EMR
Primary care paramedic
Advanced care paramedic
− Human physiology
− Basic medical equipment operation (monitors, AEDs, tank regulators)
− Vehicle operation
− Extrication
− History taking and physical examination
Medications/routes
Assist patient with their own
p.o.:
− ASA
− Glucose
IM: Epinephrine
p.o./IM/nebulized: Glucagon, Epinephrine, Ventolin, Atrovent, ASA
SL: Nitroglycerin
IV: D50W, NS
Multiple medications, including
crystalloids, colloids, narcotics, paralytics, and pressors.
Administered via: p.o. Inhalation, SL, IV, Endotracheal tube, IO, p.r.
Airway/ventilation
− Nasopharyngeal
− Oropharyngeal
− Bag Valve Mask
− NPA, OPA, BVM
− Non-visualized airways (combitube, King LT)
− End-tidal CO2 monitoring
− All EMT airways devices
− Endotracheal intubation
− Surgical airways
− Utilizing mechanical ventilators, CPAP
Cardiac care
− CPR
− AED
− CPR, AED
− 3 and 4 lead ECG
− Basic rhythm and conduction blocks on 12-lead ECG
− Manual defibrillation, cardioversion and pacing
− 12 and 15 lead ECG interpretation including BBBs, NSTEMI/STEMI localization
− ABG and basic lab collection and interpretation
− Monitoring of arterial line, CVP, pulmonary artery catheter, intra-aortic balloon pump, infusion pumps, central lines
Procedural skills
Direct pressure upon wounds
Hemostatic clamps
Pelvic binding
Intravenous access
− All of EMT
− Needle thoracocentesis
− Pericardiocentesis
− NG, OG, Foley placement
− Basic suturing
Basic Life Support or BLS care is deemed when Primary Care Paramedics (PCP) only provide EMS response. Where limited ALS is available, BLS paramedics may provide first response to a trauma scene with or without ALS backup. EMS systems have evolved novel strategies to utilize ALS care. Some have mixed crew configurations with an ACP and PCP working on an ambulance. Some systems utilize an ACP on a roving vehicle which back up BLS practitioners when needed. EMS systems find solutions to meet the evolving standards of out-of-hospital care with the levels of practitioner available in their system.
The first responder is often the first on scene during trauma. This is often provided by full-time or volunteer firefighters as part of an integrated dispatch process. There are a few models around North America where police have adopted the first responder role. Regardless, within the public safety model, outside community agencies will work closely with EMS to provide care at the scene of a traumatized patient. First responders provide the extra hands, scene control, rescue, and extrication skills required in a busy trauma scene.