level paramedic, with four-year or even graduate degrees becoming the preferred credential in such jurisdictions. Many paramedic programs in the United States are through adult career and technical schools that provide a certificate of completion upon completion of the program. All programs must meet the current national standard curriculum. The institutions offering such training vary greatly across the country in terms of programs and requirements, and each must be examined by the prospective student in terms of both content and requirements where they hope to practice. Regardless of education, all students must meet the same state requirements to take the certification exams, including the National Registry exams which consist of a psychomotor skills practical examination and a Computer Based Testing (CBT). In addition, most locales require that paramedics attend ongoing refresher courses and continuing medical education to maintain their license or certification. In addition to state and national registry certifications, most paramedics are required to be certified in pediatric advanced life support, pediatric prehospital care or pediatric emergencies for the prehospital provider, prehospital trauma life support; international trauma life support, and advanced cardiac life support. These additional requirements have education and certification from organizations such as the

Credentialling and oversight

In the U.S., the community college training model remains the most common, although some university-based paramedic education models exist. These variations in both educational approaches and standards has led to tremendous differences from one location to another. There may be situations in which a group of people with 120 hours of training, and another group (in another jurisdiction) with university degrees, were 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 an 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. To clarify, at least at a national level, the

(NHTSA), which is the federal organization with authority to administer the EMS system, defines the various titles given to prehospital medical workers based on the level of care they provide. They are EMT-P (Paramedic), EMT-I (Intermediate), EMT-B (Basic), and First Responders. While providers at all levels are considered emergency medical technicians, the term "paramedic" is most properly used in the United States to refer only to those providers who are EMT-P's. Apart from this distinction, 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 level of training and skill than a 'paramedic'. 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.

Scope of practice

In the United States there are no federal guidelines for the scope of practice for any level of EMS provider. In the field, paramedics follow a set of pre-approved procedures and interventions for particular scenarios. For example, all fifty states allow for the administration of some form of anti-convulsive. In the state of Massachusetts a paramedic may administer the

anti-convulsant Anticonvulsants (also known as antiepileptic drugs or recently as antiseizure drugs) are a diverse group of pharmacological agents used in the treatment of epileptic seizures. Anticonvulsants are also increasingly being used in the treatment of b ...

, midazolam, up to a maximum of 6 mg . While in Maine paramedics are allowed to administer midazolam in upwards of 10 mg boluses. These pre-approved procedures are known as standing orders. Standing orders cannot surpass a provider's scope of practice. Scopes of practice represent the degree to which providers are trained. The following is derived NHTSA's "National EMS Scope of Practice model". Without federal mandate, each state's office of emergency medical services may alter their respective standing orders. The purpose of the model is to provide a guide toward standardization in patient care that both improves patient outcomes but allows for reciprocity between states. Prior to certification as a paramedic, candidates must be a certified EMT. Traditionally, a paramedic is allowed to perform all skills an EMT may perform. Below are some of the key skills and procedures expected of a paramedic in the United States.

Key skills and procedures

* Assessment and evaluation of general incident scene safety. * Triage of patients in a mass casualty incident. * Patient

primary Primary or primaries may refer to: Arts, entertainment, and media Music Groups and labels * Primary (band), from Australia * Primary (musician), hip hop musician and record producer from South Korea * Primary Music, Israeli record label Works * ...

and secondary assessments. * Effective verbal and written reporting skills (Documentation). * Carrying/Lifting/Extrication of patients. * Peripheral intravenous cannulation. * Cardiac monitoring and manual

defibrillation Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). A defibrillator delivers a dose of electric current (often called a ''cou ...

. *

ECG Electrocardiography is the process of producing an electrocardiogram (ECG or EKG), a recording of the heart's electrical activity. It is an electrogram of the heart which is a graph of voltage versus time of the electrical activity of the hear ...

acquisition and interpretation. * Orotracheal intubation.

