Paramedic - Knowledge (XXG)

910:, most of whom were Black. New York City's Saint Vincent's Hospital developed the United States' first Mobile Coronary Care Unit (MCCU) under the medical direction of William Grace, MD, and based on Frank Pantridge's MCCU project in Belfast, Northern Ireland. In 1967, Eugene Nagle, MD and Jim Hirschmann, MD helped pioneer the United States' first EKG telemetry transmission to a hospital and then in 1968, a functional paramedic program in conjunction with the City of Miami Fire Department. In 1969, the City of Columbus Fire Services joined with the Ohio State University Medical Center to develop the "HEARTMOBILE" paramedic program under the medical direction of James Warren, MD and Richard Lewis, MD. In 1969, the Haywood County (NC) Volunteer Rescue Squad developed a paramedic program (then called Mobile Intensive Care Technicians) under the medical direction of Ralph Feichter, MD. In 1969, the initial Los Angeles paramedic training program was instituted in conjunction with Harbor General Hospital, now 1339: 162:, with paramedics often being at a higher grade with more responsibility and autonomy following substantially greater education and training. The primary role of a paramedic is to stabilize people with life-threatening injuries and transport these patients to a higher level of care (typically an emergency department). Due to the nature of their job, paramedics work in many environments, including roadways, people's homes, and depending on their qualifications, wilderness environments, hospitals, aircraft, and with SWAT teams during police operations. Paramedics also work in non-emergency situations, such as transporting chronically ill patients to and from treatment centers and in some areas, address social determinants of health and provide in-home care to ill patients at risk of hospitalization (a practice known as community paramedicine). 294: 578:, which should provide a compelling reason to implement preventive mental health measures within this profession. Moreover, there is an extra risk for CVDs because of the heaviness of emergency response operations. There is a need to emphasize cancer risk and the importance of constant exploration and individualized prevention patterns. Besides, there is the cumulative effect of fatigue, violence, and trauma on the health of paramedics. As a result, there is a need for systematic monitoring and preventive measures in health among paramedics. It is necessary to study long-term health risks for paramedics and apply a prophylactic approach to maintaining the health state of healthcare professionals. 743: 2393: 1223:(HCPC), and in order to qualify for registration you must meet the standards for registration, which include having a degree obtained through an approved course. The change of entry requirements does not affect currently registered Paramedics, some of whom will still only have their entry qualification, but it is common for Paramedics to continue to progress through "top up" courses, for instance, to work towards a Bachelors of Science degree. This has led to Paramedics holding a wide range of qualifications, with some qualifications (such as master's degrees in Advanced or Paramedic Practice) being a pre-requisite for paramedic prescribing. 554:, are some of the mental health issues paramedics are likely to get exposed to due to their nature of work as compared to the general population. Stable support systems that may include peer counselling and the availability of mental health resources become essential in building the resilience of paramedic professionals. Peer counselling programs appear to be an effective stress management strategy for paramedics. Taking part in open discussions with other peers who understand what the employee is going through determines the necessary supportive grounds that facilitate managing and processing feelings related to this work. 851: 1239:

assessment) in order to use the title "specialist". There are also now a growing number of these advanced paramedics who are independent and supplementary prescribers. There are also 'Critical Care Paramedics' who specialise in acute emergency incidents. In 2018, the UK government changed legislation allowing Paramedics to independently prescribe, which will open new pathways to Paramedics to progress into. This came into force on 1 April 2018, but did not immediately affect practice as guidance was still being written.

1065:. Comparisons have been made between Paramedics and nurses; with nurses now requiring degree entry (BSc) the knowledge deficit is large between the two fields. This has led to many countries passing laws to protect the title of "paramedic" (or its local equivalent) from use by anyone except those qualified and experienced to a defined standard. This usually means that paramedics must be registered with the appropriate body in their country; for example all paramedics in the United Kingdom must by registered with the 980:, which ran from 1972 to 1977, portraying the exploits of this new profession called paramedics. The show gained popularity with emergency services personnel, the medical community, and the general public. When the show first aired in 1972, there were just six paramedic units operating in three pilot programs in the whole of the US, and the term paramedic was essentially unknown. By the time the program ended in 1977, there were paramedics operating in all fifty states. The show's 169:. In the Anglo-American model, paramedics are autonomous decision-makers. In some countries such as the United Kingdom and South Africa, the paramedic role has developed into an autonomous health profession. In the Franco-German model, ambulance care is led by physicians. In some versions of this model, such as France, there is no direct equivalent to a paramedic. Ambulance staff have either the more advanced qualifications of a physician or less advanced training in 1161:

towards a university degree-based program. The province of Ontario announced that by September 2021, the entry level primary care paramedic post-secondary program would be enhanced from a two-year diploma to a three-year advanced diploma in primary care paramedicine. Resultantly, advanced care paramedics in Ontario will require a minimum of four years of post-secondary education and critical care paramedics will require five years of post-secondary education.

213:. Some specific recommendations include modified call queries, symptom screening, universal PPE use, hand hygiene, physical distancing, and stringent disinfection protocols. Research on ambulance ventilation systems found that aerosols often recirculate throughout the compartment, creating a health hazard for paramedics when transporting sick patients capable of airborne transmission. Unidirectional airflow design can better protect workers. 1278:, or anatomy and physiology courses from an accredited college or university. Paramedics in some states must attend up to 50+ hours of ongoing education, plus maintain Pediatric Advanced Life Support and Advanced Cardiac Life Support. National Registry requires 70 + hours to maintain its certification or one may re-certify through completing the written computer based adaptive testing again (between 90 and 120 questions) every two years. 38: 895:, the US government moved to develop minimum standards for ambulance training, ambulance equipment and vehicle design. These new standards were incorporated into Federal Highway Safety legislation and the states were advised to either adopt these standards into state laws or risk a reduction in Federal highway safety funding. The "White Paper" also prompted the inception of a number of emergency medical service (EMS) 436:, resulting to thousands of paramedics impacted annually. Vehicle safety features need to be known by paramedics, and so must undergo exhaustive emergency driving training, which looks into curbing the provisions that are the peril of transportation. Paramedics are frequently assaulted by patients or bystanders affecting around 2,000 EMS workers annually, which further hammers the need for training on de-escalation. 1124: 754: 1390:, firefighters have been offered free paramedic training. There are also many paramedics who volunteer for backcountry or wilderness rescue teams, and small town rescue squads. In the specific case of an ambulance service being maintained by a fire department, paramedics and EMTs may be required to maintain firefighting and rescue skills as well as medical skills, and vice versa. In some instances, such as 217: 1037: 1144:, in 1972. The program, which intended to upgrade the then mandatory 160 hours of training for ambulance attendants, was found to be too costly and premature. The program was abandoned after two years, and it was more than a decade before the legislative authority for its graduates to practice was put into place. An alternative program which provided 1,400 hours of training at the 1362:, and the transfer of critical care patients between facilities. While some jurisdictions still use physicians, nurses, and technicians for transporting patients, increasingly this role falls to specialized senior and experienced paramedics. Other areas of specialization include such roles as tactical paramedics working in police units, marine paramedics, hazardous materials ( 1636: 458: 1632:. The specific medications they are permitted to administer vary widely, based on local standards of care and protocols. For an accurate description of permitted drugs or procedures in a given location, it is necessary to contact that jurisdiction directly. A representative list of medications may commonly include: 1234:. This is a fully autonomous role, and such senior paramedics are now working in hospitals, community teams such as rapid response teams, and also in increasing numbers in general practice, where their role includes acute presentations, complex chronic care and end of life management. They work as part of the 880:. Key factors contributing to victim survival in transport to definitive care such as a hospital were identified as comprehensive trauma care, rapid transport to designated trauma facilities, and the presence of medical corpsmen who were trained to perform certain critical advanced medical procedures such as 1084:

Physicians began to take more interest in paramedics from a research perspective as well. By about 1990, the fluctuating trends began to diminish, being replaced by outcomes-based research. This research then drove further evolution of the practice of both paramedics and the emergency physicians who

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and skill set has existed in a state of flux. Requirements often originated and evolved at the local level, and were based upon the preferences of physician advisers and medical directors. Recommended treatments would change regularly, often changing more like a fashion than a scientific discipline.

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who often possessed the only local transport allowing a passenger to lie down. In most cases these ambulances were operated by drivers and attendants with little or no medical training, and it was some time before formal training began to appear in some units. An early example was the members of the

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were typically determined by local medical directors based primarily on the perceived needs of the community along with affordability. There were also large differences between localities in the amount and type of training required, and how it would be provided. This ranged from in-service training

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affecting around 6,000 EMS workers. This realization strengthens the need for science-based methods in preventing the occupational risks posed by infectious diseases with a foregrounding of the role of preventative measures geared towards protecting the health of paramedic professionals and, at the

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In many localities, paramedics operate as a direct extension of a physician medical director and practice as an extension of the medical director's license. In the United States, a physician delegates authority under an individual state's Medical Practice Act. This gives a paramedic the ability to

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trained its first group internally, before the process spread across the country. By 2010 the Ontario system involved a two-year community college based program, including both hospital and field clinical components, prior to designation as a Primary Care Paramedic, although it is starting to head

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techniques and patient-handling equipment are major factors in reducing paramedics’ physical injury risk. Workers with less than 10 years’ experience are most at risk, pointing to the need for targeted prevention strategies for newer employees. By employing the proposed measures to reduce physical

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team including Doctors, Nurses, physician Associates, Physiotherapists, Associate Physicians, Health Care Assistant and Clinical Pharmacists. Paramedic Practitioners also undertake examinations modelled upon the MRCGP (a combination of applied knowledge exams, clinical skills and work place based

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Paramedics are employed by a variety of different organizations, and the services they provide may occur under differing organizational structures, depending on the part of the world. A new and evolving role for paramedics involves the expansion of their practice into the provision of relatively

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still occurs in some jurisdictions, it has become increasingly rare. Day-to-day operations largely moved from direct and immediate medical control to pre-written protocols or standing orders, with the paramedic typically seeking advice after the options in the standing orders had been exhausted.

