Talk:Paramedics in the United States

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Removed for Relocation
A major rewrite of this article is currently in progress, and is intended to move the article from 'C' to 'B' or beyond. Information that is removed from the article will be placed here temporarily, so that it is not lost. Eventually, it may be relocated to another spot in the article, rewritten, or just discarded. Emrgmgmtca (talk) 12:46, 7 November 2008 (UTC) Occasionally, paramedics treat conditions that do not require hospitalization, such as during public gatherings or other large events ("event standby"). They derive the legal authority to practice pre-hospital medical care in the field through the license of a physician, who serves as the "medical director". Paramedics serve as an out-of-hospital extension of emergency services typically offered by medical doctors within the hospital emergency department. In some states, Paramedics are also called 'Mobile Intensive Care Paramedics' or MICPs and staff ambulances or other vehicles known as Mobile Intensive Care Units, or MICUs, further emphasizing the advanced treatment modalities employed by the paramedic.

Wouldn't a better title for this article be "Paramedics in the United States of America"? First of all, "Paramedics in United States", isn't really gramatically correct. It should be "Paramedics in the United States" since that's how the country is referred to. If you live in the U.S. you wouldn't say "I live in United States", you would say "I live in the United States". And secondly, just saying "United States" is ambiguous. There are many places where states are united for one reason or another but this article is referring to the United States of America specifically. I'm just going to be bold and move the article. Dismas|(talk) 04:12, 6 March 2006 (UTC)

NPOV
Some of the more recent additions to this page seem to be very much opposed to the IAFF in particular and fire-based EMS in general. Aside from the fact that such opinions are far from universal, they are inappropriate for an encyclopedia. Comments about the pro/anti fire-based EMS are for a more political forum. --catseyes 18:22, 22 May 2007 (UTC)


 * I would tend to agree with you that the recent edits don't really conform to WP:NPOV, so I've tagged the article with POV so that we can all work on it. It shouldn't be so negative on the fire service, although the current tensions that are going on should indeed be mentioned. I recall seeing articles in JEMS and I think on the NAEMT's site too, have to see if I can dig them up at some point. &mdash;Elipongo (Talk|contribs) 01:59, 30 May 2007 (UTC)

Hey all, I am the one probably responsible for the recent edits in question, and would be open to discussion. Certainly the wording is open to debate, but the facts of the changes I wrote, and their impact on EMS I dont think are. For example: The statements that recent attempts to mandate degrees for US paramedics were opposed by IAFF, and IAFC (through their opposition of the National Scope of Practice Draft, and the resultant removal of the degree requirement aqnd the advance practice paramedics because of that opposition) are fact, and are pertinent to the discussion of paramedics in the US as in many other countries they are degreed. The recent opposition by the IAFC and IAFF to oppose a parallel administration similar to the NFA, as recommended by a report from George Washington University, is also fact, and pertinent to the difficulties advancing the EMS profession in the US (as is the position by the various fire service interest groups in a public letter that such an administration would deprive them of HS funding). That non-fire EMS gets less than 4% of HS monies, is also appropriate because it demonstrates the difficulties facing EMS systems, and paramedics working for these agencies. Also pertinent to the discussion, IMHO. In addition the change to reflect that the "freedom house" project was the first true ALS EMS in the nation is a fact, so therefore is also appropriate to the article even though (if my memory serves me correctly) earlier versions listed the Miami project.

Basically, the changes are pertinent to provide an accurate description of the paramedic profession, not a description that was purely biased to the fire service/IAFF view of the paramedic profession. If we are speaking of neutrality, than this page should not reflect only the fire service view, or serve the fire services propaganda efforts (which is what previous versions seemed to do, IMHO), but must be reflective of the profession itself. So the comments are more reflective of the difficulties facing EMS in the nation today, than simply the Fire vs Non fire debate. BTW, I am a 17 year EMS professional (12 as a paramedic), teach EMS classes, and have worked for both sides of the fence. Thank you. - (croaker260)14 June 2007 —Preceding unsigned comment added by Croaker260 (talk • contribs) 07:42, 14 June 2007


