Paramedics in the United States
Paramedics often serve in a prehospital role, responding to Public safety answering point (9-1-1) calls in an ambulance.
A standard requirement for state licensure involves successful completion of a nationally accredited Paramedic program at the certificate or associate degree level.
[2] In the best cases, ambulances were staffed with advanced first-aid level responders who were frequently referred to as "ambulance attendants," but there was little regulation or standardized training for those staffing these early emergency response vehicles or the required equipment carried inside, and active care during transportation was not possible in the vehicles of the time.
In September 1966 the National Academy of Sciences published a report titled "Accidental Death and Disability: The Neglected Disease of Modern Society".[2].
The report noted that soldiers who were seriously wounded on the battlefields of Vietnam had a better survival rate than those individuals who were seriously injured in motor vehicle accidents on California freeways.
Early research attributed these differences in outcome to a number of factors, including comprehensive trauma 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, which allowed the victim to survive the journey to definitive care.
Several communities began experimenting with more advanced emergency medical care in the late 1960s and early 1970s: A television producer, working for producer Jack Webb,[17] of Dragnet and Adam-12 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'.
The show captured the imagination of emergency services personnel, the medical community, and the general public.
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.
Permissible skills evolved in many cases at the local level, and were based upon the preferences of physician advisers and medical directors.
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.
In addition, most locales require that paramedics attend ongoing refresher courses and continuing medical education to maintain their license or certification.
The National Association of Emergency Medical Technicians (NAEMT) along with National Registry of Emergency Medical Technicians (NREMT)[28] 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.
[29] 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.
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'.
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.
As physicians began to build a bond of trust with paramedics, and experience in working with them, their confidence levels also rose.
Without federal mandate, each state's office of emergency medical services may alter their respective standing orders.
Most services carry medications like albuterol or ipratropium to alleviate bronchospasm during an acute asthma attack.
[48] In the setting of inter-facility transfers providers may continue the administration of other medications that are not typically carried in the field (Heparin, Blood products, Potassium).
Paramedics may respond to medical incidents in an ambulance, rescue vehicle, helicopter, fixed-wing aircraft, motorcycle, bicycles, or fire suppression apparatus.
Such positions include offshore drilling platforms, phlebotomy, blood banks, research labs, educational fields, law enforcement and hospitals.
Another is Wilderness Paramedic, who receives special training to address the unique challenges of providing emergency medical care in remote and austere environments.