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Changes in procedures also included the manner in which the work of paramedics was overseen and managed. In the early days medical control and oversight was direct and immediate, with paramedics calling into a local hospital and receiving orders for every individual procedure or drug. While this

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under the medical direction of Leonard Cobb, MD. The Marietta (GA) initial paramedic project was instituted in the Fall of 1970 in conjunction with Kennestone Hospital and Metro Ambulance Service, Inc. under the medical direction of Luther Fortson, MD. The Los Angeles County and City established

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and standard precautions are necessary to prevent harmful exposures for paramedics. Desirable implementation of the ordered processing of hazardous material and the proper decontamination process are effective strategies in combating hazard risk. Such steps are necessary to ensure fewer cases of

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The development of the profession has been a gradual move from simply transporting patients to hospital, to more advanced treatments in the field. In some countries, the paramedic may take on the role as part of a system to prevent hospitalization entirely and, through practitioners, are able to

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Lindsley, William G.; Blachere, Francoise M.; McClelland, Tia L.; Neu, Dylan T.; Mnatsakanova, Anna; Martin, Stephen B.; Mead, Kenneth R.; Noti, John D. (2019-10-22). "Efficacy of an ambulance ventilation system in reducing EMS worker exposure to airborne particles from a patient cough aerosol

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As described above, many jurisdictions have different levels of paramedic training, leading to variations in what procedures different paramedics may perform depending upon their qualifications. Three common general divisions of paramedic training are the basic technician, general paramedic or

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services after the end of World War II. Training was frequently conducted internally, although national levels of coordination led to more standardization of staff training. Ambulance services were merged into county-level agencies in 1974, and then into regional agencies in 2006. The regional

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provides global views by laying international standards to protect the well-being of the staff involved in the healthcare provided, irrespective of whether it is an emergency or routine operation. Such regulatory bodies, as the ones promoting national and global safety standards, ensure that

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Paramedics are exposed to a variety of hazards such as lifting patients and equipment, treating those with infectious disease, handling hazardous substances, and transportation via ground or air vehicles. Employers can prevent occupational illness or injury by providing safe patient handling

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and clinical hours for a paramedic program of 1,500 or more hours of classroom training and 500+ clinical hours to be accredited and nationally recognized. Calendar length typically varies from 12 months to upwards of two years, excluding degree options, EMT training, work experience, and

1181:. They operate in MED evac and ambulances. They are legalized under the 1976 Doctors Ordinance (Decree). In a 2016 study at the Ben Gurion University of the Negev it was found that 73% of trained paramedics stop working within a five-year period, and 93% stop treating within 10 years. 1060:

The variations in educational approaches and standards required for paramedics has led to large differences in the required qualifications between locations—both within individual countries and from country to country. Within the UK training is a three-year course equivalent to a

943:. It would take several more years before these technologies drifted through to civilian applications. In North America, physicians were judged to be too expensive to be used in the pre-hospital setting, although such initiatives were implemented, and sometimes still operate, in 2409:(off-line medical control) and direct physician consultation via phone or radio (on-line medical control). Under this paradigm, paramedics effectively assume the role of out-of-hospital field agents to regional emergency physicians, with independent clinical decision. 505:

can be used for eye protection. Underhand protection, paramedics can employ gloves mainly to curb burns. One of the principles of PPE is that choices should be guided by specific risks associated with various emergencies, which warrant different PPE requirements.

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Throughout the 1970s and 1980s, the paramedic field continued to evolve, with a shift in emphasis from patient transport to treatment both on scene and en route to hospitals. This led to some services changing their descriptions from "ambulance services" to

1016:, was instrumental in organizing emergency health services in southern California earlier in his career during the 1970s, in the paramedic program in Pittsburgh, and had a substantial role in the founding of the paramedic programs in Toronto and 1135:

While the evolution of paramedicine described above is focused largely on the US, many other countries followed a similar pattern, although often with significant variations. Canada, for example, attempted a pilot paramedic training program at

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motorized ambulances started to be developed, but once they proved their effectiveness on the battlefield during the war the concept spread rapidly to civilian systems. In terms of advanced skills, once again the military led the way. During

173:. In other versions of the Franco-German model, such as Germany, paramedics do exist. Their role is very similar to the role of paramedics in the Anglo-American model with an advanced scope of autonomy and practice, and the added element of 1385:

for their area, although this employer could itself be working under a number of models, including a specific autonomous public ambulance service, a fire department, a hospital based service, or a private company working under contract. In

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prerequisites. It is required to be a certified Emergency Medical Technician prior to starting paramedic training. Entry requirements vary, but many paramedic programs also have prerequisites such as one year required work experience as an

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In some cases paramedics may gain further qualifications to extend their status to that of a paramedic practitioner or advanced paramedic, which may allow them to administer a wider range of drugs and use a wider range of clinical skills.

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Associated technologies also rapidly evolved and changed, with medical equipment manufacturers having to adapt equipment that worked inadequately outside of hospitals, to be able to cope with the less controlled pre-hospital environment.

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advanced technician, and advanced paramedic. Common skills that these three certification levels may practice are summarized in the table below. The skills for the higher levels automatically also assume those listed for lower levels.

395:. As a result, they must understand how to deliver care safely to remain protected in the service provision. They need to remain cautious for them to stay safe in the process of providing care. There are numerous associated risks from 3288:

Tamminga, Sietske J; Emal, Lima M; Boschman, Julitta S; Levasseur, Alice; Thota, Anilkrishna; Ruotsalainen, Jani H; Schelvis, Roosmarijn MC; Nieuwenhuijsen, Karen; van der Molen, Henk F (2023-05-12). Cochrane Work Group (ed.).

2828:"Interim Recommendations for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points/Emergency Communication Centers (PSAP/ECCs) in the United States During the Coronavirus Disease (COVID-19) Pandemic" 2551: 864: 1097:, to changes in drug protocols. As the profession grew, some paramedics went on to become not just research participants, but researchers in their own right, with their own projects and journal publications. In 2010, the 834:

to perform the advanced procedures. While both of these experiments had certain levels of success, the technology had not yet reached a sufficiently advanced level to be fully effective; for example, the Toronto portable

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Not all ambulance personnel are paramedics, although the term is sometimes used informally to refer to any ambulance personnel. In some English-speaking countries, there is an official distinction between paramedics and

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to reduce and eliminate crash-related injuries to EMS workers. Through effective training, the threat cases are more likely to be mitigated, and the paramedics will have a better chance to provide services as required.

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The provision of municipal ambulance services and paramedics, can vary by area, even within the same country or state. For instance, in Canada, the province of British Columbia operates a province-wide service (the

739:. After returning home, some veterans began to attempt to apply what had they had seen on the battlefield to their own communities, and commenced the creation of volunteer life-saving squads and ambulance corps. 650:

Throughout the evolution of pre-hospitalization care, there has been an ongoing association with military conflict. One of the first indications of a formal process for managing injured people dates from the

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These early developments in formalized ambulance services were decided at local levels, and this led to services being provided by diverse operators such as the local hospital, police, fire brigade, or even

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in 1970. Other cities and states passed their own paramedic bills, leading to the formation of services across the US. Many other countries also followed suit, and paramedic units formed around the world.

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Verbeek, Jos H; Rajamaki, Blair; Ijaz, Sharea; Sauni, Riitta; Toomey, Elaine; Blackwood, Bronagh; Tikka, Christina; Ruotsalainen, Jani H; Kilinc Balci, F Selcen (2020-04-15). Cochrane Work Group (ed.).

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In places where paramedics are recognised health care professionals registered with an appropriate body, they can conduct all procedures authorised for their profession, including the administration of

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level prior to commencing employment was then tried, and made mandatory in 1977, with formal certification examinations being introduced in 1978. Similar programs occurred at roughly the same time in

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Paramedics work in various settings including NHS and Independent Ambulance Providers, Air Ambulances, Emergency Departments and other alternative settings. Some paramedics have gone on to become

181:) or on scene with a rapid response vehicle / helicopter. The role of paramedics in Germany has evolved from support to physicians in the field to the central role in pre-hospital emergency care. 2405:

practice within limited scope of practice in law, along with state DOH guidelines and medical control oversight. The authority to practice in this manner is granted in the form of standing orders

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by injection in emergency situations, and pharmacists' mates on warships were permitted to do even more without the guidance of a physician. The Korean War also marked the first widespread use of

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Paramedicine continues to grow and evolve into a formal profession in its own right, complete with its own standards and body of knowledge, and in many locations paramedics have formed their own

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in local systems, through community colleges, and up to university level education. This emphasis on increasing qualifications has followed the progression of other health professions such as

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Fratta, Kyle A.; Levy, Matthew J.; Brothers, James M.; Baer, Gamaliel D.; Scharf, Becca; Fratta, Kyle A.; Levy, Matthew J.; Brothers, James M.; Baer, Gamaliel D.; Scharf, Becca (2020-09-12).