 * Hello Croaker260, thanks for writing. Part of the problem is one of balance, as a neutral encyclopedia we can't play favorites- the fire service's point of view needs to be represented too. Another problem is one of tone- the way a lot of the article is phrased right now comes off as a bit of a rant against the fire service, RNs, etc- again, not something that looks very good in an encyclopedia. The biggest issue, however, is that no sources for the information have been cited. Per the Verifiability Policy, "The threshold for inclusion in Wikipedia is verifiability, not truth."
 * I too find myself frustrated and annoyed by the obstacles placed in the way of EMS, however we have to keep in mind that [WP:SOAP|Wikipedia is not a soapbox]] and do our best to keep our own opinions out of the mix and try to write good, informative, neutral articles. &mdash;Elipongo (Talk contribs) 08:15, 14 June 2007 (UTC)

Wow, this article is really opinionated and slanted. It seriously needs to be edited so there is only facts represented.

Cleanup
I propose to 1) Focus on "in the United States of America" and delete information covered by the global topic Paramedics. 2) Edit word choice, tighten sentences, improve consistency.

I offer edits in small increments. Stevecalloway 12:05, 1 August 2007 (UTC)

Dubious
...exploitation of EMS by the fire service.

Are not fire service agencies part of the emergency medical services? Who or what is being exploited? Stevecalloway 19:28, 16 August 2007 (UTC)

...registered nurses and physician assistants are not permitted to provide patient care without training at the EMT-Basic level...

The sentence above should be removed. Nursing and medical doctor curriculum teach subjects and skills well beyond EMT-B. Consider this equally irrelevant example: Paramedics are not permitted to operate an ambulance without a driver's license. Stevecalloway 19:28, 16 August 2007 (UTC)

Stevecalloway, Tennessee's EMS code specifically excludes anyone but an EMT, Paramedic, RN, RT or MD from working on an ambulance. It also states that ANY ambulance transport, reguardless of the mode or team makeup, must have an EMT to be in code. Many states also adopt this model of the law. PAs, MAs, LPNs, and other healthcare providers are not allowed without express permission from Medical Control Physicians. Many state laws also state that even if someone identifies themselves as an MD to you on a scene, it's meaningless until certian steps and criteria are met, which vary from state to state. Just because someone is an MD, doesn't mean they can tell YOU what to do. 198.254.16.200 (talk) 14:59, 10 April 2008 (UTC)Chance Gearheart, EMT-IV, Lebonheur Children's Medical Center Pedi-Flite Critical Care Team


 * Expanding on the legal authority of paramedics would make a good section and a positive contribution to the article. The context of the disputed sentence was that EMT-B skill level is equivalent to, or above, registered nurses and physician assistants by virtue of ambulance permission. The legal authority to work an ambulance supports the skills and abilities of an EMT, (below even an EMT-P paramedic), but is a poor way to compare skills with other professions. In my opinion, the comparison of paramedics with other health professionals has given this article a negative slant. Better, we should focus on the what/how/why of paramedics rather than the what/how/why others compare less favorably. Stevecalloway (talk)

Deletions
Multiple paragraphs removed August 2007 can be found in Talk History dated before April 26, 2008.


 * Source added to IAFC fighting against degrees with minor rewrite to reflect their current stance.

JPINFV (talk) 04:59, 4 March 2008 (UTC)

EMT-Paramedic vs "Paramedic" and the patch caption
I feel that the caption to the patch is misleading. Numerous states (California and Texas, for example. Albeit Texas also has a "Licensed Paramedic" level for college educated medics (2 year EMS degree or any 4 year degree)), as well as the National Registry, officially recognize the level as EMT-Paramedic. As well, numerous state patches reflect this designation. State and/or agency patches differ between them as to design, including the designation of the levels (EMT-Paramedic vs Paramedic or EMT vs EMT-Basic). As this is supposed to be more of a national article, I feel that the current wording and caption are out of place in the article. JPINFV (talk) 05:16, 4 March 2008 (UTC)
 * Please suggest an alternative wording for the caption. The issue is confusing to the public primarily because, contrary to the legal designations, paramedics are not called EMTs in the field. Example, if a BLS crew is calling for ALS, they might say "send me a paramedic" but not "send me an EMT" (though technically, paramedics are EMTs of the highest order). The point is to emphasize in this article that there is an ostensible difference between EMTs and Paramedics in the field. In NYC, the paramedic is officially an AEMTP, but they are simply called paramedics. Nurses can be either ASN, BSN, MSN, CCRN, CEN, etc., but they are still nurses in the public eye.  There needs to be some simple standard for differentiating between ALS and BLS, especially now (as you pointed out) that there are even 4-year paramedic degrees in some areas. Forget the public, there are doctors who couldn't tell you the difference between "paramedic" and "EMT" (basic) to save their lives, and this is more than a mere pretention in the highly structured ranking system of medical care. The patch was put forth to simply show that paramedics have their own unique patches to designate their level of care, it was not meant to say that all patches say "EMS Paramedic, City of New York" -- although I see your point. Alexfox29 (talk) 01:23, 6 March 2008 (UTC)


