ements with a single private company for the operation of their EMS systems. Other Canadian provinces use still other approaches to the provision of service and the operating environment in which paramedics will work.
In Australia, paramedics work exclusively for the State Ambulance Service, including Ambulance Victoria service (http://www.ambulance.vic.gov.au/), among others. Public ambulance services in Australia are exclusively third-service option. These services are operated directly by each of the states and territories. A separate service is provided for the Australian Capitol Territory. Unlike the U.S., Australian paramedics are not typically employed in hospitals or the fire brigade. While there are a handful of private ambulance companies operating in Australia, these do not typically provide what would normally be described as 'paramedic' levels of service.
In some centers, some paramedics have begun to specialize their practice. This specialization frequently is to some degree tied to the environment in which the paramedic will work. One of the earliest examples of this involved aviation medicine, and the use of helicopters. Another was the transfer of critical care patients between facilities. While some jurisdictions still use physicians, nurses and technicians for this purpose, increasingly, this role falls to specially-trained, very senior and experienced paramedics, who perform this role as their primary job function. Other areas of specialization include such roles as tactical paramedics working in police tactical units, marine paramedics, hazardous materials (Hazmat)teams, and Heavy Urban Search and Rescue. Still others work in physical isolation, on offshore oil platforms, oil and mineral exploration teams, and in the military. In some cases, one can even find paramedics working on cruise ships! A new and evolving role for paramedics involves the expansion of their practice into the provision of relatively simple primary health care and assessment services.
Examples of skills performed by paramedics[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-arr