The paramedicine profession has undergone a transformation from “stretcher bearers to practitioners” in a relatively short space of time. Increasingly, access to cutting-edge technology means that paramedics undertake sophisticated remote diagnostic testing and deliver life-saving interventions in patients’ homes and the community.

During COVID-19, paramedics, in partnership with multidisciplinary allied health teams, successfully triaged patients to prevent avoidable hospital admissions, and they continue to play a critical role in front-line decision making and triage that can determine the outcomes for the patient and the healthcare system.

Paramedics are often the first medical responders to almost every kind of medical emergency outside the hospital setting.  They are known for their versatility, composure, and ability to respond competently to confronting medical emergencies.

Paramedics do more than just transfer people to hospital. Their roles span multiple sectors and settings, including healthcare (e.g., hospitals and clinics), public health, emergency services (e.g., police, fire, and coastguards), social and mental healthcare, and public safety.

What do paramedics do?

Paramedics  make decisions about the provision of medical care in complex, often high-pressure, unpredictable, and unfamiliar environments.

Paramedics make initial environmental assessments, before drawing on the resources available to them to ascertain a patient’s medical history and the circumstances surrounding the emergency. They draw on their refined communication and clinical examination skills in order to make rapid diagnoses. They then use their emergency medicine skills to formulate and implement management plans to address a variety of illnesses and injuries affecting people of all ages.

Paramedics can respond to almost any emergency medical situation, from delivering newborn babies to providing care to elderly people and those at the end-of-life stages; they attend vehicle accidents, respond to suspected heart attacks, strokes, asthma attacks (and other breathing difficulties), fires, provide care for snake bites, suspected neck or spinal injuries, the list goes on and on!

Paramedics are proficient in the use of technology and other equipment (e.g., defibrillators, spinal and traction splints) to provide care to critically ill and injured people. They can administer oxygen, medications, and can initiate intravenous drips as required, very often providing ongoing care to a patient on the way to the hospital.

Paramedics are responsible for documenting the details of the incidents they respond to, their patient assessments and the care provided and communicating these details to other members of the care team as appropriate.

Although they often work alone when providing initial care to patients, they also work closely with a range of healthcare professionals, including general practitioners, mental health crisis teams, nurses, pharmacists.

Given the distressing circumstances to which they are often called, paramedics also provide support to the relatives, carers, friends, and members of the public who may have witnessed or provided earlier care to the patient.

 

Where do paramedics work?

Most paramedics work with public ambulance services, (or in the case of New Zealand, private ambulance services holding publicly funded service contracts).There are some emerging roles for paramedics in different settings such as general practice, urgent care centres, emergency departments, and in telehealth settings.

Paramedics are often in attendance at public gatherings where health emergencies and accidents are like to occur, for example, at sporting events or music festivals.

Paramedicine practice has evolved, and paramedics now work more diverse settings, such as general practice, hospital emergency departments, and in the justice system. Known as paramedic practitioners, these are generalists who have attained advanced qualifications to enable them to practice to a broader and high scope.

Important character traits for paramedicine

An essential quality of paramedics is the ability to make decisions under pressure—this is especially so when faced with multiple cases. Paramedics must also be calm in the face of unpredictability and unfamiliarity.

They must be physical fit so they can negotiate different, sometimes hazardous environments and terrains. They must also be fit enough to independently provide patient care that may be physically demanding.

Paramedics must be able to keep up with rapidly developing technology and maintain their skills in working with a range of tools and equipment. Paramedics are organised and conscientious, as they are accountable for keeping ambulances and equipment stocked and in good working order.

 

Professional education and regulatory frameworks

In Australia, it typically takes three years of full-time study to become a paramedic, where aspiring paramedics undertake either a bachelor of paramedicine or paramedic science. There are multiple options for paramedics who wish to advance their skills, including postgraduate short courses, graduate certificates, and diploma level study. Those who strive to become a paramedic practitioner undertake a master’s degree.

In Aotearoa New Zealand, it takes three years of full-time study—Bachelor of Health Science in Paramedicine—to become a paramedic. There are multiple options for paramedics who wish to advance their skills, including postgraduate short courses, graduate certificates, and diploma level study. Those who strive to become a paramedic practitioner undertake a master’s degree or PhD

In the UK, depending on the chosen professional preparation pathway, it takes between two and four years to become a paramedic. Paramedics can attain a bachelor’s or a master’s degree in paramedic science to begin their pathway toward registration as a paramedic. Alternatively, they can undertake a degree apprenticeship, which integrates a larger proportion of work-based learning. For those keen to be qualified more quickly (i.e., within two years), a full-time accelerated program is an option.

In South Africa, there are two ways to become a paramedic: by completing a series of short courses or the full four-year bachelor’s degree. Both ways also require about 1000 hours of clinical practice.

In the USA, aspiring paramedics complete a bachelor’s degree, or a series of associate certificates as they work toward attaining their degree.

Regulatory frameworks

In the UK and Australia, paramedicine is regulated nationally by the Health and Care Professions Council and the Australian Health Practitioner Regulation Agency, respectively. In South Africa, paramedicine is regulated nationally by the Health Professions Council of South Africa.

In Aotearoa New Zealand, paramedics are regulated by Te Kaunihera Manapou | Paramedic Council (Te Kaunihera) under the Health Practitioners Competence Assurance Act 2003.

In Canada, the regulation of paramedicine varies according to the states. Paramedics are government regulated in British Columbia, Ontario, Quebec, Prince Edward Island, and Newfoundland and Labrador. In the remaining five states, paramedics are self-regulated. There are currently no regulation frameworks in the Canadian territories.

Paramedicine is self-regulated in the USA. There are currently no regulatory frameworks for paramedicine in India.

 

Paramedicine workforce considerations

Like the other emergency services, paramedics operate 24 hours a day, 365 days per year, and unlike many of the other allied health professions, paramedics work long (often 12-hour) shifts. Even before the COVID-19 pandemic started, paramedics were under significant demand and many reported symptoms of work-related stress and burnout. Paramedics are exposed to various occupational factors that can negatively influence their mental health, including workplace violence, traumatic and distressing clinical scenarios, and demanding and irregular shift work schedules. These among other factors can increase the risk of poor mental health and symptoms including poor sleep, psychological distress, anxiety, and depression.

COVID-19 Pandemic

The pandemic increased the burden on overstretched health systems globally, with paramedics acutely feeling the impact, receiving a higher volume of callouts, and experiencing significantly impacted workflows; proper handling of PPE contributed to the latter.

With many hospitals and emergency departments at capacity, they often found themselves unable to hand over their acutely ill patients to hospital workers to continue to provide the care needed, leaving them unable to respond to other calls and patients in need.

These additional pressures are a cause for concern when considering the retention and wellbeing of paramedics.

 

Find out more about paramedicine

Here are some links to websites and resources for and about paramedics:

• The Australasian College of Paramedicine
• American Paramedic Association
• Paramedic Council of New Zealand
• Paramedic Association of Canada
• College of Paramedics – UK
• Paramedical Council of India

 

Check out our interview with paramedic Bianca Jackson.

If you have questions about the paramedicine profession, or if you wish to share your experiences as a paramedic, please leave a comment below.

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