 * My problem with the patch is that the caption is boarder-line factually wrong from a national prospective because there are plenty of patches that retain the EMT-Paramedic designation. Given that it's a national article, I'm not opposed to a blurb about different nomenclature in standard practice, but the caption seems to be worded as 'paramedic patches exclude EMT to avoid confusion.' I'm not going to argue that paramedics are generally called "paramedics" while Basics are generally called "EMTs." Of course this doesn't even address the fact that each state has their own intermediate/alternative designations (EMT-CC, EMT-IV, EMT-I [roman numeral 1, not intermediate], EMT-II [2. roman numeral examples are the legislative name for Basic and Intermediates in California]), EMT-I85, EMT-I99, etc). As such, I think that the NHTSA/NREMT (yes, two separate entities, but more providers are familiar with NREMT than NHTSA and the NREMT's guidelines stems from the NHTSA) levels are more appropriate for articles with a national scope. I've got an exam tomorrow morning and I'll see what I can put together as an alternative sometime soon (I'm looking at expanding the "skills" section and am tempted to seek renaming it to "procedures"). I do think, given proper support (i.e. not stubs), that there is more than enough difference and material for a state by state page on EMS. Looking at the edit, I can't speak to what intermediates are called (are they called "EMTs" or by their designation?) since the area I worked in didn't/couldn't [California EMT-Intermediates=limited ALS" which required an express reason and approval from state EMSA for a county to certify them] utilize them.JPINFV (talk) 04:16, 6 March 2008 (UTC)
 * Your reasoning is understood. This is a gray area that is even more gray between regions, and it's difficult to nail down. Paramedics are EMTs, yet they're not called EMTs in practive. A common phrase heard in the field is, "Are you an EMT or a Paramedic?" Many people, and many physicians and nurses, don't know the difference. Intermediates were called "IV-techs" in one of the regions I worked in; there are "Critical Care Techs" in another region.  New York City EMS and FDNY only use the EMT and Paramedic designations. I've put my two cents in from my region, so I will leave it to you to shape it the way you see fit as someone who represents a new set of eyes and a distant region, and maybe we can thow a little NHTSA/NREMT in there to create a more nationwide perspective. Alexfox29 (talk) 07:50, 6 March 2008 (UTC)
 * I removed the reference to EMTs in the patch caption and tried to soften the EMT versus Paramedic statements to leave room for the ambiguity between official level of care designations and typical field jargon. Feel free to adjust further.  Your points on this were well made. Alexfox29 (talk) 15:07, 6 March 2008 (UTC)


 * Under the new National EMS Scope of Practice guidelines going into effect soon, the "EMT-Paramedic" vs "Paramedic" is going to be clarified, i.e., the official title will be "Paramedic" nationwide. In fact, all titles from Certified First Responder up through EMT-Paramedic will be changing. www.nemses.org —Preceding unsigned comment added by Pohlea (talk • contribs) 13:41, 28 September 2008 (UTC)

Paramedic vs RN?
In the following excerpt:

Paramedics in the United States, working independently and under the direction of emergency medical control physicians, generally provide the most advanced level of emergency medical care available to the general public outside of a hospital setting (flight crews utilizing registered nurses, mid-level providers (PA, NP) or physicians being the primary exception).

