Paramedicine

Paramedicine is the unique domain of practice that represents the intersection of health care, public health, and public safety. While discussed for many years, the concept of paramedicine was first formally described in the EMS Agenda for the Future (1996). Paramedicine represents an expansion of the traditional notion of emergency medical services as simply an emergency response system. Paramedicine is the totality of the roles and responsibilities of paramedics and represents the highest level of the practice of out of hospital medicine by non-physicians.

Paramedicine is a health profession focused on assisting individuals, families, and communities in attaining, re-attaining, and maintaining optimal health, often following acute or sudden onset of medical or traumatic events. Paramedicine is practiced predominantly in the out of hospital setting. The practice of paramedicine is an art, based on the sciences of human anatomy, physiology, and pathophysiology. The goal of paramedicine is to promote optimal quality of life, as defined by persons and families, throughout their life experiences, from birth to care at the end of life.

Much of the practice of paramedicine includes complex independent decision making, often in the face of incomplete, ambiguious and conflicting information. Examples of such decision making include response readiness and response, scene management, patient assessment, clinical problem solving, emergency vehicle operations, leadership, planning, therapeutic communications, disposition decisions, patient education, resource coordination. The practice of paramedicine involves the application of concepts of medical care under challanging, uncontrolled, and austere conditions.

In addition to the independent portion of practice, paramedicine involves the performance of medical skills and tasks which are regulated by law. For such regulated tasks (i.e. starting an IV, administering a medication, performing invasive tasks, etc.), the practice of paramedicine is ‘dependent.’ The dependent portion of the practice of paramedicine is based on a collaborative relationship with a physician medical director who provides medical oversight. The contemporary philosophy of medical oversight involves the physician providing treatment protocols in such a fashion as to encourage clinical problem solving and decision making. The decision regarding which protocol to implement is based on the formation of a paramedic diagnosis.

Paramedicine is based on the emerging concept of paramedic theory which is the study and analysis of how the three pillars of paramedicine (health care/medicine, public health, and public safety) interact and intersect. As stated in the IoM Report EMS at the Crossroads (2006), EMS is currently highly fragmented and largely separated from the overall health care system. A major emphasis of paramedic theory is the integration of emergency medical services, both intra-professionally and extra-professionally. Intra-professional integration is the study of resource allocation, distribution, deployment and efficiency. Extra-professional study involves the integration of EMS with the nation’s existing (and future) emergency care and health care system.

Other areas of inquiry in paramedic theory are: emergency response, response planning, community education, inter-facility transfer, disaster preparedness/response, emergency management, pandemic and epidemic, emergency response planning, special operations, medical aspects of rescue, etc.