Paramedic

From Wikipedia, the free encyclopedia

A paramedic is an Emergency medical technician certified to the highest level of training who responds to medical and trauma emergencies in the pre-hospital setting ("in-field") for the purpose of stabilizing a patient's condition before and during transportation to an appropriate medical facility, usually by ambulance.

Paramedics work in a variety of other environments, including providing advanced care to patients being transferred between facilities, working as part of a healthcare team in a facility (usually in the emergency department), or providing emergency and sometimes primary care at high-traffic or remote locations (casinos, sporting events, oil rigs, etc.). Paramedics most often will transport patients to an emergency department, but "treat-and-release" practice does occur in some systems.

Paramedics practice under the 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"). Paramedics derive the legal ability to provide care through a medical doctor's license in much the same way nurses do. (At present, in the United States, there is no paramedic equivalent to the nurse practitioner; i.e., a provider able to practice independent of a physician's direct or indirect supervision.) Paramedics are employed by a variety of emergency medical services agencies, including cities or municipalities, a private companies, or hospitals.

Skills performed by paramedics

Some of the many skills performed (as permitted by local protocol):

• Follow American Heart Association Advanced Cardiac Life Support (ACLS) guidelines (United States);
• Follow American Heart Association Pediatric Advanced Life Support (PALS) guidelines (United States);
• Follow International Trauma Life Support (ITLS) or Pre-Hospital Trauma Life Support (PHTLS) guidelines;
• Provide advanced cardiac care, including:
  • Manual defibrillation;
  • Synchronized cardioversion;
  • Transcutaneous pacing;
  • Perform Electrocardiogram monitoring and interpretation, including 12-lead ECG;
• Provide basic and advanced airway management, including:
  • Visualize the airway by use of the laryngoscope and remove foreign bodies with Magill forceps;
  • Perform endotracheal and nasotracheal intubation, (including use of the Eschmann catheter);
  • Perform retrograde intubation;
  • Perform Rapid Sequence Intubation (generally known as RSI);
  • Perform surgical cricothyroidotomy;
  • Perform needle cricothyrotomy/transtracheal jet insufflation;
• Establish vascular access for medication administration and fluid resuscitation via several routes:
  • Peripheral (and, rarely, central) intravenous cannulation;
  • Intraosseous cannulation (placement of needle into marrow space of a large bone), either by hand (pediatric patients) or with a drill or spring-loaded device (adult patients);
• Utilize noninvasive diagnostic devices such as pulse oximetry and capnography;
• Perform needle decompression, or chest tube placement in some services for tension pneumothorax;
• Place a nasogastric tube and perform gastric suctioning;
• Administer medications via intramuscular, subcutaneous, intravenous, sublingual, endotracheal, rectal, intraosseous and buccal routes
• Use of glucometry for diabetic patients
• Obtain venous blood samples
• Ventilator and IV pump management (usually at the "critical care paramedic" level)

Paramedics administer a variety of emergency medications; the individual medications vary widely based on medical director preference, local standard of care, and state law. These drugs range from calcium channel blockers that slow the heart rate to sympathomimetics like dopamine for severe hypotension (low blood pressure). They may also administer elective medications such as those which relieve pain or decrease nausea and vomiting. Nitroglycerin may be administered for chest pain, and other medications used to treat cardiac conditions and arrythmia may also be administered.

Unlike most other health care providers, paramedics typically are not directly supervised by physicians. Rather, paramedics provide care under protocols written by physicians, which guide clinical decisions. In certain cases paramedics in the field may contact their Medical Director to seek permission to perform certain uncommon procedures, administer certain medications, or discuss the appropriate treatment for a complicated situation. However, the paramedic, based on the patient's physical exam and history, decides which treatment protocol is most appropriate or if additional information/advice is needed from an emergency physician.

In some areas, paramedics are employed in emergency departments and critical care inpatient units. Paramedics may be beneficial to patient care in that setting due to their specialized knowledge and skills related to the management of acute emergencies. Experienced paramedics also can be found as the sole medical provider at remote industrial locations, such as oil rigs and platforms offshore. Their knowledge, skills, and resourcefulness are useful here as well; transport can take hours or days, without communication with a physician.

In the field, most paramedics work on ambulances, but a growing minority are employed by fire departments. In many areas firefighter/paramedics act as first responders, able to provided advanced care before an ambulance arrives. Some fire departments operate ambulances, while in many areas ambulance service is provided by a volunteer ambulance corps, a municipal third service, a hospital-based ambulance agency, or a private company.

Depending on the system, paramedics may work with either another paramedic or an EMT on an ambulance. Paramedics usually work in shifts of eight, twelve, or twenty four hours.

In the media

Emergency! (1970's) was based on the work of paramedics in the Los Angeles Fire Department

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.

See also

• Ambulance
• Emergency medical services
• Paramedics in Canada
• Paramedics in France
• Paramedics in Germany
• Paramedics in the United States of America
• Paramedics in the United Kingdom
• Paramedics in Australia
• Paramedics in Türkiye

References

• American Heart Association (Jan. 2006)
• Meisel, Zachary (Nov. 8, 2005). "Ding-a-Ling-a-Ling". Slate.
• UMMC. (n. d.). Tribute to R. Adams Cowley, MD. Retrieved December 30, 2005 from http://www.umm.edu/shocktrauma/history.html.

Türkiye Paramedikleri

External links

• National Registry of Emergency Medical Technicians