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calls, which include patient care and transport. These injuries are prevalent but not impossible to overcome; they require preventive measures to minimize the chance of them happening. Safe

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Charlier, Bruno; Coglianese, Albino; De Rosa, Federica; De Caro, Francesco; Piazza, Ornella; Motta, Oriana; Borrelli, Anna; Capunzo, Mario; Filippelli, Amelia; Izzo, Viviana (2021-01-14).

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In some areas, paramedics are only permitted to practice many advanced skills while assisting a physician who is physically present, except for immediately life-threatening emergencies.

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equipment, implementing a training program to educate paramedics on job hazards, and supplying PPE such as respirators, gloves, and isolation gowns when dealing with biological hazards.

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offer comprehensive guidelines that highlight the integration of safety protocols, technological advancements, and procedural innovations to enhance paramedic safety and well-being.

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Durham, Mark; Westhead, Pete; Griffiths, David; Lyon, Richard; Lau-Walker, Margaret (2020). "Prehospital neuromuscular blockade post OHCA: UK's first paramedic-delivered protocol".

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offer paramedic programs and two-year associate degrees, a handful of universities also offer a four-year bachelor's degree component. The national standard course minimum requires

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The early technicians with limited training, performing a small and specific set of procedures, has become a role beginning to require a foundation degree in countries such as

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One way of ensuring paramedics work at optimal efficiency is to provide them with protective equipment and gear to mitigate the possible risks when executing their duties.

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and there is now a significant standardization of training and skills. The UK model has three levels of ambulance staff. In increasing order of clinical skill these are:

3531:"The effects of emergency medical service work on the psychological, physical, and social well-being of ambulance personnel: a systematic review of qualitative research" 1190: 126:

trained in the medical model, whose main role has historically been to respond to emergency calls for medical help outside of a hospital. Paramedics work as part of the

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While there are varying degrees of training and expectations around the world, a set of skills practised by paramedics in the pre-hospital setting commonly includes:

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Some paramedics have begun to specialize their practice, frequently in association with the environment in which they will work. Some early examples of this involved

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Expanded resuscitation skills including supraglottic airway placement, monitoring of capnography, administration of epinephrine/adrenaline (in some jurisdictions).

1313: 3106:"Work-related posttraumatic stress disorder in paramedics in comparison to data from the general population of working age. A systematic review and meta-analysis" 43: 3456:"Factors Influencing Use of Personal Protective Equipment Among Emergency Medical Services Responders During the COVID-19 Pandemic: A Retrospective Chart Review" 615: 591: 441: 233: 2745:"Which extended paramedic skills are making an impact in emergency care and can be related to the UK paramedic system? A systematic review of the literature" 992:

and responsible for the UCLA paramedic program; he would go on to help establish paramedic programs throughout the US, and was the founding publisher of the

2597: 347: 2467: 2139:(placement of needle into marrow space of a large bone), central venous access (using central venous catheter by way of external jugular or subclavian), 1265:

options. Paramedic education programs typically follow the U.S. NHTSA EMS Curriculum, DOT or National Registry of EMTs. While many regionally accredited

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By the early 1960s experiments in improving medical care had begun in some civilian centres. One early experiment involved the provision of pre-hospital

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injuries, it will be possible to mitigate the hazards faced by paramedics, to help paramedics stay safe while rendering the most needed services.

4810: 4800: 363: 868:—was published in the United States. This paper presented data showing that soldiers who were seriously wounded on the battlefields during the 711:

While civilian communities had organized ways to deal with prehospitalisation care and transportation of the sick and dying as far back as the

210: 189:, or undertaking 'see and refer' visits, where the paramedic directly refers a patient to specialist services without taking them to hospital. 3766: 1219:

degree in Pre-Hospital Care or Paramedic Science. As the title "Paramedic" is legally protected, those utilising must be registered with the

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In Israel, paramedics are trained in either of the following ways: a three-year degree in Emergency Medicine (B.EMS), a year and three months

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framework for paramedics is highly dependent on the overall structure of emergency medical services in the territory where they are working.

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pandemic strengthens the necessity of following safety protocols. Preventive measures for healthcare workers from needlestick injuries and

2392: 3168:"Causes of stress and poor wellbeing among paramedic students in Saudi Arabia and the United Kingdom: a cross-cultural qualitative study" 3054:"Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff" 4474: 3722: 2418: 1539: 1220: 1066: 2366:), fracture/dislocation reduction, umbilical venous access, chemically facilitated extrication, emergency surgical procedures such as 1399: 1394:, a fire department may provide emergency medical services, but as a rapid response or rescue unit rather than a transport ambulance. 1391: 3791: 2688:"Veränderungen und Entwicklungen in der präklinischen Notfallversorgung: Zentrale Herausforderungen für das Rettungsdienstmanagement" 257:

Paramedics are widely recognized to face high risks of physical injuries in their line of work. More than 22,000 EMS providers visit

1009: 523: 3673: 1137: 530:. The psychological aspect is intertwined with the nature of the paramedics' work. Exposure to traumatic events such as accidents, 493:. The different types of PPE include respiratory, eye, face, and hand protection. Under respiratory protection, paramedics can use 2812: 974:, happened to encounter "firemen who spoke like doctors and worked with them". This concept developed into the television series 138:

of a paramedic varies between countries, but generally includes autonomous decision making around the emergency care of patients.

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across the US including paramedic programs. The success of these units led to a rapid transition to make them fully operational.

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Svenson, James; Biedermann, Marc (2011). "Ketamine: a unique drug with several potential uses in the prehospital setting".

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used to reduce the irritability or agitation of patients, to relieve symptoms of seizure, or provide procedural sedation

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each year for work-related injuries. Some physical injuries encountered when providing healthcare services include

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Intravenous fluids, dextrose infusion (hypoglycemia), and symptom relief medications such as ondansetron (nausea),

1235: 1128: 1030: 417: 166: 127: 27: 4536: 2604: 2003: 1382: 919: 918:, MD and James Lewis, MD. In 1969, the Seattle "Medic 1" paramedic program was developed in conjunction with the 627: 595: 237: 134:. They also have roles in emergency medicine, primary care, transfer medicine and remote/offshore medicine. The 4457: 3397:

Reichard, Audrey A.; Marsh, Suzanne M.; Tonozzi, Theresa R.; Konda, Srinivas; Gormley, Mirinda A. (2017-07-04).

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Lawn, Sharon; Roberts, Louise; Willis, Eileen; Couzner, Leah; Mohammadi, Leila; Goble, Elizabeth (2020-07-03).

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filling a similar function; this organisation continued, and evolved into what is now known throughout the

4672: 2342: 2296: 2208: 1606: 1178: 1069:(HCPC) in order to call themselves a paramedic. In the United States, a similar system is operated by the 567: 2603:. Health Resources and Services Administration, Office of Rural Health Policy. March 2012. Archived from 1230:, a role that practices independently in the pre-hospital environment in a capacity similar to that of a 844: 444:

have conducted ambulance crash testing, resulting in the development of 10 test methods published by the

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administration by nasal cannula, rebreathing and non-rebreathing mask, positive pressure ventilation by

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and temporary. In time, however, these arrangements began to formalize and become permanent. During the

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occurring only after significant research demonstrated their need and effectiveness (an example being

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Emergency medical services (EMS) personnel deliver emergency medical treatment before hospital arrival

4634: 4597: 2504: 2452: 2447: 2015: 1262: 1118: 1102: 1062: 806:". These innovations would not find their way into the civilian sphere for nearly twenty more years. 527: 515: 498: 362:

usage in implementation and vaccination compliance are effective transmission reduction measures for

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and strict adherence to post-exposure protocols, enhances safety. Additionally, staying updated with

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The role of a paramedic varies widely across the world, as EMS providers operate with many different

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Low-risk and immediate requirements, e.g., aspirin and nitroglycerin (chest pain), oral glucose and

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Today, university qualifications are expected for paramedics, with the current entry level being a

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McCann-Pineo, Molly; Li, Timmy; Barbara, Paul; Levinsky, Brian; Berkowitz, Jonathan (2022-05-05).

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to evacuate the wounded from forward positions to medical units, leading to the rise of the term "

4759: 4687: 4513: 4310: 4232: 3845: 2913: 2359: 2140: 1842: 1514: 1454: 1343: 1231: 803: 762: 728: 724: 696: 659:, no longer able to fight, were given the task of organizing the removal of the wounded from the 623: 367: 315: 270: 4207:

Metcalf, Matthew (2018). "Ketamine administration by HART paramedics: a clinical audit review".

2031: 872:

had a better survival rate than people who were seriously injured in motor vehicle accidents on

366:

among paramedics. Exposures to blood pathogens and body fluids through incidents, for example,

4764: 4744: 4728: 4718: 4659: 4372: 4362: 4302: 4267: 4224: 4167: 3799: 3617: 3609: 3570: 3552: 3493: 3475: 3436: 3418: 3379: 3361: 3320: 3267: 3249: 3207: 3189: 3145: 3127: 3083: 3030: 3012: 2905: 2897: 2776: 2725: 2707: 2175: 2120: 1938: 1885: 1706: 1572: 1458: 1355: 1266: 1145: 1141: 981: 967: 915: 885: 881: 631:

evidence-based approaches reinforce adherence to their occupational health being safeguarded.

