Technical Standards in EMT-Basic and Paramedic Programs for Admission and Retention
Functional Job Analysis
The Paramedic must be a confident leader who can accept the challenge and high degree of responsibility entailed in the position. The Paramedic must have excellent judgement and be able to prioritize decisions and act quickly in the best interest of the patient, must be self-disciplined, able to develop patient rapport, interview hostile patients, maintain safe distance, and recognize and utilize communication unique to divers e multicultural groups and ages within those groups. Must be able to function independently at optimum level in a non-structured environment that is constantly changing.
Even though the Paramedic is generally part of a two- person team generally working with a lower skill and knowledge level Basic EMT, it is the Paramedic who is held responsible for safe and therapeutic administration of drugs including narcotics. Therefore, the Paramedic must not only be knowledgeable about medications but must be able to apply this knowledge in a practical sense. Knowledge and practical application of medications include thoroughly knowing and understanding the general properties of all types of drugs including analgesics, anesthetics, anti-anxiety drugs, sedatives and hypnotics, anti-convulsants, central nervous stimulants, psychotherapeutics which include antidepressants, and other anti-psychotics, anticholerginics, cholergenics, muscle relaxants, antidysrythmics, anti-hypertensives, anticoagulants, diuretics, bronchodilators, opthalmics, pituitary drugs, gastro-intestinal drugs, hormones, antibiotics, antifungals, antiinflammatories, serums, vaccines, antiparasitics, and others.
The Paramedic is personally responsible, legally, ethically, and morally for each drug administered, for using correct precautions and techniques, observing and documenting the effects of the drugs administered, keeping ones own pharmacological knowledge-base current as to changes and trends in administration and use, keeping abreast of all contraindications to administration of specific drugs to patients based on their constitutional make-up, and using drug reference literature.
The responsibility of the Paramedic includes obtaining a comprehensive drug history from the patient that includes names of drugs, strength, daily usage and dosage. The Paramedic must take into consideration that many factors, in relation to the history given, can affect the type medication to be given. For example, some patients may be taking several medications prescribed by several different doctors and some may lose track of what they have or have not taken. Some may be using nonprescription/over the counter drugs. Awareness of drug reactions and the synergistic effects of drugs combined with other medicines and in some instances, food, is imperative. The Paramedic must also take into consideration the possible risks of medication administered to a pregnant mother and the fetus, keeping in mind that drugs may cross the placenta.
The Paramedic must be cognizant of the impact of medications on pediatric patients based on size and weight, special concerns related to newborns, geriatric patients and the physiological effects of aging such as the way skin can tear in the geriatric population with relatively little to no pressure. There must be an awareness of the high abuse potential of controlled substances and the potential for addiction, therefore, the Paramedic must be thorough in report writing and able to justify why a particular narcotic was used and why a particular amount was given. The ability to measure and re-measure drip rates for controlled substances/medications is essential. Once medication is stopped or not used, the Paramedic must send back unused portions to proper inventory arena.
The Paramedic must be able to apply basic principles of mathematics to the calculation of problems associated with medication dosages, perform conversion problems, differentiate temperature reading between centigrade and Fahrenheit scales, be able to use proper advanced life support equipment and supplies (i.e. proper size of intravenous needles) based on patient's age and condition of veins, and be able to locate sites for obtaining blood samples and perform this task, administer medication intravenously, administer medications by gastric tube, administer oral medications, administer rectal medications, and comply with universal pre-cautions and body substance isolation, disposing of contaminated item s and equipment properly.
The Paramedic must be able to apply knowledge and skills to assist overdosed patients to overcome trauma through antidotes, and have knowledge of poisons and be able to administer treatment. The Paramedic must be knowledgeable as to the stages drugs /medications go through once they have entered the patients system and be cognizant that route of administration is critical in relation to patient's needs and the effect that occurs.
The Paramedic must also be capable of providing advanced life support emergency medical services to patients including conducting of and interpreting electrocardiograms (EKGs), electrical interventions to support the cardiac functions, performing advanced endotracheal intubations in airway management and relief of pneumothorax and administering of appropriate intravenous fluids and drugs under direction of off-site designated physician.
