ramedics working under the direction of emergency medical control physicians, provide the most advanced level of emergency medical care available to the general public outside of a hospital setting. Exceptions to this general statement include those physicians who sometimes operate with air ambulance services, and some jurisdictions with specially trained Critical Care Paramedic for inter-hospital critical care transfers.
Canada[change | edit source]
In most of Canada there are 3 levels of Paramedics: the Primary Care Paramedic with limited pharmaceutical protocols, the Advanced Care Paramedic with full ACLS qualification, and the Critical Care Transport Paramedic with very advanced qualifications. Several variations to this system occur in the City of Toronto and the province of Saskatchewan, which uses a four level model with Level I (Primary Care), Level II (Intermediate Care), Level III (Advanced Care) and Critical Care Transport Paramedics. It should also be noted that many Canadian jurisdictions do not use multiple levels of paramedics. There are many smaller and isolated communities which, for reasons of potential skills decay, medical control issues, or costs, operate with Primary Care Paramedics only. In Canada, paramedics provide the most advanced level of emergency medical care available to the general public outside of a hospital setting. Advanced Care and Critical Care Paramedics are able to perform more delegated medical acts than any other health professional besides physicians in the pre-hospital setting.
In a number of Canadian centres, paramedics are currently using a 12-Lead ECG to diagnose ST-Elevated Myocardial Infarction (STEMI), a specific type of heart attack. The experience of paramedics from the City of Ottawa with the use of this procedure was recently a topic of an article in the New England Journal of Medicine. Ottawa paramedics were the first paramedic service in Canada to have this STEMI protocol, which is now being implemented across the world, available to treat their patients.
Europe[change | edit source]
In many parts of Europe a different paradigm is used for prehospital care, in which doctors, nurses and occasionally medical students function as pre-hospital providers, either in conjunction with or instead of paramedics. The following are two fairly representative examples illustrating the differing approach to the idea of paramedics in Europe.
France[change | edit source]
Paramedics, as we understand the role, do not exist in France. Within France, EMS is provided by means of an organization called a SAMU for each French Departement (county). Emergency response may be through the use of a fire department-based ambulance, such as the Paris Fire Department (www.pompiersparis.fr), or by an ambulance (labeled SAMU)staffed by a physician-led team (SMUR). The French philosophy is to provide more definitive care at the scene during life-threatening emergencies, and a SMUR team, consisting of a physician, a nurse, and an ambulance driver, may elect to conduct the majority of care, even resusctitation attempts, at the scene, prior to transport. SMUR teams are typically hospital-based. Since 1986, fire department-based ambulances have had the option of providing resuscitation service (reanimation) using specially-trained nurses, operating on protocols, in the role that we would normally expect to be performed by the paramedic. In actual practise, however, such units, and nurses, are extremely rare outside of the City of Paris. In France non-emergency and low-priority ambulance services are normally provided by private companies, with no formal requirements for the training of their staff.
Germany[change | edit source]
In Germany, the closest role to that of paramedic is called Rettungassistent. Although there are others working in EMS in Germany, this is considered to be the only professional role, and the training of subordinate staff can vary greatly. The Rettungassistent is required to complete two years of training, the first consisting of theory classes at the post-secondary level, and ho