607: 543: 486: 421: 396: 202: 135: 4654: 4581: 4359:

American Sirens: The Incredible Story of the Black Men Who Became America's First Paramedics

4294: 4259: 4216: 4159: 3601: 3560: 3542: 3483: 3467: 3426: 3410: 3369: 3351: 3310: 3302: 3257: 3241: 3197: 3179: 3135: 3117: 3073: 3065: 3020: 3002: 2889: 2802: 2766: 2756: 2715: 2699: 2499: 2212: 1932: 1720: 1406:, the service is provided by each municipality, either as a distinct service, linked to the 1387: 1258: 1174: 1153: 1013: 896: 770: 758: 746: 413: 278: 262: 3707:

Division of Medical Sciences, Committee on Trauma and Committee on Shock (September 1966),

514:

Paramedic are involved in challenging professions and can be subject to different kinds of

4754: 4697: 4682: 4644: 4461: 2304: 2162:

Expanded drug therapy options (epinephrine, anti-arrhythmics), ECG interpretation, manual

2079:

Assessment (rate, effort, symmetry, skin color), obstructed airway maneuver, supplemental

1942: 1869: 1794: 1474: 1407: 1363: 936: 672: 603: 599: 551: 490: 482: 412:

Paramedics are confronted with many challenges exhibited in the form of environmental and

286: 225: 2345:, point-of-care blood chemistry interpretation (glucose, lactate, hemoglobin, troponin). 3431: 3398: 3315: 3290: 3202: 3167: 3140: 3105: 2417:, and are personally answerable to a regulator. For example, in the United Kingdom, the 2396:

Paramedics load an injured woman into an air ambulance after a head-on collision in the

1855:

and aspirin are used to treat cardiac ailments such as angina and myocardial infarctions

216: 3565: 3530: 3488: 3374: 3339: 3291:"Individual-level interventions for reducing occupational stress in healthcare workers" 3262: 3229: 3078: 3053: 3025: 2990: 2794: 2771: 2744: 2720: 2687: 2397: 2328: 2300: 2273: 2261: 2163: 2148: 2084: 2064: 2051: 1846: 1838: 1740: 1678: 1535: 1505: 1504:

airway adjuncts, and manual removal of obstructions via direct laryngoscopy and use of

1501: 1485: 1466: 1435: 906:

was the first civilian emergency medical service in the United States to be staffed by

732: 712: 502: 494: 281:

mostly occur in the back and neck, and injuries are most prevalent while responding to

150:), in which paramedics have additional educational requirements and scope of practice. 37: 3974: 2795:"Emergency medical services workers: how employers can prevent injuries and exposures" 2686:

Lauer, Daniel; Bandlow, Stephan; Rathje, Maik; Seidl, Andreas; Karutz, Harald (2022).

224:

To further safeguard paramedics, incorporating evidence-based strategies for managing

4784: 4614: 4314: 2917: 2269: 2226: 2204: 2197: 2156:, basic airway adjuncts, suctioning, BVM ventilation, semi-automatic defibrillation. 2047: 1852: 1812: 1562: 1497: 1439: 1057:, which also progressed from on the job training to university level qualifications. 985: 948: 940: 840: 836: 610:

hazards are managed by operating under the guidelines and recommendations offered by

539: 474: 4236: 3677: 2964: 1123: 753: 158:

The paramedic role is closely related to other healthcare positions, especially the

4723: 4677: 4541: 4508: 3306: 3069: 2324: 2288: 2230: 2133: 2096: 2008: 1906: 1762: 1701: 1524: 1510: 1371: 1293: 989: 787: 652: 587: 478: 343: 319: 3649: 3414: 3166:

Alzahrani, Adnan; Keyworth, Chris; Wilson, Caitlin; Johnson, Judith (2023-05-05).

2893: 1036: 4220: 4179: 3471: 1253:

In the United States, the minimum standards for paramedic training is considered

4298: 4263: 4049: 2761: 2630: 2494: 2386: 2367: 2335: 2320: 2308: 2246: 2220: 2136: 2116: 1956: 1952: 1928: 1910: 1902: 1820: 1816: 1744: 1736: 1714: 1656: 1629: 1616: 1612: 1520: 1462: 1450: 1041: 1017: 869: 782: 775: 375: 371: 339: 327: 266: 3547: 3455: 3356: 3184: 3122: 2743:

Evans, Rachel; McGovern, Ruth; Birch, Jennifer; Newbury-Birch, Dorothy (2012).

2703: 178: 4619: 4413: 4376: 3605: 3399:"Occupational Injuries and Exposures among Emergency Medical Services Workers" 2421:

regulates paramedics and can censure or strike a paramedic from the register.

2371: 2112: 1960: 1889: 1873: 1859: 1802: 1798: 1728: 1697: 1689: 1582: 1578: 1543: 1470: 1359: 1254: 1077: 976: 907: 873: 799: 791: 676: 586:

The regulatory guidelines are fundamental in eliminating occupational risk in

4466: 4391: 4306: 4271: 4228: 4163: 3613: 3556: 3479: 3422: 3365: 3253: 3193: 3131: 3016: 2901: 2807: 2711: 939:

technologies were more advanced, particularly due to initiatives such as the

618:, targeting the healthcare industry especially. These include properly using 4692: 4602: 3589: 2292: 2284: 2280: 2250: 2193: 1916: 1881: 1877: 1827: 1790: 1780: 1776: 1772: 1693: 1685: 1670: 1652: 1644: 1289: 1196: 971: 932: 778:

receiving a mandatory five days of training from St. John as early as 1889.

664: 656: 538:

are some of the factors undermining the psychological health of paramedics.

331: 170: 131: 97: 4171: 3996: 3621: 3588:

Kearney, Jason; Muir, Carlyn; Smith, Karen; Meadley, Ben (September 2023).

3574: 3497: 3440: 3383: 3324: 3271: 3245: 3211: 3149: 3087: 3034: 2909: 2780: 2729: 3711:, Washington, D.C.: National Academy of Sciences-National Research Council 2572: 1635: 562:

The long-term health risks that need to be observed by the paramedics are

4702: 3007: 2526: 2489: 2363: 2265: 2254: 2242: 1970: 1924: 1784: 1768: 1758: 1724: 1710: 1674: 1666: 1662: 1568: 1375: 1270: 795: 680: 535: 425: 355: 335: 311: 4454: 3709:

Accidental Death and Disability: The Neglected Disease of Modern Society

3635: 1931:(organophosphates), sodium bicarbonate (tricyclic antidepressants), and 1585:, and recognition of and procedures for obstetrical emergencies such as 860:

Accidental Death and Disability: The Neglected Disease of Modern Society

574:

risk. There are a variety of challenges paramedics encounter, including

501:. Chemical splashes are also a common hazard faced by paramedics, where 2353:

Splinting of bone fractures, uncomplicated and complicated childbirth.

2057:

Use of supraglottic airway devices such as the I-Gel or King-LT airway

1648: 1403: 1157: 1149: 1054: 877: 830:, which was staffed by a regular ambulance crew, along with a hospital 823: 819: 815: 668: 547: 429: 4328: 4063: 1996:

Emergency Medical Technician - United States (120-200 hrs. education)

1200:

ambulance services, most often trusts, are under the authority of the

2123:, basic shock management and hypothermia prevention, pelvic binding. 2080: 1964: 1920: 1752: 1602: 1301: 944: 831: 736: 716: 660: 571: 274: 1048:

The training, knowledge-base, and skill sets of both paramedics and

370:

which jeopardizes paramedics at risk of infectious diseases such as

209:

and other agencies and organizations have issued guidance regarding

2178:

electrodes and ability to transmit to hospital for interpretation.

2071:(in some jurisdictions), use of magill forceps, airway suctioning. 1093:). Such changes affected everything from simple procedures such as 469:

keeps paramedics’ occupational risks low. Examples of PPEs include

457: 3945: 2462: 2391: 2100: 1634: 1337: 1122: 1035: 849: 752: 741: 470: 456: 292: 215: 4098: 2692:

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz

1761:(often D50W, a solution of 50% dextrose in water), used to treat 1553:

Administration of emergency drugs/medications (see section below)

16:

Healthcare professional who works in emergency medical situations

4390:. National Highway Traffic Safety Administration. Archived from 2090: 1596: 1004:

magazine creation resulted from Page's previous purchase of the

960: 663:

and providing some form of care. Such individuals, although not

342:. Furthermore, adhering to infection control practices, such as 4470: 3792:"HCPC - Health and Care Professions Council - Protected titles" 1342:

Firefighter paramedics assist a simulated burn victim during a

1073:, although this is only accepted by forty of the fifty states. 201:

Infectious disease has become a major concern, in light of the

1177:

training. Paramedics manage and provide medical guidelines in

1094: 379: 4351:

Coach and horses: my history in the ambulance dispute 1989/90

4050:"Paramedic Schools in Oregon with Training Program Overviews" 1713:, also known as anticholinergic drugs, used to speed up slow 963:

Harbor Medical Center for a proposed new show about doctors,

3104:

Hoell, Andreas; Kourmpeli, Eirini; Dressing, Harald (2023).