Medications

One of the primary differences between emergency medical technicians and paramedics includes the breadth and number of medications paramedic ambulances typically carry. Due to the variation between each state EMS office it would be cumbersome and unrealistic to list each and every single medication paramedics carry across the United States. Instead, different medications are carried to serve similar patient-care scenarios. Most services carry medications like

albuterol Salbutamol, also known as albuterol and sold under the brand name Ventolin among others, is a medication that opens up the medium and large airways in the lungs. It is a short-acting β2 adrenergic receptor agonist which works by causing rel ...

ipratropium Ipratropium bromide, sold under the trade name Atrovent among others, is a type of anticholinergic (SAMA: short acting muscarinic antagonist) medication which opens up the medium and large airways in the lungs. It is used to treat the symptoms ...

to alleviate bronchospasm during an acute asthma attack. They carry cardiac medications to reverse deadly heart rhythms like amiodarone and

lidocaine Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia. When used for local anaesthesia or in nerve blocks, lidoca ...

. They can also use medications like

atropine Atropine is a tropane alkaloid and anticholinergic medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate, and to decrease saliva production during surgery. It is typically given i ...

adenosine Adenosine ( symbol A) is an organic compound that occurs widely in nature in the form of diverse derivatives. The molecule consists of an adenine attached to a ribose via a β-N9-glycosidic bond. Adenosine is one of the four nucleoside building ...

and different types of

beta-blockers Beta blockers, also spelled β-blockers, are a class of medications that are predominantly used to manage abnormal heart rhythms, and to protect the heart from a second heart attack after a first heart attack (secondary prevention). They are al ...

as heart rate controls. Paramedics may also utilize a number of other medications for analgesia, such as antiemetics and anti-convulsants. In the setting of inter-facility transfers providers may continue the administration of other medications that are not typically carried in the field (

Heparin Heparin, also known as unfractionated heparin (UFH), is a medication and naturally occurring glycosaminoglycan. Since heparins depend on the activity of antithrombin, they are considered anticoagulants. Specifically it is also used in the treatm ...

, Blood products, Potassium).

Variations in scope

The aforementioned skills and medications are often standing orders in state protocols. The expectations and responsibilities of providers varies across state lines. There are instances where special waivers granted by states allowing paramedic services to go beyond their protocols. For example, some paramedics in New Hampshire may be allowed to perform a surgical

cricothyrotomy A cricothyrotomy (also called cricothyroidotomy) is an incision made through the skin and cricothyroid membrane to establish a patent airway during certain life-threatening situations, such as airway obstruction by a foreign body, angioedema, or ...

, medics in Virginia are allowed to use ultrasound as a diagnostic technique and paramedics in Arizona are allowed to perform rapid-sequence intubation utilizing paralytic and sedating medication to completely control a patient's airway.

Employment

Paramedics are employed by various public and private

emergency service Emergency services and rescue services are organizations that ensure public safety and health by addressing and resolving different emergencies. Some of these agencies exist solely for addressing certain types of emergencies, while others deal wit ...

providers. These include private ambulance services,

fire department A fire department (American English) or fire brigade (Commonwealth English), also known as a fire authority, fire district, fire and rescue, or fire service in some areas, is an organization that provides fire prevention and fire suppression se ...

s, public safety or

police department The police are a constituted body of persons empowered by a state, with the aim to enforce the law, to ensure the safety, health and possessions of citizens, and to prevent crime and civil disorder. Their lawful powers include arrest and ...

s, hospitals, law enforcement agencies, the military, and municipal EMS agencies in addition to and independent from police or fire departments, also known as a 'third service'. Paramedics may respond to medical incidents in an

, rescue vehicle, helicopter, fixed-wing aircraft, motorcycle, or fire suppression apparatus. Paramedics may also be employed in medical fields that do not involve transportation of patients. Such positions include offshore drilling platforms,

phlebotomy Phlebotomy is the process of making a puncture in a vein, usually in the arm, with a cannula for the purpose of drawing blood. The procedure itself is known as a venipuncture, which is also used for intravenous therapy. A person who performs a ph ...