I'm not sure that it is universally agreed that registered nurses constitute a higher level of care than paramedics. With due respect to nurses and paramedics alike, I'd like to remove "registered nurses" from the example of when a higher level of care is available. Thoughts on this? Alexfox29 (talk) 01:40, 6 March 2008 (UTC)
 * Is it not true, though, that flight crews generally provide a higher level of care, in terms of knowledge, critical care/emergency experience, and skill set, than ground ambulances, and that a characteristic component of flight crews over ground ambulances are the presence of a flight nurse, mid level provider, or physician (of which are generally not found on emergency ambulances)? JPINFV (talk) 03:58, 6 March 2008 (UTC)
 * Your point is not unreasonable. I don't dispute that flight crews can be more skilled than ground crews, often because they were hired with a great deal of EMS or critical care experience already under their belt. And it is true that the provider components of many flight crews are exactly as you have enumerated. However, I think the way the entry was made, it could be interpreted to mean that the RN, when utilized, represents a higher level of care in the field than the paramedic. While a handful of EMS flight nurses may rival paramedics (and may actually be paramedics themselves), can nurses really provide a higher level of EMS care than paramedics in any meaningful way? This is an honest question, so if you have specifics as to the different skill sets, please fill me in.  Also worth remembering, mainstream RNs, PAs and MDs facing medical emergencies regularly reliquish care to paramedics, so I think we have to be careful about giving the impression that in any field context where RNs (or even PAs and MDs) are utilized, they necessarily represent a higher level of emergency care than paramedics. Alexfox29 (talk) 07:38, 6 March 2008 (UTC)
 * How would something like this be? "Paramedics.. working independently and under the direction of emergency medical control physicians, generally provide the most advanced level of emergency medical care available to the public outside of a hospital setting, although in some cases EMS flight crews utilize advanced level providers such as physicians." Alexfox29 (talk) 15:25, 6 March 2008 (UTC)
 * That would work.JPINFV (talk) 02:29, 7 March 2008 (UTC)
 * Coming from someone who works on a flight team, most states and agencies require the RNs be trained as EMT-Bs, Is or Paramedics before they can fly, with special experience areas in Critical Care (ICU, PICU, NICU) or ED work. These aren't just regular floor RNs that fly. Also, Flight Paramedics have certifications and advanced creditials all their own, expecially those services that are CAMS or CAMTS accredited. But, you have to remember as well, there are specialized ground transport teams that work for corporations such as Rural/Metro, and specialty hospitals such as Mercy Childrens or Lebonheur Childrens that also run ground EMS Critical Care transport trucks as well. I think limiting this article to just the definition of the Street Paramedic is misinforming people. Also, alexfox29, I don't know of very many flight teams that are rotar-wing based that utilize physicians in the transport. Most utilize an RN/Medic model, or an RN-Paramedic and Respiratory Therapist if it is a Pediatric team. Physicians are more common in smaller hospital or rural area transport teams, where there may be insufficient trained staff to staff a MICU truck.

198.254.16.200 (talk) 14:48, 10 April 2008 (UTC) Chance Gearheart, EMT-IV, LeBonheur Childrens Medical Center Pedi-Flite Critical Care Team


 * One thing to consider, though, is that numerous emergency medicine residency programs require time, both as a provider and observer, on ambulance and aeromedical units. While these physicians aren't board certified yet, they are licensed physicians (assuming that the physician isn't PGY 1). Overall, the article, like most of the EMS articles, really needs a complete rewrite with proper sourcing. There should be way more than the 15 references already included. Even the EMT article is over 30 references and doesn't cover nearly the scope of this article. -JPINFV (talk) 15:58, 10 April 2008 (UTC)

RN v Paramedics part 2. Simply put, licensed physicians do make up parts of flight teams in plenty of systems with emergency medicine residencies. The physicians in these cases can very well be fully licensed physicians, and as such, represent the highest level of medical care. Furthermore, there are systems that only use paramedics. In terms of medical control, the system's medical director (again, physician) ultimately determines what paramedics can and can't do and what they have to call in to do, if they even need base hospital permission at all. Out side of systems (cough, Southern California, cough) that extremely limit any degree of latitude in patient care without base hospital contact, it is very probable that a paramedic will be talking to a physician, not a registered nurse. JPINFV (talk) 03:28, 14 May 2008 (UTC)


