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"Paramedic" can be difficult to define as the term is sometimes used to refer to anyone responding to a medical emergency outside of a hospital. The term "paramedic" can refer to a specialized health care professional with 3-5 years of post-secondary education or a basic first-aider depending on what jurisdiction is in question. Generally, a paramedic responds to medical and trauma emergencies in the pre-hospital environment, provides emergency treatment and, when appropriate, transports a patient to a hospital for further assessment or follow-up care. Depending on the system, paramedics may work with either another paramedic or less highly trained personnel such as an Emergency Medical Technician EMT (in the US and UK).
Paramedics are employed by a variety of different agencies: by government (as part of a public hospital system, as a separate municipal EMS service, or sometimes, especially in the United States, as part of a fire department) or by private sector organizations (private hospitals, private ambulance companies). Paramedics may also work in other settings (e.g., emergency departments, hospital inpatient units, medical clinics, doctors' offices, oil rigs, steel mills, and casinos).
In the US, there are 4 levels of prehospital care defined by the US Department of Transportation (which regulates prehospital education). In order of level of training, they are First Responder, Emergency Medical Technician-Basic(EMT-B), Emergency Medical Technician-Intermediate (EMT-I), and Emergency Medical Technician-Paramedic (EMT-P). Some systems within the US refer to both EMT-Ps and EMT-Is as "paramedics". In Canada there are 3 levels of Paramedics, with the Primary Care Paramedic equivalent to an EMT or RN, the Advanced Care Paramedic equivalent to the standard paramedic, and the Critical Care Paramedic employed in the flight paramedic role (except in Alberta which uses the terms EMT and EMT-Paramedic).
In many parts of Europe and some cities in Canada, a different paradigm is used for prehospital care in which doctors, nurses and occasionally medical students function as prehospital providers, either in conjunction with or instead of paramedics. Other parts of the world, such as Hong Kong, are currently progressing toward a system staffed with paramedics. [1].
Historically, paramedics have functioned under the authority and indirect supervision of a physician, both through standing protocols (off-line medical control) or through direct physician consultation via phone or radio (on-line medical control). In many modern jurisdictions this "medical control" has been deemphasized or eliminated as paramedicine matures into a stand-alone profession.
Although there is a great deal of variation in what paramedics are trained and permitted to do from region to region, some skills performed by paramedics in various jurisdictions have included:
Paramedics in some places administer a variety of emergency medications; the individual medications vary widely based on medical director preference, local standard of care, and law. These drugs range from calcium channel blockers that slow the heart rate to sympathomimetics like dopamine for severe hypotension (low blood pressure). Medications for treating respiratory conditions such as albuterol are common. They may also administer elective medications such as those which relieve pain or decrease nausea and vomiting. Nitroglycerin, aspirin, and morphine may be administered for chest pain. Other medications are used to treat cardiac conditions such as a myocardial infarction and various dysrhythmias.
In other places, the term paramedic is used to describe anyone who has a role in emergency medical care, and may not indicate a level of training or the ability to perform medical procedures at all.
The 1970's television show Emergency! was a very popular series which centered around the work of paramedics in the Los Angeles County Fire Department, and the staff at the fictional Rampart Emergency Hospital. Emergency! has been widely credited with inspiring many municipalities to develop their own paramedic programs, and has inspired many to enter the fields of emergency medicine. The show was a top rated program for its entire production run (1972 - 1979), as well as in syndicated television reruns -- even inspiring a Saturday morning cartoon series.
Paramedics is also the name of a show on the Discovery Health Channel, which details the life and work of emergency medical squads across the country. It is also the name of a 1988 Comedy which highlighted the lighter side of EMS.
Paramedic: On the Front Lines of Medicine (1998), by Peter Canning, is an autobiographical account of a paramedic's first year on the job. Rescue 471: A Paramedic's Stories (2000) is the sequel.
Bringing Out the Dead (1999), directed by Martin Scorsese and starring Nicholas Cage is one of very few films about paramedics. The main character is paramedic Frank Pierce who works in New York's Hell's Kitchen. He's become burned out and haunted by visions of the people he's failed to save including a little girl.
Into the Breach: A Year of Life and Death with EMS (2002) Book written by J.A. Karam is the true story of paramedics, emergency medical technicians, and heavy-rescue specialists fighting to control trauma and medical emergencies. Into the Breach offers an unusual opportunity to bear witness to unimaginable suffering, heroic stoicism, and the inventiveness of American EMS workers fighting to save lives.
Parts of Third Watch (1999) were devoted to adventures of the fictional 55th precinct FDNY EMS unit, created by ER executive producer John Wells.
Saved (2006), a TNT series centered around paramedic Wyatt Cole (Tom Everett Scott), his partner, and their chaotic lives on and off the job.