The Paramedic is a person who must not only remain calm while working in difficult and stressful circumstances, but must be capable of staying focused while assuming the leadership role inherent in carrying out the functions of the position. Good judgement along with advanced knowledge and technical skills are essential in directing other team members to assist as needed. The Paramedic must be able to provide top quality care, concurrently handle high levels of stress, and be willing to take on the personal responsibility required of the position. This includes not only all legal ramifications for precise documentation, but also the responsibility for using the k now ledge and skills acquired in real life threatening emergency situations.
The Paramedic must be able to deal with adverse and often dangerous situations which include responding to calls in districts kn own to have high crime and mortality rates. Self-confidence is critical, as is a desire to work with people, solid emotional stability, a tolerance for high stress, and the ability to meet the physical, intellectual, and cognitive requirements demanded by this position.
Aptitudes required for work of this nature are good physical stamina, endurance, and body condition that would not be adversely affected by frequently having to walk, stand, lift, carry, and balance at times, in excess of 125 pounds. Motor coordination is necessary because over uneven terrain, the patients, the Paramedics, and other workers well being must not be jeopardized.
The Paramedic provides the most extensive pre-hospital care and may work for fire departments, private ambulance services, police departments or hospitals. Response times for nature of work are dependent upon nature of call. For example, a Paramedic working for a private ambulance service that transports the elderly from nursing homes to routine medical appointments and check-ups may endure somewhat less stressful circumstances than the Paramedic who works primarily with 911 calls in a districts known to have high crime rates. Thus, the particular stresses inherent in the role of the Paramedic can vary, depending on place and type of employment.
However, in general, in the analyst s opinion, the Paramedic must be flexible to meet the demands of the ever-changing emergency scene. When emergencies exists, the situation can be complex and care of the patient must be started immediately. In essence, the Paramedic in the EMS system uses advanced training and equipment to extend emergency physician services to the ambulance. The Paramedic must be able to make accurate independent judgements while following oral directives. The ability to perform duties in a timely manner is essential, as it could mean the difference between life and death for the patient.
Use of the telephone or radio dispatch for coordination of prompt emergency services is required, as is a pager, depending on place of employment. Accurately discerning street names through map reading, and correctly distinguishing house numbers or business addresses are essential to task completion in the most expedient manner. Concisely and accurately describing orally to dispatcher and other concerned staff, one's impression of patient's condition, is critical as the Paramedic works in emergency conditions where there may not be time for deliberation. The Paramedic must also be able to accurately report orally and in writing, all relevant patient data. At times, reporting may require a detailed narrative on extenuating circumstances or conditions that go beyond what is required on a prescribed form. In some instances, the Paramedic must enter data on computer from a laptop in ambulance. Verbal skills and reasoning skills are used extensively.
Description of tasks (encompasses the range of all tasks performed by lower level EMTs)
1. Answers verbally to telephone or radio emergency calls from dispatcher to provide advanced efficient and immediate emergency medical car e to critically ill and injured persons using a full range of equipment.
2. Drives ambulance to scene of emergency, reads map, responds safely and quickly to the address or location as directed by radio dispatcher, observes traffic ordinances and regulations. Visually inspects and assesses or sizes up the scene upon arrival to determine if scene is safe, determines the mechanism of illness or injury, the total number of patients involved, and remains calm and confident while demonstrating leadership and responsibility.
3. Radios dispatcher for additional help or special rescue and/or utility services. Reports verbally to the responding EMS unit or communications center as to the nature and extent of injuries and the number of patients. Recognizes hazards. Conducts triage, sorting out and classifying priorities for most immediate need for treatment. Uses excellent judgement to identify priorities based on the most critical needs for patient survival.
4. Searches for medical identification as clue in providing emergency care, i.e. identification bracelet for patient who is diabetic. Reassures patient and bystanders while working in a confident and efficient manner, a voids misunderstandings and undue haste while working expeditiously to accomplish the task. Extricates patient from entrapment, works with other EMS providers in rendering emergency care and protection to the entrapped patient. Performs emergency moves, assists other EMS providers in the use of prescribed techniques and appliances for safe removal of the patient.
