medics[change | edit source]
Skills by certification level[change | edit source]
Although there is a great deal of variation in what paramedics are trained and permitted to do from region to region, some skills performed by paramedics include:
|Treatment issue||Common technician skills||Paramedic/advanced technician skills||Advanced paramedic skills|
|Airway management||Manual and repositioning, Oro- and nasopharyngeal airway adjuncts, manual removal of obstructions, suctioning||endotracheal intubation (in some cases, naso as well), advanced airway management, ETT, LMA, ETOA, and combitube, deep suctioning, use of Magill forceps||Rapid sequence induction, surgical airways (including needle cricothyrotomy and others)|
|Breathing||Initial assessment (rate, effort, symmetry, skin color), obstructed airway maneuver, passive oxygen administration by nasal canula, rebreathing and non-rebreathing mask, active oxygen administration by Bag-Valve-Mask (BVM) device.||pulse oximetry, active oxygen administration by endotracheal tube or other device using BVM||Use of mechanical transport ventilators, active oxygen administration by surgical airway, decompression of chest cavity using needle/valve device (needle thoracotomy)|
|Circulation||Assessment of pulse (rate, rhythm, volume), blood pressure and capillary refill, patient positioning to enhance circulation, recognition and control of hemorrhage of all types using direct and indirect pressure and tourniquets||Ability to interpret assessment findings in terms of levels of perfusion, intravenous fluid replacement, vasoconstricting drugs||intravenous plasma volume expanders, blood transfusion, intraosseous (IO) cannulation (placement of needle into marrow space of a large bone), central venous access (central venous catheter by way of external jugular or subclavian)|
|Cardiac arrest||Cardiopulmonary resuscitation, airway management, manual ventilation with BVM, automatic external defibrillator||Dynamic resuscitation including intubation, drug administration (includes anti-arrhythmics), ECG interpretation (may be limited to Lead II) Semi-automatic or manual defibrillator||Expanded drug therapy options, ECG interpretation (12 Lead), manual defibrillator, synchronized mechanical or chemical cardioversion, external pacing of the heart|
|Cardiac Monitoring||Cardiac monitoring and interpretation of ECGs||12-lead ECG monitoring and interpretation||18-lead ECG monitoring and interpretation|
|Drug administration||Limited oral, limited aerosol, limited injection (usually IM)||Intramuscular, subcutaneous, intravenous injection (bolus), IV drip||per ETT, per rectal tube, per infusion pump|
|Drug types permitted||Low-risk/immediate requirements (e.g. ASA (chest pain), nitroglycerin (chest pain), oral glucose (diabetes), glucagon (diabetes), epinephrine (Allergic Reaction), ventolin (Asthma)). Note: Some jurisdictions also permit naloxone (Narcotic Overdose), nitrous oxide (for pain); considerable variation by jurisdiction||Considerable expansion of permitted drugs, but still typically limited to about 20, including analgesics (narcotic or otherwise) (for pain), antiarrhythmics (irregularities in heartbeat), major cardiac resuscitation drugs, bronchodilators (for breathing), vasoconstrictors (to improve circulation), sedatives||Dramatically expanded (up to 60) drug list, Note: In some jurisdictions advanced levels of paramedics are permitted to administer any drug, as long as they are familiar with it. Note: In some jurisdictions certain types of advanced paramedics have limited authority to prescribe.|
|Patient assessment||Basic physical assessment, 'vital' signs, history of general and current condition||More detailed physical assessment and history, auscultation, interpretation of assessment findings, ECG interpretation, glucometry, capnography, pulse oximetry||Interpretation of lab results, interpretation of chest x-rays, interpretation of cranial CT scan, limited medical diagnosis (e.g. rule out fracture using Ottawa Ankle Rules)|
|Wound management||Assessment, control of bleeding, applicatio