2095:

Decompression of tension pneumothorax by needle or incision

2054:

airway adjuncts, manual removal of obstructions, suctioning

1834:

used to treat conditions such as asthma and acute bronchitis

1496:

insertion, manual repositioning, sterile suctioning, use of

598:

provide specific guidelines. For example, in United States,

4434: 4079:"Salaries, Strong Recruitment Ease Area Paramedic Shortage" 2552:"Salaries, Strong Recruitment Ease Area Paramedic Shortage" 1639:

A paramedic preparing an intravenous infusion for a patient

1300:, and increasingly in Canada and parts of the U.S. such as 1297: 1628:

Paramedics carry and administer a wide array of emergency

1071:

National Registry of Emergency Medical Technicians (NREMT)

391:

Paramedics encounter daily risks associated with handling

4035: 2853:"First Responders, Law Enforcement & Public Services" 1999:

Emergency Medical Responder - Canada (80 hrs. education)

622:, handling hazardous substances, and adequately managing 322:

in puncture-resistant containers and wearing appropriate

3870:"NHS England » Prescribing training for paramedics" 3846:"HCPC - Health and Care Professions Council - Standards" 719:

between 1598 and 1665, such arrangements were typically

4444: 4439: 2573:"What's the Difference Between an EMT and a Paramedic?" 2341:

Advanced assessment, 4 and 12-lead ECG interpretation,

1565:

management, including immobilization and safe transport

1304:, where a degree is required for entry level practice. 1105:

for physicians who work in emergency medical services.

4449: 3767:"Study in Ben Gurion University with Magen David Adom" 1845:

used to treat inflammatory respiratory conditions and

1659:, used to relieve pain or decrease nausea and vomiting 1076:

As paramedicine has evolved, a great deal of both the

4445:

National Association of Emergency Medical Technicians

4412:

University of Maryland Medical Center. Archived from

2799:

National Institute for Occupational Safety and Health

2510:

National Association of Emergency Medical Technicians

3918:"Independent Prescribing | Professional Development" 2037:

Advanced Care Paramedic - Canada (4 yr. education)

2021:

Primary Care Paramedic - Canada (2-3 yr. education)

592:

Occupational Safety and Health Administration (OSHA)