5. Determines nature and extent of illness or injury in patient, takes pulse, blood pressure, and temperature, visually observes patient, recognizes the mechanisms of injury, takes comprehensive medical history of patient, including patient s current usage of prescribed and non-prescribed medications/drugs. Communicates with and provides verbal direction to Basic EMT to assist with tasks within the Basics scope of practice. Obtains consent and refusal. Uses good judgement to draw conclusions with often, limited information; verbally communicates effectively to provide quality treatment to diverse age and cultural groups. Provides family support, manages the difficult patient, conducts fundamental mental status assessment, restrains patient, and intervenes pharmacologically.
6. Positions unresponsive patient, protects the seizing patient, identifies and treats the hypoglycemic patient, provides heating/cooling interventions, manages burns and exposures, overdoses, conducts ingestion management. Manually stabilizes neck and body of child and adult, immobilizes extremities, straightens selected fractures and reduces selected dislocations. Delivers newborn. Provides pre-hospital emergency care of simple and multiple system trauma such as controlling hemorrhage, bandaging wounds, manually stabilizing painful, swollen joints and injured extremities, and immobilizing spine.
7. Uses basic and advanced life support equipment to open airway and upper airway adjuncts, removes foreign bodies, uses upper airway suction devices, performs orotracheal intubation, nasotracheal intubation, oral intubation with pharmacological assistance and surgery on airway. Uses dual or single lumen airway devices. Provides mouth to mouth barrier device ventilation, oxygen administration, chest injury management, bag-valve mask resuscitation. Uses powered ventilation devices, hand held aerosol nebulizer. Performs cardio-pulmonary resuscitation, uses automatic defibrillator apparatus in application of electric shock to heart, manages amputation, uses anti-shock garment, conducts peripheral venous access, intraosseous infusion, manual defibrillation, interprets EKGs, uses external pacemaker.
8. Administers medication (narcotics), determines the patient's most appropriate body route based on patient diagnosis. Calculates amount of medication to be given in relation to patient's weight, age, and other factors that warrant adjustment of volume . Uses oral, auto-injection, sublingual, inhalation, subcutaneous, intramuscular, intraosseous, transcutaneous, rectal, endotracheal, and intravenous routes including central and peripheral lines and venesection as well as infusion pumps to administer medications.
9. Assists other EMS providers in lifting patient onto stretcher, places patient in ambulance, secures stretcher. Continues to monitor patient en route to hospital.
10. Checks, maintains vehicles, and provides mechanical report. Restocks and replaces used supplies, uses appropriate disinfecting procedures to clean equipment, checks all equipment to insure adequate working condition for next response. Takes inventory of and accounts for all medications (narcotics) given. Keeps log of all transactions. Prepares accurate and legible medical reports. Provides medical reports to staff.
11. Transports non-emergency patients to regularly scheduled appointments, for example, transport geriatric patients in nursing homes. Uses computer to enter data for EMS reports.
12. Supervises the activities and educational experiences of assign ed observers and students. Complies with regulations in handling the deceased.
13. Functions as the primary direct care provider of emergency health care services to sick and injured patients in pre-hospital settings. Works primarily in advanced life support units affiliated with fire departments, police departments, rescue squads, hospitals, or private ambulance services under the off-site supervision of a physician, usually through radio communication, is usually the senior level member of a two person team, working in conjunction with a Basic EMT.
14. Accepts primary responsibility for all aspects of advanced life support given to the patient, including use of advanced life support equipment and administration of medication that includes narcotics; responsible for thorough written documentation of all activity related to patient care and medication dispensation. Successfully completes continuing education and refresher courses as required by employers, medical direction, and licensing or certifying agencies. Meets qualifications within the functional job analysis.
Must be at least 18 years of age and be a high school graduate or equivalent. Must have proof of valid drivers license. Ability to communicate verb ally; via telephone and radio equipment; ability to lift, carry, and balance up to 125 pounds (250 with assistance); ability to interpret and respond to written, oral, and diagnostic form instructions; ability to use good judgment and remain calm in high-stress situations and take on role of leader.
Must have the ability to read road maps; drive vehicle, accurately discern street signs and address numbers, read medication/prescription labels and directions for usage in quick, accurate, and expedient manner, ability to communicate verbally with patients and significant others in diverse cultural and age groups to interview patient, family members, and bystanders, and ability to discern deviations/changes in eye/skin coloration due to patients condition and to the treatment given. Must be able to document, in writing, all relevant information in prescribed format in light of legal ramifications of such; ability to converse with dispatcher and EMS providers via phone or radio as to status of patient.