 * I think that in the vast majority of cases, and the vast majority of 911 events, the general public will be dealing with paramedics in the prehospital setting -- not nurses, not doctors, not residents, not flight crews, corpsmen, pilots, beach patrol, or HAZMAT/SWATmedics -- but everyday EMS Paramedics, period. Even when RN/Paramedic flight crews are called in, who's to suggest that the RN is a "higher" level of care?  And this is, after all, an article about paramedics! Should we move this debate to the RN article? Let the medics have some breathing room here. I think to say that "in general" paramedics represent the highest level of prehospital care sums it up.  It is sufficient without getting into all of the other nitty gritty and extenuating circumstances regarding special nurses or interns or residents doing a training rotation on an ambulance, etc.  In fact, paramedics often TEACH Residents and Interns and RNs the ins and outs of ACLS.  And to suggest that Registered Nurses represent a higher level of care in the field is suggesting that RNs are inherently superior to paramedics in Emergency Prehospital Care, and 99.9% of nurses are not.  I can understand an RN thinking the contrary, but that is a premise that simply goes against the realities of the field.


 * Career Paramedics and EMTs work in austere environments that EVEN MOST FLIGHT CREWS do not deal with. A helicopter is like a hospital room in the air -- very clinical -- as opposed to trying to tube someone under a train in the subway or pinned in an upside-down vehicle.  I've never seen a nurse or doc do that in ALL MY YEARS -- only paramedics, hundreds of times.  The two states in which I've worked -- and this includes the NYC system (busiest EMS system in the world) -- it is absolutely forbidden for a paramedic crew to relinquish care to an RN in the field.  C'mon! RNs control every floor and every unit in the hospital, and WE ARE HAPPY to allow a handful to come out and work in the field with us since their skills are absolutely valuable. ;) But don't diminish the medics, please!  Let the medics have their domain and due recognition -- the field is OUR domain -- we've earned it.  We are every bit as proficient as RNs -- MORE proficient in the field (since that's our domain) -- and incidentally my training from start to finish required MORE classroom time and flaming hoops than a friend of mine who was going through RN school at the same time.


 * No disrespect to RNs and others, but this is an article about PARAMEDICS, and I think we shouldn't be embellishing it with marginally important points about those who assist paramedics any more than we should touting paramedics in the RN or MD articles. EMS crews are SOOOOOOOooooo unsung compared to MDs and RNs... It really irks me that they're showing up here looking for a piece of an article entitled "Paramedics." 69.126.101.55 (talk) 07:12, 12 June 2008 (UTC)


 * First off, I'd disagree with the notion that the public interacts most with paramedics. Considering the sheer difference in numbers between the amount of EMT-Bs compared to EMT-Ps, the public is most likely to interact with a basic (as unfortunately as it might be). Next, what is the major difference between most air ambulance crews and most ground ambulance crews? If you answered a nurse, you are correct. Furthermore, are you suggesting that information that makes this article more complete should be removed because it might step on some paramedic's ego? Seriously now, because that's what your rant is focused on. Either the fact that nurses (who, in general, ARE more educated, and no, I'm not a nurse). Either the article is correct and verifiable or not. I honestly do not care if someone's ego gets hurt because there's an entire 2 sentences that mention a few unique situations. As a final note, you can save the rhetoric. The people who are editing this page generally have prehospital care experience.JPINFV (talk) 12:36, 12 June 2008 (UTC)

I am an RN, and I have a humble suggestion: what do you think of eliminating any "Paramedic vs RN" language from the article? This is really a case of comparing apples and oranges. Paramedics are the most qualified practitioners to provide emergency medical care, especially in the field, though some paramedics provide vital services in hospitals. RNs are the most qualified practitioners to deliver NURSING care, which is usually provided in hospital, but sometimes provided in the field (such as air ambulances). These two professions use different bodies of knowledge to provide different services to patients. Quibbling about which profession is most qualified is like arguing over whether the pitcher or the catcher is the most qualified to play baseball. Both are equally qualified to do their jobs, but their jobs are different. I support mentioning the presence of RNs on flight crews because, while most pre-hospital care is provided by EMTs of varying levels, that care is sometimes provided by a team of practitioners with different knowledge and skills. I also think that readers of this article should know that hospital care, while provided primarily by nurses, is also provided by paramedics in some cases (such as paramedics staffing emergency departments) and both are properly trained to do their jobs. In an "alligators up to the elbows" situation, the differences may not be clear to an untrained observer. In fact, in some cases we may perform functions usually performed by a different team member. So what? This has nothing to do with the definitions of paramedicine or nursing. Our roles should not be viewed as a hierarchy or a chain of command, but rather, as the work of colleagues with training in separate and distinct areas of healthcare, attempting to meet related, but different patient needs, independently in some cases, and as team mates in others. —Preceding unsigned comment added by Ex89158 (talk • contribs) 16:41, 27 August 2009 (UTC)