4737: 4711: 4653: 4590: 4527: 4064:"MOH order from 09.08.2017 р. № 918" 1351:basic primary health care and assessment services. 1085:oversaw their work, with changes to procedures and 104: 89: 84: 74: 64: 56: 51: 4440:National Registry of Emergency Medical Technicians 2965:"Emergency Medical Services Workers | NIOSH | CDC" 2929: 2927: 2515:National Registry of Emergency Medical Technicians 1195:In the United Kingdom, ambulances were originally 822:, Northern Ireland, in 1966. This was repeated in 703:in the Republic of Ireland and various countries. 4192:: CS1 maint: DOI inactive as of September 2024 ( 3989:"Emergency Medical Technician-Paramedic - CAAHEP" 3723:"1967-Metro Ambulance Service (Atlanta, Georgia)" 2882:Journal of Occupational and Environmental Hygiene 1517:to relieve pneumothorax and pericardial tamponade 1191:Emergency medical personnel in the United Kingdom 826:, Canada in 1968 using a single ambulance called 4066:(in Ukrainian). www.apteka.ua. November 1, 2017. 3638:. Occupational Safety and Health Administration. 2279:Significantly expanded drug list, most commonly 1374:, oil and mineral exploration teams, and in the 959:While doing background research at Los Angeles' 847:, and weighed around 45 kilograms (99 lb). 481:or specific clothing; they protect workers from 2334:More detailed physical assessment and history, 1755:. These are often known as "vasoactive" agents. 1381:The majority of paramedics are employed by the 4450:NHTSA Emergency Medical Services National Page 2181:Twelve lead ECG monitoring and interpretation 2027:Paramedic - United States (1-2 yr. education) 1611:Surgical procedures such as field amputation, 1320:introduced two specialties — "paramedic" and " 1127:Firefighters assist while paramedics from the 735:employing the first uses of the principles of 44:Australian Capital Territory Ambulance Service 4482: 3821:"Entry requirements and training (paramedic)" 3338:Becker, Julia; Hugelius, Karin (2021-12-18). 1449:Patient assessment, including acquisition of 854:EMTs caring for a collapsed woman in New York 8: 2661:"Befugnisse: Was darf ein Notfallsanitäter?" 923:paramedic programs following the passage of 794:battlefield medics administered painkilling 2103:, use of mechanical transport ventilators. 1805:, used when an emergency procedure such as 667:, were probably among the world's earliest 310:is common in the paramedic profession. The 4489: 4475: 4467: 4150:De Backer D (2011). "Treatment of shock". 2857:Centers for Disease Control and Prevention 2832:Centers for Disease Control and Prevention 1684:Beta and calcium channel blockers such as 207:Centers for Disease Control and Prevention 36: 3564: 3546: 3487: 3430: 3373: 3355: 3314: 3261: 3201: 3183: 3139: 3121: 3077: 3024: 3006: 2806: 2770: 2760: 2719: 582:Regulatory guidelines and recommendations 1985: 1044:indicate the changing nature of the job. 3636:"Chemical Hazards and Toxic Substances" 3295:Cochrane Database of Systematic Reviews 3058:Cochrane Database of Systematic Reviews 2543: 2030:Intensive Care Paramedic - Australia ( 1480:Airway management techniques including 931:In the military, however, the required 4185: 3509: 3507: 2959: 2957: 2955: 2953: 2951: 2949: 2947: 2945: 2631:"Community Paramedics: Redefining EMS" 2567: 2565: 2249:(anaphylaxis or respiratory failure), 1410:, or contracted out to a third party. 318:is critical. Including, the immediate 211:workplace hazard controls for COVID-19 32: 4567:Advanced emergency medical technician 4139:from the original on 22 October 2021. 3725:. National EMS museum. Archived from 3460:Western Journal of Emergency Medicine 3283: 3281: 3223: 3221: 3161: 3159: 3099: 3097: 3046: 3044: 2874: 2872: 2268:), and non-narcotic pain management ( 2200:injection of a limited list of drugs 2025:Advanced Life Support (ALS) Provider 1446:, and administration of cardiac drugs 994:Journal of Emergency Medical Services 679:. A similar situation existed in the 564:Post Traumatic Stress Disorder (PTSD) 446:Society of Automotive Engineers (SAE) 408:Environmental and operational hazards 7: 2115:using direct and indirect pressure, 2011:- United States (3-6 mo. education) 1257:, but many colleges offer paramedic 1099:American Board of Emergency Medicine 1050:emergency medical technicians (EMTs) 399:in prehospital settings. The use of 2629:Hilton, Michael (7 February 2018). 2419:Health and Care Professions Council 1823:, used to sedate combative patients 1696:used to slow down excessively high 1556:Bleeding control and management of 1221:Health and Care Professions Council 1067:Health and Care Professions Council 810:Pre-hospital emergency medical care 510:Mental health and stress management 360:Personal Protective Equipment (PPE) 324:personal protective equipment (PPE) 100:; hospital; pre-hospital; transport 4385:"National Scope of Practice Model" 2046:Assessment, manual repositioning, 1994:Basic Life Support (BLS) Provider 1571:management, including assessment, 1400:British Columbia Ambulance Service 14: 4410:"Tribute to R Adams Cowley, M.D." 4077:McCaffrey, Raymond (2008-04-04). 3234:Journal of Public Health Research 2815:from the original on Apr 5, 2023. 1477:interpretation (glucose, lactate) 1131:load a patient into an ambulance. 914:, under the medical direction of 453:Protective measures and equipment 3514:U.S fire administration (2022). 2641:from the original on Dec 2, 2020 2532:List of EMS provider credentials 2473:Paramedics in the United Kingdom 1826:Respiratory medications such as 1461:acquisition and interpretation, 776:Toronto Police Ambulance Service 590:; authoritative bodies like the 432:have huge impact on paramedics' 4099:"Clinical Operating Guidelines" 2934:US fire administration (2022). 2478:Paramedics in the United States 2067:(surgical airway), delayed and 1973:to control post-partum bleeding 1807:rapid sequence intubation (RSI) 1249:Paramedics in the United States 904:Freedom House Ambulance Service 596:World Health Organization (WHO) 442:Department of Homeland Security 4811:Occupational safety and health 4801:Protective service occupations 3942:"Our Mission | NHTSA EMS" 3307:10.1002/14651858.CD002892.pub6 3070:10.1002/14651858.CD011621.pub4 701:Order of Malta Ambulance Corps 689:Order of St. John of Jerusalem 671:by default, being required to 568:cardiovascular diseases (CVDs) 520:post-traumatic stress disorder 404:health hazards to paramedics. 1: 4287:Journal of Paramedic Practice 4252:Journal of Paramedic Practice 4209:Journal of Paramedic Practice 3922:www.collegeofparamedics.co.uk 3898:www.collegeofparamedics.co.uk 3676:. Toronto EMS. Archived from 3415:10.1080/10903127.2016.1274350 2894:10.1080/15459624.2019.1674858 2276:, ketorolac, acetaminophen). 2154:Cardiopulmonary resuscitation 1978:Skills by certification level 1858:Diuretic medications such as 1619:(if trained and credentialed) 1532:positive pressure ventilation 1432:cardiopulmonary resuscitation 1428:Advanced cardiac life support 1368:Heavy Urban Search and Rescue 1333: 1210:emergency medical technicians 273:incidences. Injuries such as 248:Types of occupational hazards 232:is crucial. Agencies such as 144:emergency medical technicians 4791:Emergency medical responders 4562:Emergency medical technician 4552:Emergency medical dispatcher 4361:. New York: Hachette Books. 4221:10.12968/jpar.2018.10.10.430 3749:"Emergency Medical Services" 3472:10.5811/westjem.2022.2.55217 3172:BMC Health Services Research 2184:Advanced ECG interpretation 1913:used for nausea and vomiting 1851:Cardiac medications such as 1681:, used to treat severe pain. 1322:emergency medical technician 1276:emergency medical technician 160:emergency medical technician 111:Emergency medical technician 21:Emergency medical technician 4750:Critical emergency medicine 4668:Kendrick extrication device 4640:Nontransporting EMS vehicle 4630:Light horse field ambulance 4557:Emergency medical responder 4333:www.paramedicultrasound.com 4299:10.12968/jpar.2020.12.5.202 4264:10.12968/jpar.2011.3.10.552 4036:"National Registry of EMTs" 4011:"National Registry of EMTs" 2762:10.1136/emermed-2012-202129 2667:(in German). 4 January 2024 2665:Notfallsanitäter-Aktuell.de 2319:Basic physical assessment, 1657:paracetamol (acetaminophen) 1575:, and dislocation reduction 749:paramedics training in 1931 731:devised a system of mobile 558:Health risks and monitoring 420:. Slips, trips, and falls; 4829: 4498:Emergency medical services 4455:College of Paramedics (UK) 3594:Journal of Safety Research 3548:10.1186/s12888-020-02752-4 3403:Prehospital Emergency Care 3357:10.1186/s12873-021-00554-9 3185:10.1186/s12913-023-09374-y 3123:10.3389/fpubh.2023.1151248 3110:Frontiers in Public Health 2749:Emergency Medicine Journal 2704:10.1007/s00103-022-03588-x 2468:Paramedics in South Africa 2400:region of Ontario, Canada. 2348: 2314: 2236: 2203:limited list of drugs for 2187: 2169: 2166:, intubation, ultrasound. 2146: 2106: 2074: 2041: 1530:Oxygen administration and 1331: 1246: 1236:allied health professional 1188: 1129:Toronto Paramedic Services 1116: 1031:emergency medical services 925:The Wedsworth-Townsend Act 912:Harbor–UCLA Medical Center 638: 383:same time, the community. 177:backup, either virtually ( 128:emergency medical services 28:Paramedic (disambiguation) 25: 18: 4537:Certified first responder 4504: 3606:10.1016/j.jsr.2023.05.012 2374:(in some jurisdictions). 