A paramedic is a healthcare professional trained in the medical model, whose main role has historically been to respond to emergency calls for medical help outside of a hospital. Paramedics work as part of the emergency medical services (EMS), most often in ambulances. They also have roles in emergency medicine, primary care, transfer medicine and remote/offshore medicine. The scope of practice of a paramedic varies between countries, but generally includes autonomous decision making around the emergency care of patients. Not all ambulance personnel are paramedics, although the term is sometimes used informally to refer to any ambulance personnel. In some English-speaking countries, there is an official distinction between paramedics and emergency medical technicians (or emergency care assistants), in which paramedics have additional educational requirements and scope of practice.
Functions and duties The paramedic role is closely related to other healthcare positions, especially the emergency medical technician, with paramedics often being at a higher grade with more responsibility and autonomy following substantially greater education and training. The primary role of a paramedic is to stabilize people with life-threatening injuries and transport these patients to a higher level of care (typically an emergency department). Due to the nature of their job, paramedics work in many environments, including roadways, people's homes, and depending on their qualifications, wilderness environments, hospitals, aircraft, and with SWAT teams during police operations. Paramedics also work in non-emergency situations, such as transporting chronically ill patients to and from treatment centers and in some areas, address social determinants of health and provide in-home care to ill patients at risk of hospitalization (a practice known as community paramedicine). The role of a paramedic varies widely across the world, as EMS providers operate with many different models of care. In the Anglo-American model, paramedics are autonomous decision-makers. In some countries such as the United Kingdom and South Africa, the paramedic role has developed into an autonomous health profession. In the Franco-German model, ambulance care is led by physicians. In some versions of this model, such as France, there is no direct equivalent to a paramedic. Ambulance staff have either the more advanced qualifications of a physician or less advanced training in first aid. In other versions of the Franco-German model, such as Germany, paramedics do exist. Their role is very similar to the role of paramedics in the Anglo-American model with an advanced scope of autonomy and practice, and the added element of emergency physician backup, either virtually (Tele-Notarzt) or on scene with a rapid response vehicle / helicopter. The role of paramedics in Germany has evolved from support to physicians in the field to the central role in pre-hospital emergency care. The development of the profession has been a gradual move from simply transporting patients to hospital, to more advanced treatments in the field. In some countries, the paramedic may take on the role as part of a system to prevent hospitalization entirely and, through practitioners, are able to prescribe certain medications, or undertaking 'see and refer' visits, where the paramedic directly refers a patient to specialist services without taking them to hospital.
Occupational hazards Paramedics are exposed to a variety of hazards such as lifting patients and equipment, treating those with infectious disease, handling hazardous substances, and transportation via ground or air vehicles. Employers can prevent occupational illness or injury by providing safe patient handling equipment, implementing a training program to educate paramedics on job hazards, and supplying PPE such as respirators, gloves, and isolation gowns when dealing with biological hazards. Infectious disease has become a major concern, in light of the COVID-19 pandemic. In response, the U.S. Centers for Disease Control and Prevention and other agencies and organizations have issued guidance regarding workplace hazard controls for COVID-19. Some specific recommendations include modified call queries, symptom screening, universal PPE use, hand hygiene, physical distancing, and stringent disinfection protocols. Research on ambulance ventilation systems found that aerosols often recirculate throughout the compartment, creating a health hazard for paramedics when transporting sick patients capable of airborne transmission. Unidirectional airflow design can better protect workers.
Physical injuries Paramedics are widely recognized to face high risks of physical injuries in their line of work. More than 22,000 EMS providers visit the emergency room each year for work-related injuries. Some physical injuries encountered when providing healthcare services include lifting injuries, back strains, and needlestick incidences. Injuries such as sprains and strains mostly occur in the back and neck, and injuries are most prevalent while responding to 911 calls, which include patient care and transport. These injuries are prevalent but not impossible to overcome; they require preventive measures to minimize the chance of them happening. Safe lifting techniques and patient-handling equipment are major factors in reducing paramedics' physical injury risk. Workers with less than 10 years' experience are most at risk, pointing to the need for targeted prevention strategies for newer employees. By employing the proposed measures to reduce physical injuries, it will be possible to mitigate the hazards faced by paramedics, to help paramedics stay safe while rendering the most needed services.
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