Fair use rationale for Image:NYCEMS paramedic.jpg
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BetacommandBot (talk) 14:58, 8 March 2008 (UTC)


 * This was resolved. Alexfox29 (talk) 07:32, 10 March 2008 (UTC)

The photograph of the "NYC Paramedics" is actually a photo of NYC EMT-Basics. The unit is 4-Charlie based out of Beth Israel hospital in the lower East side. —Preceding unsigned comment added by Pohlea (talk • contribs) 13:50, 28 September 2008 (UTC)

Added section on Critical Care/flight Paramedics
I added some information on Critical Care Team certification and Flight paramedic certifications to the Professional Discrepancies section. Feel free to move it or give it it's own section if you'd like. I'm ashamed of you EMS people out there. There are actually SEVERAL different professional branches for Medics, like Tactical Operations, Wilderness Ops, Flight Medicine, and many other! 198.254.16.200 (talk) Chance Gearheart, EMT-IV, LeBonheur Childrens Medical Center Pedi-Flite Critical Care Team. —Preceding comment was added at 14:45, 10 April 2008 (UTC)

Intro Paragraphs
I did some rearranging of the introduction paragraphs, and made some clarifications. Please discuss.

November 2008 assessment
This article is insufficiently referenced to meet B class standards. Additionally, here's a short list of some current problems that should be easy to fix: Hope this helps, WhatamIdoing (talk) 05:23, 8 November 2008 (UTC)
 * Too many capital letters. They're paramedics, not Paramedics.  It's the fire department, not the Fire Department.  And so forth.
 * Two external links are in the text. We don't want the reader to click on the link to NREMT's website; we want them to finish reading this article.  Links can be more to ==External links==, or turned into refs, or just removed.  The best-case scenario is that we have an article for the organization:  then we wikilink it.
 * Too many wikilinks of the same words. For example, paramedic is linked three times in the history section.  Once is enough for any large section.  Also, you don't need to wikilink things that are just incidental to the main point.
 * A handful of minor typos. For example, a sentence ends with two periods (..).  Another is missing a space between a word and its abbreviation.  Read through each section carefully in "Preview" mode to make sure you've caught all the small typos.
 * Check all the wikilinks to make sure they go to the best page. See RSI for the one I happened to notice.
 * Too many abbreviations. Unless the abbreviation is widely known (e.g., I'd expect a young teenager to recognize 'EMT'), then don't include it unless you actually use it in the sentences that follow.
 * I think that this finally has it ready. It's much improved (you'd think I'd learn not to trust someone else's work, but I think I finally caught everything.  By the way, all of those abbreviations are pretty much an industry standard, particularly in the U.S.!  At any rate, it's ready for another look.  Sorry I bothered you before it was actually done. Emrgmgmtca (talk) 16:31, 10 November 2008 (UTC)

Description of the profession
To mirror the description of the paramedic put forth by the EMS Agenda for the Future, as supported by the NREMT, NASEMSO, DOT/NHTSA, and individual states, I have redone the introduction section of this page. The former content lead readers to glean inaccurate information regarding role of the paramedic in the United States. A standard, widely accepted description should takes its place. Additionally, the term "skills" is antiquated; in medicine, the word "procedure" is universal to describe any mechanical medical interventions. As the movement towards a more normative education standard for EMS grows, we should use terminology that matches what our counterparts use in the hospital and clinic. For precedent, see the national standard curricula where a concerted effort is obvious to revert terminology to that of all other medical professions. Arguing that the term "skills" is widely used shows failure to understand contemporary practice.