2211:, intravenous injection ( 2004:Intermediate Life Support 1589:, cord presentation, and 1383:emergency medical service 1314:Emergency Medicine Reform 1206:emergency care assistants 920:Harborview Medical Center 858:In 1966, a report called 148:emergency care assistants 35: 4547:Emergency care assistant 4329:"Prehospital Ultrasound" 4164:10.2143/ACB.66.6.2062611 3967:"Degree Programs in EMS" 3697:Br Heart J 1986;56:491-5 2808:10.26616/NIOSHPUB2017194 2598:"Community Paramedicine" 2069:rapid sequence induction 1898:ventricular fibrillation 1864:congestive heart failure 1581:, including assessment, 1490:rapid sequence induction 1006:PARAMEDICS International 707:Early ambulance services 653:Imperial Legions of Rome 641:History of the ambulance 306:The risk of contracting 205:. In response, the U.S. 19:Not to be confused with 4796:Health care occupations 4357:Hazzard, Kevin (2022). 4353:. Glantaff House, 2010. 4166:(inactive 2024-09-12). 3518:. Emmitsburg, MD: FEMA. 2443:Paramedics in Australia 2415:prescription medication 2323:, history taking, lung 2061:Endotracheal intubation 2014:Paramedic - Australia ( 1894:ventricular tachycardia 1866:and severe hypertension 1328:Structure of employment 1228:Paramedic Practitioners 1202:National Health Service 1179:mass casualty incidents 845:lead-acid car batteries 693:Commonwealth of Nations 461:EMS workers wearing PPE 422:motor vehicle incidents 297:A paramedic wearing PPE 124:healthcare professional 3674:"Toronto EMS: History" 3344:BMC Emergency Medicine 3246:10.4081/jphr.2021.1993 2401: 2297:neuromuscular blockers 1890:abnormal heart rhythms 1747:(low blood pressure), 1640: 1624:Emergency Pharmacology 1607:mass casualty incident 1372:offshore oil platforms 1347: 1318:Ministry of Healthcare 1132: 1045: 1040:Bicycle paramedics in 855: 818:care by physicians in 765: 750: 462: 330:, including those for 298: 221: 4519:Advanced life support 4132:. 13 September 2018. 3240:(1): jphr.2021.1993. 2558:on September 8, 2011. 2505:Health care providers 2463:Paramedics in Ireland 2458:Paramedics in Germany 2437:Paramedics by country 2395: 2381:Medicolegal authority 2257:(narcotic overdose). 2238:Drug types permitted 1638: 1444:transcutaneous pacing 1430:, or ACLS, including 1341: 1334:Paramedics by country 1126: 1039: 853: 756: 745: 499:airborne contaminants 460: 296: 219: 130:(EMS), most often in 4635:Motorcycle ambulance 4598:Air medical services 4152:Acta Clinica Belgica 3650:"Health emergencies" 3516:EMS Safety Practices 3008:10.7759/cureus.10404 2936:EMS Safety Practices 2453:Paramedics in France 2448:Paramedics in Canada 2189:Drug administration 2119:, wound packing and 2085:bag valve mask (BVM) 1647:medications such as 1370:, and paramedics on 1346:mass casualty drill. 1119:Paramedics in Canada 1103:medical subspecialty 1024:Evolution and growth 675:wounds and complete 516:psychological stress 434:occupational hazards 368:needlestick injuries 193:Occupational hazards 154:Duties and functions 26:For other uses, see 4806:Medical credentials 4770:Wilderness medicine 4577:Emergency physician 4435:National EMS Museum 4123:"Medical Directive" 4084:The Washington Post 2579:. 18 September 2014 2316:Patient assessment 2171:Cardiac Monitoring 2128:fluid resuscitation 1987: 1832:ipratropium bromide 1591:placental abruption 1587:breech presentation 1549:Fluid resuscitation 1494:supraglottic airway 1482:tracheal intubation 1283:professional bodies 1217:Bachelor of Science 988:, was a pioneer of 965:television producer 862:—commonly known as 685:Knights Hospitaller 532:medical emergencies 393:hazardous chemicals 364:infectious diseases 308:infectious diseases 302:Infectious diseases 230:environmental risks 175:emergency physician 4760:Emergency medicine 4688:Spinal precautions 4514:Basic life support 4460:2020-05-13 at the 4349:Conaghan, Joseph. 3874:www.england.nhs.uk 2851:CDC (2020-04-30). 2826:CDC (2020-02-11). 2610:on August 24, 2020 2402: 2360:butterfly stitches 2350:Other procedures. 2141:pericardiocentesis 2043:Airway management 1986: 1843:methylprednisolone 1641: 1515:pericardiocentesis 1457:, history taking, 1455:chest auscultation 1392:Los Angeles County 1348: 1267:community colleges 1232:nurse practitioner 1212:, and paramedics. 1138:Queen's University 1133: 1046: 856: 766: 751: 729:Jonathan Letterman 725:American Civil War 697:St. John Ambulance 624:workplace violence 542:issues, including 463: 397:chemical exposures 387:Chemical exposures 320:disposal of sharps 316:infectious disease 299: 259:the emergency room 226:chemical exposures 222: 185:prescribe certain 42:Paramedics of the 4778: 4777: 4765:Military medicine 4745:Aviation medicine 4729:Search and rescue 4719:Ambulance station 4368:978-0-306-92607-5 3796:www.hcpc-uk.co.uk 2378: 2377: 2134:Intraosseous (IO) 2121:hemostatic agents 2016:Bachelor's Degree 1947:hemorrhagic shock 1919:for a variety of 1886:magnesium sulfate 1837:Steroids such as 1765:(low blood sugar) 1707:Parasympatholytic 1605:of patients in a 1459:electrocardiogram 1453:, physical exam, 1414:Scope of practice 1356:aviation medicine 1263:bachelor's degree 1146:community college 1142:Kingston, Ontario 1063:bachelor's degree 982:technical advisor 968:Robert A. Cinader 955:Public notability 916:J. Michael Criley 902:Founded in 1967, 886:airway management 882:fluid replacement 771:funeral directors 757:Ambulance of the 414:operational risks 253:Physical injuries 203:COVID-19 pandemic 136:scope of practice 116: 115: 4818: 4655:Casualty lifting 4582:Medical director 4491: 4484: 4477: 4468: 4424: 4422: 4421: 4405: 4403: 4402: 4396: 4389: 4380: 4337: 4336: 4325: 4319: 4318: 4282: 4276: 4275: 4247: 4241: 4240: 4204: 4198: 4197: 4191: 4183: 4147: 4141: 4140: 4138: 4127: 4119: 4113: 4112: 4110: 4109: 4095: 4089: 4088: 4074: 4068: 4067: 4060: 4054: 4053: 4046: 4040: 4039: 4032: 4026: 4025: 4023: 4022: 4013:. Archived from 4007: 4001: 4000: 3995:. Archived from 3985: 3979: 3978: 3973:. Archived from 3963: 3957: 3956: 3954: 3953: 3944:. Archived from 3938: 3932: 3931: 3929: 3928: 3914: 3908: 3907: 3905: 3904: 3890: 3884: 3883: 3881: 3880: 3866: 3860: 3859: 3857: 3856: 3842: 3836: 3835: 3833: 3832: 3817: 3811: 3810: 3808: 3807: 3798:. Archived from 3788: 3782: 3781: 3779: 3778: 3769:. Archived from 3763: 3757: 3756: 3745: 3739: 3738: 3736: 3734: 3729:on 14 April 2013 3719: 3713: 3712: 3704: 3698: 3695: 3689: 3688: 3686: 3685: 3670: 3664: 3663: 3661: 3660: 3646: 3640: 3639: 3632: 3626: 3625: 3585: 3579: 3578: 3568: 3550: 3526: 3520: 3519: 3511: 3502: 3501: 3491: 3451: 3445: 3444: 3434: 3394: 3388: 3387: 3377: 3359: 3335: 3329: 3328: 3318: 3285: 3276: 3275: 3265: 3225: 3216: 3215: 3205: 3187: 3163: 3154: 3153: 3143: 3125: 3101: 3092: 3091: 3081: 3048: 3039: 3038: 3028: 3010: 2986: 2980: 2979: 2977: 2976: 2961: 2940: 2939: 2938:. MD, USA: FEMA. 2931: 2922: 2921: 2876: 2867: 2866: 2864: 2863: 2848: 2842: 2841: 2839: 2838: 2823: 2817: 2816: 2810: 2791: 2785: 2784: 2774: 2764: 2740: 2734: 2733: 2723: 2683: 2677: 2676: 2674: 2672: 2657: 2651: 2650: 2648: 2646: 2626: 2620: 2619: 2617: 2615: 2609: 2602: 2594: 2588: 2587: 2585: 2584: 2569: 2560: 2559: 2554:. Archived from 2548: 2500:Flight Paramedic 2245:(hypoglycemia), 2217:intravenous drip 1991:Treatment issue 1988: 1933:hydroxocobalamin 1721:Sympathomimetics 1527:(IO) cannulation 1469:, point-of-care 1259:associate degree 1154:British Columbia 1014:medical director 759:Magen David Adom 747:German Red Cross 626:. Moreover, the 518:, for instance, 497:masks to filter 491:chemical hazards 418:prehospital care 76:Activity sectors 40: 33: 4828: 4827: 4821: 4820: 4819: 4817: 4816: 4815: 4781: 4780: 4779: 4774: 4755:Diving medicine 4733: 4707: 4698:Vacuum mattress 4683:Scoop stretcher 4657: 4649: 4645:Water ambulance 4625:Combination car 4586: 4523: 4500: 4495: 4462:Wayback Machine 4431: 4419: 4417: 4408: 4400: 4398: 4394: 4387: 4383: 4369: 4356: 4346: 4344:Further reading 4341: 4340: 4327: 4326: 4322: 4284: 4283: 4279: 4258:(10): 552–556. 4249: 4248: 4244: 4215:(10): 430–437. 4206: 4205: 4201: 4184: 4149: 4148: 4144: 4136: 4130:AustinTexas.gov 4125: 4121: 4120: 4116: 4107: 4105: 4097: 4096: 4092: 4076: 4075: 4071: 4062: 4061: 4057: 4048: 4047: 4043: 4034: 4033: 4029: 4020: 4018: 4009: 4008: 4004: 3987: 3986: 3982: 3965: 3964: 3960: 3951: 3949: 3940: 3939: 3935: 3926: 3924: 3916: 3915: 3911: 3902: 3900: 3892: 3891: 3887: 3878: 3876: 3868: 3867: 3863: 3854: 3852: 3850:www.hcpc-uk.org 3844: 3843: 3839: 3830: 3828: 3819: 3818: 3814: 3805: 3803: 3790: 3789: 3785: 3776: 3774: 3765: 3764: 3760: 3747: 3746: 3742: 3732: 3730: 3721: 3720: 3716: 3706: 3705: 3701: 3696: 3692: 3683: 3681: 3672: 3671: 3667: 3658: 3656: 3648: 3647: 3643: 3634: 3633: 3629: 3587: 3586: 3582: 3528: 3527: 3523: 3513: 3512: 3505: 3453: 3452: 3448: 3396: 3395: 3391: 3337: 3336: 3332: 3301:(5): CD002892. 3287: 3286: 3279: 3227: 3226: 3219: 3165: 3164: 3157: 3103: 3102: 3095: 3064:(4): CD011621. 3050: 3049: 3042: 2988: 2987: 2983: 2974: 2972: 2963: 2962: 2943: 2933: 2932: 2925: 2888:(12): 804–816. 2878: 2877: 2870: 2861: 2859: 2850: 2849: 2845: 2836: 2834: 2825: 2824: 2820: 2793: 2792: 2788: 2742: 2741: 2737: 2698:(10): 987–995. 