Good manual dexterity with ability to perform all tasks related to advanced emergency patient care and documentation. Ability to bend, stoop, balance, and crawl on uneven terrain; and the ability to withstand varied environmental conditions such as extreme heat, cold, and moisture. Ability to perform quickly, precise, practical mathematical calculations pertinent to ratio and proportion of medication and supplies used in emergency patient care. Must be independent, confident, able to work independently without defined structure, have good stable reasoning ability with ability to draw valid conclusions expediently relevant to patient s condition, often, using limited information. Must have knowledge and skills relevant to position and be able to implement them in stressful situations. Must be cognizant of all legal, ethical, and moral obligations inherent within scope of practice.
Must be able to perform mathematical calculations/ratios and apply them in expedient, practical manner. Must be independent, confident, able to work independently without structure, have good stable reasoning ability and able to draw valid conclusions quickly relevant to patient's condition, often, using limited information. Must have knowledge and skills relevant to position and be able to implement them in practical fashion in stressful situations. Must be cognizant of all legal, ethical, and moral obligations inherent within scope of practice.
Must have successful completion of approved curriculum with achievement of passing scores on written and practical certification examinations as defined by programmatic guidelines. Re-certification is dependent upon an individual's successful completion of inter-agency approved Paramedic continuing education fresher courses. At any given time, performs any or all tasks performed by a lower level EMT. May supervise activities of students or interns, and/or may engage in writing of journal articles or teach. Meets qualifications within the functional job analysis.
Must demonstrate competency in assessment of a patient, handling emergencies using Basic Life Support equipment and techniques. Must be able to perform CPR, control bleeding, provide non-invasive treatment of hypoperfusion, stabilize/immobilize injured bones and the spine, manage environmental emergencies and emergency childbirth. Must be able to use a semi-automatic defibrillator. Must be able to assist patients with self-administration or administer emergency medications as described in state and local protocol.
Must be capable of utilizing all EMT-B and AEMT-intermediate skills and equipment. Must be able to perform under Advanced Cardiac Life Support (ACLS) and Basic Trauma Life Support (BTLS) standards. Must be knowledgeable and competent in the use of a cardiac monitor/defibrillator and intravenous drugs and fluids. The EMT-Paramedic has reached the highest level of pre-hospital care certification.
Description of Tasks:
- Responds to calls when dispatched. Reads maps, may drive ambulance to emergency site using most expeditious route permitted by weather and road conditions. Observes all traffic ordinances and regulations.
- Uses appropriate body substance isolation procedures. Assesses the safety of the scene, gains access to the patient, assesses extent of injury or illness. Extricates patient from entrapment. Communicates with dispatcher requesting additional assistance or services as necessary. Determines nature of illness or injury. Visually inspects for medical identification emblems to aid in care (medical bracelet, charm, etc.). Uses prescribed techniques and equipment to provide patient care. Provides additional emergency care following established protocols. Assesses and monitors vital signs and general appearance of patient for change. Makes determination regarding patient status and priority for emergency care using established criteria. Reassures patient, family members, and bystanders.
- Assists with lifting, carrying and properly loading patient into the ambulance. Avoids mishandling patient and undue haste. Determines appropriate medical facility to which patient will be transported. Transports patient to medical facility providing ongoing medical care as necessary en route. Reports nature of injury or illness to receiving facility. Asks for medical direction from medical control physician and carries out medical control orders as appropriate. Assists in moving patient from ambulance into medical facility. Reports verbally, and in writing, observations of the patient's emergency and care provided (including written report(s) and care provided by certified first responders prior to EMT-B/AEMT arrival on scene) to emergency department staff and assists staff as required.
- Complies with regulations in handling deceased; notifies authorities and arranges for protection of property and evidence at scene.
- Replaces supplies, properly disposes of medical waste. Properly cleans contaminated equipment according to established guidelines. Checks all equipment for future readiness. Maintains ambulance in operable condition. Ensures cleanliness and organization of ambulance, its equipment and supplies. Determines vehicle readiness by checking operator maintainable fluid, fuel, and air pressure levels. Maintains familiarity with all specialized equipment.