Scope of Practice Re-write
I've just rewritten the table to reflect the current National EMS Scope of Practice Model as defined by the NHTSA and endorsed by the NREMT. At present, the table needs considerable cleanup. Also, the following sections could use review to remove any redundancy. While I think that the NHTSA's format does outline the basic foundation of what skills are available to various levels of EMS, I find it to be inadequate as far as illustrating common medications and therapies ("Physician Approved Medications" is rather vague). I propose we keep a section below to list some of the common or otherwise available medications and procedures used by EMS as well as outline what the CC-EMT-P standards and expanded scope entails. Any thoughts? WarwulfX (talk) 01:04, 12 March 2012 (UTC)


 * I removed central venous access. Paramedics can maintain, but not place, central lines. Please don't replace unless you (authors in general) can cite, having worked as a paramedic in 6 states, and now as a medical director, I know this is incorrect. Similarly, paramedics can maintain and troubleshoot G tubes, but obviously can't place them (these are both sterile physician placed devices).


 * Seems some people tend to add things they believe should be in the scope of practice. Though, some people may consider External Jugular Vein cannulation a form of central venous access (technically). The National EMS Scope of Practice does NOT include CVA or G-tube insertion. We can use, manage, and maintain these, but not insert. Furthermore, the article doesn't even make mention of these at all. I think we should adhere strictly to the procedures listed in that PDF, as any variation could be considered a local change and not indicative of the profession as a whole. Technically, I need to get rid of Surgical Crics and Nasotracheal Intubation, as they are not specifically referenced (despite my personal beliefs on the usefulness of these procedures). WarwulfX (talk) 07:09, 17 February 2013 (UTC)

Realistically the scope of practice portion is incredibly important. Scope of practice differs from standing orders though. Scope of practice refers to what paramedics have been trained to do at the national level competency. Standing orders (which differ based on protocols) limit a paramedic's practical application by reducing what they are allowed to do without medical direction. Nikolasm1999 (talk) 19:59, 20 February 2021 (UTC)

Firefighters?
In the United States I've only heard the term Paramedic to refer to a service provided by the fire department's ambulance service. The term "ambulance" generically to refer to any type of ambulance. — Preceding unsigned comment added by RobertGary1 (talk • contribs) 23:03, 14 May 2012 (UTC)
 * I'm afraid that usage is inaccurate from both a technical standpoint as well as among common usage. The term "Paramedic" denotes a healthcare provider or agency that is trained and credentialed at the Paramedic level. Fire department ambulances may be certified at the Paramedic level. Or they can be credentialed at a lower level. Same applies to commercial, non-profit, and volunteer ambulances. Ambulance refers specifically to the emergency vehicle. Fire departments may be Paramedic first response agencies without necessarily providing ambulance service. 19:04, 21 May 2012 (UTC)

External links modified
Hello fellow Wikipedians,

I have just added archive links to 2 one external links on Paramedics in the United States. Please take a moment to review my edit. If necessary, add after the link to keep me from modifying it. Alternatively, you can add to keep me off the page altogether. I made the following changes:
 * Added archive https://web.archive.org/20060901161043/http://www.umc.pitt.edu/media/pcc040223/BHMS_freedom_house.html to http://www.umc.pitt.edu/media/pcc040223/BHMS_freedom_house.html
 * Added archive https://web.archive.org/20090315022311/http://www.dgprotocols.com:80/amiodarone.html to http://www.dgprotocols.com/amiodarone.html

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Cheers.—cyberbot II  Talk to my owner :Online 02:19, 15 January 2016 (UTC)

Citation for salary?
For this industry, one of the most common issues seen on salary reporting websites is the fact that they lump EMTs and paramedics into the same category, distorting the average salaries. While paramedics don't make great money, they still generally make a lot more than what is mentioned here without citation, especially post-COVID. I'd appreciate an accurate citation or removing this section. — Preceding unsigned comment added by 75.174.143.99 (talk) 19:37, 30 October 2021 (UTC)

Scottish Photo
The Scottish photo of paramedics in training seems odd, is this here for a good reason? TheMouseMen (talk) 17:46, 30 March 2022 (UTC)