What is a Paramedic and a History of EMS
First, let’s discuss what “paramedic” means. The first part of the word, “para-,” means “alongside,” and of course “medic” refers to their medical work.
Paramedics are, in most cases and in most places, an extension of the physician in the emergency department. We’ll cover more specific parts of the job later, but for now, let’s point out that a paramedic is a certified medical technician who operates with the permission, and under the license, of a physician (usually, a physician who is board-certified in Emergency Medicine).
They are not doctors, but most paramedics are permitted to perform emergency procedures that are otherwise only permitted to be performed by doctors, such as certain surgical procedures. The paramedic performs in contemporary US society much as the house-call physician of old; they come to the home or place of business, or wherever someone might be sick or injured, to help them right then and there. While there, they also help the patient decide if a trip in an ambulance to the nearest emergency department is warranted.
Most paramedics obtain their certification from the state in which they work, and most states use the National Registry of Emergency Medical Technicians (NREMT) as their resource for training and testing prospective paramedics. Obtaining NREMT certification is often the first certification step for a paramedic to work as such, and most states permit anyone who passes that state’s background check and is also NREMT certified to become state certified as a paramedic. Although it’s worth noting that some states have begun licensing their paramedics, so additional testing may be required.
About Emergency Medical Services
Emergency Medical Services, or EMS, has its roots in ancient history.
The primary motivation for ambulance transport of injured patients comes to us from human military experience, with the Greek and Egyptian armies known to have transported injured soldiers by chariot, and the French Army under Napoleon being credited as the first to operate a triage system to prioritize the wounded for treatment and transport.
In the United States, poor treatment of wounded soldiers during the early parts of the Civil War prompted several changes in the battlefield treatment of the wounded, including transport by horse-driven ambulances.
Through the early parts of the 20th century, EMS was often a scoop-and-run process, using fire department rescue units, police “meat wagons,” and even hearses to pickup patients and transport them to physicians. Many of these early ambulances were not staffed with medical personnel.
Then, in 1966, the Committee on Trauma and the Committee on Shock of the National Academy of Sciences–National Research Council published Accidental Death and Disability: The Neglected Disease of Modern Society.
This paper noted that (among other things) in most cases, people in the United States who were injured were less likely to survive their injuries, suffered a much higher rate of disability and death than did soldiers on the battlefields of Vietnam, and concluded that most ambulance services were poorly-equipped and trained.
It noted, too, that about half of all ambulance services were staffed by morticians.
The White Paper (as it is often referred to in EMS) advocated for changes to EMS and ambulance services, including improvements in the stocking of equipment and supplies for ambulances, providing medically-trained attendants, and improving protocols and treatment guidelines. These efforts continue to this day, where EMS systems around the nation work to improve patient treatment both on the scene and during transport.
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