2685: 2684: 2680: 2670: 2668: 2659: 2658: 2654: 2644: 2642: 2628: 2627: 2623: 2613: 2611: 2607: 2600: 2596: 2595: 2591: 2582: 2580: 2571: 2570: 2563: 2550: 2549: 2545: 2540: 2434: 2383: 2358:Wound closure ( 2305:tranexamic acid 2032:Master's Degree 2006:(ILS) Provider 1980: 1951:Broad spectrum 1943:tranexamic acid 1870:Antiarrhythmics 1795:succinylcholine 1626: 1475:blood chemistry 1421: 1416: 1358:and the use of 1336: 1330: 1310: 1251: 1245: 1193: 1187: 1167: 1121: 1115: 1026: 957: 937:miniaturization 893:The White Paper 891:As a result of 865:The White Paper 843:was powered by 812: 733:field hospitals 709: 648: 643: 637: 584: 560: 552:substance abuse 512: 455: 410: 389: 304: 255: 250: 195: 156: 107: 94: 92: 77: 67: 66:Occupation type 47: 46:during training 31: 24: 17: 12: 11: 5: 4826: 4825: 4822: 4814: 4813: 4808: 4803: 4798: 4793: 4783: 4782: 4776: 4775: 4773: 4772: 4767: 4762: 4757: 4752: 4747: 4741: 4739: 4738:Related fields 4735: 4734: 4732: 4731: 4726: 4721: 4715: 4713: 4709: 4708: 4706: 4705: 4700: 4695: 4690: 4685: 4680: 4675: 4670: 4664: 4662: 4651: 4650: 4648: 4647: 4642: 4637: 4632: 4627: 4622: 4617: 4612: 4611: 4610: 4600: 4594: 4592: 4588: 4587: 4585: 4584: 4579: 4574: 4569: 4564: 4559: 4554: 4549: 4544: 4539: 4533: 4531: 4525: 4524: 4522: 4521: 4516: 4511: 4505: 4502: 4501: 4496: 4494: 4493: 4486: 4479: 4471: 4465: 4464: 4452: 4447: 4442: 4437: 4430: 4429:External links 4427: 4426: 4425: 4406: 4381: 4367: 4354: 4345: 4342: 4339: 4338: 4320: 4293:(5): 202–207. 4277: 4242: 4199: 4158:(6): 438–442. 4142: 4114: 4103:www.google.com 4090: 4069: 4055: 4041: 4027: 4002: 3999:on 2015-07-08. 3993:www.caahep.org 3980: 3977:on 2015-06-26. 3958: 3933: 3909: 3885: 3861: 3837: 3825:Health Careers 3812: 3783: 3758: 3740: 3714: 3699: 3690: 3665: 3641: 3627: 3580: 3535:BMC Psychiatry 3521: 3503: 3466:(3): 396–407. 3446: 3409:(4): 420–431. 3389: 3330: 3277: 3217: 3155: 3093: 3040: 2981: 2941: 2923: 2868: 2843: 2818: 2786: 2755:(7): 594–603. 2735: 2678: 2652: 2621: 2589: 2561: 2542: 2541: 2539: 2536: 2535: 2534: 2529: 2523: 2522: 2518: 2517: 2512: 2507: 2502: 2497: 2492: 2486: 2485: 2484:Related fields 2481: 2480: 2475: 2470: 2465: 2460: 2455: 2450: 2445: 2439: 2438: 2433: 2430: 2398:Kawartha Lakes 2382: 2379: 2376: 2375: 2356: 2354: 2351: 2347: 2346: 2339: 2332: 2329:pulse oximetry 2317: 2313: 2312: 2301:blood products 2277: 2274:methoxyflurane 2262:dipenhydramine 2258: 2253:(asthma), and 2239: 2235: 2234: 2224: 2201: 2190: 2186: 2185: 2182: 2179: 2172: 2168: 2167: 2164:defibrillation 2160: 2157: 2151: 2149:Cardiac arrest 2145: 2144: 2131: 2124: 2109: 2105: 2104: 2093: 2088: 2077: 2073: 2072: 2065:cricothyrotomy 2058: 2055: 2052:nasopharyngeal 2044: 2040: 2039: 2023: 2001: 1992: 1979: 1976: 1975: 1974: 1969:Hormones like 1967: 1949: 1939:Blood products 1936: 1914: 1900: 1888:used to treat 1867: 1856: 1849: 1847:adrenal crisis 1839:hydrocortisone 1835: 1824: 1813:Antipsychotics 1810: 1788: 1766: 1756: 1741:cardiac arrest 1733:norepinephrine 1718: 1704: 1682: 1679:methoxyflurane 1660: 1625: 1622: 1621: 1620: 1609: 1600: 1595:Management of 1593: 1576: 1566: 1560: 1554: 1551: 1546: 1536:bag-valve-mask 1528: 1518: 1508: 1506:magill forceps 1502:nasopharyngeal 1486:cricothyrotomy 1478: 1467:pulse oximetry 1447: 1436:defibrillation 1420: 1417: 1415: 1412: 1329: 1326: 1309: 1306: 1247:Main article: 1244: 1241: 1189:Main article: 1186: 1185:United Kingdom 1183: 1166: 1163: 1117:Main article: 1114: 1111: 1025: 1022: 970:, working for 956: 953: 947:countries and 811: 808: 713:bubonic plague 708: 705: 655:, where aging 647: 644: 636: 633: 583: 580: 559: 556: 511: 508: 503:safety goggles 454: 451: 409: 406: 388: 385: 303: 300: 254: 251: 249: 246: 194: 191: 167:models of care 155: 152: 114: 113: 108: 105: 102: 101: 95: 90: 87: 86: 82: 81: 78: 75: 72: 71: 68: 65: 62: 61: 58: 54: 53: 49: 48: 41: 15: 13: 10: 9: 6: 4: 3: 2: 4824: 4823: 4812: 4809: 4807: 4804: 4802: 4799: 4797: 4794: 4792: 4789: 4788: 4786: 4771: 4768: 4766: 4763: 4761: 4758: 4756: 4753: 4751: 4748: 4746: 4743: 4742: 4740: 4736: 4730: 4727: 4725: 4722: 4720: 4717: 4716: 4714: 4710: 4704: 4701: 4699: 4696: 4694: 4691: 4689: 4686: 4684: 4681: 4679: 4676: 4674: 4671: 4669: 4666: 4665: 4663: 4661: 4656: 4652: 4646: 4643: 4641: 4638: 4636: 4633: 4631: 4628: 4626: 4623: 4621: 4618: 4616: 4615:Ambulance bus 4613: 4609: 4606: 4605: 4604: 4601: 4599: 4596: 4595: 4593: 4589: 4583: 4580: 4578: 4575: 4573: 4570: 4568: 4565: 4563: 4560: 4558: 4555: 4553: 4550: 4548: 4545: 4543: 4540: 4538: 4535: 4534: 4532: 4530: 4526: 4520: 4517: 4515: 4512: 4510: 4507: 4506: 4503: 4499: 4492: 4487: 4485: 4480: 4478: 4473: 4472: 4469: 4463: 4459: 4456: 4453: 4451: 4448: 4446: 4443: 4441: 4438: 4436: 4433: 4432: 4428: 4416:on 2006-07-18 4415: 4411: 4407: 4397:on 2021-03-24 4393: 4386: 4382: 4378: 4374: 4370: 4364: 4360: 4355: 4352: 4348: 4347: 4343: 4334: 4330: 4324: 4321: 4316: 4312: 4308: 4304: 4300: 4296: 4292: 4288: 4281: 4278: 4273: 4269: 4265: 4261: 4257: 4253: 4246: 4243: 4238: 4234: 4230: 4226: 4222: 4218: 4214: 4210: 4203: 4200: 4195: 4189: 4181: 4177: 4173: 4169: 4165: 4161: 4157: 4153: 4146: 4143: 4135: 4131: 4124: 4118: 4115: 4104: 4100: 4094: 4091: 4086: 4085: 4080: 4073: 4070: 4065: 4059: 4056: 4051: 4045: 4042: 4037: 4031: 4028: 4017:on 2016-08-10 4016: 4012: 4006: 4003: 3998: 3994: 3990: 3984: 3981: 3976: 3972: 3971:www.naemt.org 3968: 3962: 3959: 3948:on 2015-08-14 3947: 3943: 3937: 3934: 3923: 3919: 3913: 3910: 3899: 3895: 3889: 3886: 3875: 3871: 3865: 3862: 3851: 3847: 3841: 3838: 3826: 3822: 3816: 3813: 3802:on 2016-10-20 3801: 3797: 3793: 3787: 3784: 3773:on 2018-01-21 3772: 3768: 3762: 3759: 3754: 3750: 3744: 3741: 3728: 3724: 3718: 3715: 3710: 3703: 3700: 3694: 3691: 3680:on 2010-12-26 3679: 3675: 3669: 3666: 3655: 3651: 3645: 3642: 3637: 3631: 3628: 3623: 3619: 3615: 3611: 3607: 3603: 3599: 3595: 3591: 3584: 3581: 3576: 3572: 3567: 3562: 3558: 3554: 3549: 3544: 3540: 3536: 3532: 3525: 3522: 3517: 3510: 3508: 3504: 3499: 3495: 3490: 3485: 3481: 3477: 3473: 3469: 3465: 3461: 3457: 3450: 3447: 3442: 3438: 3433: 3428: 3424: 3420: 3416: 3412: 3408: 3404: 3400: 3393: 3390: 3385: 3381: 3376: 3371: 3367: 3363: 3358: 3353: 3349: 3345: 3341: 3334: 3331: 3326: 3322: 3317: 3312: 3308: 3304: 3300: 3296: 3292: 3284: 3282: 3278: 3273: 3269: 3264: 3259: 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July 2017. 2800: 2796: 2790: 2787: 2782: 2778: 2773: 2768: 2763: 2758: 2754: 2750: 2746: 2739: 2736: 2731: 2727: 2722: 2717: 2713: 2709: 2705: 2701: 2697: 2694:(in German). 2693: 2689: 2682: 2679: 2666: 2662: 2656: 2653: 2640: 2636: 2632: 2625: 2622: 2606: 2599: 2593: 2590: 2578: 2574: 2568: 2566: 2562: 2557: 2553: 2547: 2544: 2537: 2533: 2530: 2528: 2525: 2524: 2520: 2519: 2516: 2513: 2511: 2508: 2506: 2503: 2501: 2498: 2496: 2493: 2491: 2488: 2487: 2483: 2482: 2479: 2476: 2474: 2471: 2469: 2466: 2464: 2461: 2459: 2456: 2454: 2451: 2449: 2446: 2444: 2441: 2440: 2436: 2435: 2431: 2429: 2426: 2422: 2420: 2416: 2410: 2408: 2399: 2394: 2390: 2388: 2380: 2373: 2369: 2365: 2361: 2357: 2355: 2352: 2349: 2344: 2340: 2337: 2333: 2330: 2326: 2322: 2318: 2315: 2310: 2306: 2302: 2298: 2294: 2290: 2286: 2282: 2278: 2275: 2271: 2270:nitrous oxide 2267: 2263: 2259: 2256: 2252: 2248: 2244: 2240: 2237: 2232: 2228: 2227:Infusion pump 2225: 2222: 2218: 2214: 2210: 2206: 2205:intramuscular 2202: 2199: 2198:intramuscular 2195: 2191: 2188: 2183: 2180: 2177: 2174:Placement of 2173: 2170: 2165: 2161: 2158: 2155: 2152: 2150: 2147: 2142: 2138: 2135: 2132: 2129: 2125: 2122: 2118: 2114: 2110: 2107: 2102: 2098: 2094: 2092: 2089: 2086: 2082: 2078: 2075: 2070: 2066: 2062: 2059: 2056: 2053: 2049: 2048:oropharyngeal 2045: 2042: 2038: 2035: 2033: 2028: 2024: 2022: 2019: 2017: 2012: 2010: 2005: 2002: 2000: 1997: 1993: 1990: 1989: 1984: 1977: 1972: 1968: 1966: 1963:for cases of 1962: 1958: 1954: 1950: 1948: 1944: 1940: 1937: 1934: 1930: 1926: 1922: 1918: 1915: 1912: 1908: 1904: 1901: 1899: 1895: 1891: 1887: 1883: 1879: 1875: 1871: 1868: 1865: 1861: 1857: 1854: 1853:nitroglycerin 1850: 1848: 1844: 1840: 1836: 1833: 1829: 1825: 1822: 1818: 1814: 1811: 1808: 1804: 1800: 1796: 1792: 1789: 1786: 1782: 1778: 1774: 1770: 1767: 1764: 1760: 1757: 1754: 1750: 1746: 1742: 1738: 1734: 1730: 1726: 1722: 1719: 1716: 1712: 1709:drug such as 1708: 1705: 1703: 1699: 1695: 1691: 1687: 1683: 1680: 1676: 1672: 1668: 1664: 1661: 1658: 1654: 1650: 1646: 1643: 1642: 1637: 1633: 1631: 1623: 1618: 1614: 1610: 1608: 1604: 1601: 1598: 1594: 1592: 1588: 1584: 1580: 1577: 1574: 1570: 1567: 1564: 1563:Spinal injury 1561: 1559: 1555: 1552: 1550: 1547: 1545: 1541: 1537: 1533: 1529: 1526: 1522: 1519: 1516: 1512: 1509: 1507: 1503: 1499: 1498:oropharyngeal 1495: 1491: 1487: 1483: 1479: 1476: 1472: 1468: 1464: 1460: 1456: 1452: 1448: 1445: 1441: 1440:cardioversion 1437: 1433: 1429: 1426: 1425: 1424: 1419:Common skills 1418: 1413: 1411: 1409: 1405: 1402:) whereas in 1401: 1395: 1393: 1389: 1384: 1379: 1377: 1373: 1369: 1365: 1361: 1357: 1352: 1345: 1340: 1335: 1327: 1325: 1323: 1319: 1315: 1312:As a part of 1307: 1305: 1303: 1299: 1295: 1291: 1286: 1284: 1279: 1277: 1272: 1268: 1264: 1260: 1256: 1250: 1243:United States 1242: 1240: 1237: 1233: 1229: 1224: 1222: 1218: 1213: 1211: 1207: 1203: 1198: 1192: 1184: 1182: 1180: 1176: 1173:training, or 1172: 1164: 1162: 1159: 1155: 1151: 1147: 1143: 1139: 1130: 1125: 1120: 1112: 1110: 1106: 1104: 1100: 1096: 1092: 1088: 1082: 1079: 1074: 1072: 1068: 1064: 1058: 1056: 1051: 1043: 1038: 1034: 1032: 1023: 1021: 1019: 1015: 1012:, the show's 1011: 1007: 1003: 999: 995: 991: 987: 986:James O. 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