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I hear it more than you would think. "Like you know, the job you do, the EM... 911 rescue thing". Ah yes. You mean my former, though still occasional, career as a paramedic? Normally met with recognition and a smile.

I realize this may be somewhat of a dry post to many who are familiar with the contents, but given the amount of email I consistently receive that asks similar questions, I figured after three years on line I should probably answer. Better late than never I suppose. So what is the burning question? Some sick and twisted, smutty detail of my expansive and oh so busy whirlwind sex life? Think again! If I find it you'll be the first to know.

No, the most prominent question I get on this site is some form of inquiry as to what a paramedic really is and what do we really do. Of course the level of ignorance varies from "why does an ambulance driver work in the helicopter", to "you guys are just doctors right", and of course every other question that exists between those polarities. The truth of what paramedics are and do really does exist between those polarities, and a few more as well. The best way for me to do this I have decided, is in a number of posts over time, as the topic is just so huge. To start off though, I will give an introduction to just what it is that a paramedic does, and the varying levels of education and training required.

Are there different levels of paramedics? In a nutshell, yes. For example in Ontario, every person who works in the EMS field full time is a certified paramedic. We no longer have the designation of EMT, as the education requirements for level one paramedics, who are actually called Primary Care Paramedics, are two years full time resulting in a community college degree. As of the year 1999, all paramedics graduating had to be from the college system. What is different from an EMT? Paramedics are assigned the responsibility of what are called delegated medical acts. These are procedures and treatments that are normally only provided by a physician. Obviously in emergency care, adaptability is key, so it mandates that non physicians be skilled in this area. Thus, paramedics.

The role the public generally understands would be that of the Advanced Care Paramedic. These individuals have gone back to school, either community college, hospital based or undergraduate settings, and have taken another two year program of study in advanced life support, physiology, and trauma management. In most places in the province and across North America, these are your highest trained paramedics and are often able to deliver a wealth of emergency drugs and treatment, cardiac defriibulation, advanced airway management etc. These are your Third Watch people.

In Ontario, and in many places through out the US, there is a third level made up of a small number of elite medics. They are often called Critical Care Paramedics (in my case as I was California trained and certified, I am known as an Intensive Care Flight Paramedic). The role of these highly specialized professionals is to literally bring the ICU or critical care environment to the patient. Normally our patients are very critically ill, usually unconscious, and often being mechanically ventilated. Virtually all of the calls I have performed as a flight paramedic have been life threatening, or patients have had otherwise very serious conditions.

The training and scope of practice for this level usually begins in a hospital based program and progresses to the medical divisions of many universities. In my case the culmination of my paramedic education was a masters in acute community care and public health. Not necessarily related to my work as an intensive care flight paramedic, but it provided for exactly the background required for my previous research position and my current position in public health ethical policy.

The scope of practice can vary widely and is usually left up to what the physician responsible for the program feels his / her medics can handle and are sufficiently trained for. In my case, when I work the occasional shift in the helicopter we have an open medication scope. Meaning, that any medication or medical therapy the patient may require, we are authorized to perform, as long as it is one we are familiar with. At last count we carried in our kit bags exactly three hundred and six various emergency and critical care drugs. And yes, it's a lot to stay on top of.

In terms of procedures, we are certified to provide some of the most challenging as well as some of the most potentially complication inducing. Though if done correctly these are procedures which often see an immediate and dramatic return to health from time sensitive critical emergencies. Recent additions to the scope of practice have included surgical cricothyrotomy, pericardial centesis, and the management and maintenance of intra aortic balloon pumps.

So that will bring it to a close for this little introduction to the field. The next time I post in this thread will be discussing the various roles a paramedic can end up functioning in. Regardless of training received or in some cases, given the roles we end up starring in, occasionally it is training never heard of!