, blood banks, research labs, educational fields, law enforcement and hospitals. Aside from their traditional roles, paramedics may also participate in one of many specialty arenas: * Critical care transporters move patients by ground ambulance or aircraft between medical treatment facilities. This may be done to allow a patient to receive a higher level of care in a more specialized facility. Registered Nurses with training in

Emergency Nursing Emergency nursing is a specialty within the field of professional nursing focusing on the care of patients who require prompt medical attention to avoid long-term disability or death. In addition to addressing "true emergencies," emergency nurses i ...

may work with paramedics in these settings. Paramedics participating in this role generally also provide care not traditionally administered by Paramedics who respond to 911 calls. Examples of this are blood transfusions,

intra-aortic balloon pump The intra-aortic balloon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion and indirectly increases cardiac output through afterload reduction. It consists of a cylindrical polyurethane balloon that sits in the aorta, ...

s, and mechanical ventilators. * Tactical paramedics work on law enforcement teams (

SWAT In the United States, a SWAT team (special weapons and tactics, originally special weapons assault team) is a police tactical unit that uses specialized or military equipment and tactics. Although they were first created in the 1960s to ...

). These medics, usually from the EMS agency in the area, are commissioned and trained to be tactical operators in law enforcement, in addition to paramedic duties. Advanced medical personnel perform dual roles as operator and medic on the teams. Such an officer is immediately available to deliver advanced emergency care to other injured officers, suspects, innocent victims and bystanders. The advantage to having dual role paramedics is that medical care is provided almost immediately. * Hospital paramedics are sometimes employed in either of the

outpatient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care ...

and inpatient areas.

Emergency department An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of pati ...

s employ the largest number of paramedics working inside of hospitals. Considered ambulatory care,

emergency department An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of pati ...

s are classified as an

area of a hospital. Depending on their scope of practice and job description within the emergency department, paramedics are allowed to triage and assess incoming patients, provide analysis and interpretation of both labs and

EKG Electrocardiography is the process of producing an electrocardiogram (ECG or EKG), a recording of the heart's electrical activity. It is an electrogram of the heart which is a graph of voltage versus time of the electrical activity of the hear ...

intravenous therapy Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutri ...

, drug administration, transportation of

patients to diagnostic testing or their inpatient rooms. Paramedics are also employed indirectly in the inpatient areas of hospitals as well. Paramedics are utilized in

intensive care unit 220px, Intensive care unit An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensiv ...

s assisting other licensed staff with ICU patients and they are utilized on high risk transport teams by providing transportation, continuation of care and assisting in sedation of patients during minimally invasive and invasive procedures at the bedside and in diagnostic areas. Because of the nature and purpose of these teams, paramedics work closely with

radiology Radiology ( ) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiat ...

interventional radiology Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs bo ...

nuclear medicine Nuclear medicine or nucleology is a medical specialty involving the application of radioactive substances in the diagnosis and treatment of disease. Nuclear imaging, in a sense, is "radiology done inside out" because it records radiation emitting ...

and

anesthesiology Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, ...

Salary

The salary of a paramedic in the US varies. The mean average is $30,000, with the lowest 10% earning under $20,000 and the top 10% earning over $50,000, considerably less than the salaries of

paramedics in Canada A paramedic is a healthcare professional, providing pre-hospital assessment and medical care to people with acute illnesses or injuries. In Canada, the title paramedic generally refers to those who work on land ambulances or air ambulances p ...

. Factors such as education and location of the paramedic's practice influence the salary. Paramedic supervisors and managers may make between $60,000- $80,000, depending on location.

References

* National Academy of Sciences and National Research Council. ''Accidental Death and Disability: The Neglected Disease of Modern Society''. Washington, D.C.: The National Academies Press, 1966.

External links

National Association of Emergency Medical Technicians homepage

National Registry of Emergency Medical Technicians

NHTSA Emergency Medical Services national page

Paramedicine.com
{{EMSworld Emergency medical services in the United States