Editing Paramedic (section)

==Scope of practice==
===Common skills===
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:<ref>{{Cite web|url=http://www.austintexas.gov/omd|title=Clinical Operating Guidelines|website=www.google.com|access-date=2019-12-28}}</ref>

* [[Advanced cardiac life support]], or ACLS, including [[cardiopulmonary resuscitation]], [[defibrillation]], [[cardioversion]], [[transcutaneous pacing]], and administration of cardiac drugs
* Patient assessment, including acquisition of [[vital signs]], physical exam, [[chest auscultation]], history taking, [[electrocardiogram]] acquisition and interpretation, [[capnography]], [[pulse oximetry]], point-of-care [[ultrasound]] and basic [[blood chemistry]] interpretation (glucose, lactate)
*Airway management techniques including [[tracheal intubation]], [[cricothyrotomy]], [[rapid sequence induction]], [[supraglottic airway]] insertion, manual repositioning, sterile suctioning, use of [[oropharyngeal]] and [[nasopharyngeal]] airway adjuncts, and manual removal of obstructions via direct laryngoscopy and use of [[magill forceps]]
* [[Thoracostomy|Thorocostomy]] and [[pericardiocentesis]] to relieve pneumothorax and pericardial tamponade
* [[Intravenous]] (IV) and [[intraosseous]] (IO) cannulation
* Oxygen administration and [[positive pressure ventilation]] via [[bag-valve-mask]], [[Continuous positive airway pressure|CPAP]] device, or [[ventilator]]
* [[Fluid resuscitation]]
* Administration of emergency drugs/medications (see section below)
* Bleeding control and management of [[shock (circulatory)|shock]]
* [[Spinal injury]] management, including immobilization and safe transport
* [[Fracture]] management, including assessment, [[splint (medicine)|splint]]ing, and dislocation reduction 
* [[Obstetrics]], including assessment, [[childbirth]], and recognition of and procedures for obstetrical emergencies such as [[breech presentation]], cord presentation, and [[placental abruption]]
* Management of [[burn]]s, including classification, estimate of surface area, recognition of more serious burns, and treatment
* [[Triage]] of patients in a [[mass casualty incident]]
* Surgical procedures such as field amputation, [[escharotomy]], or [[thorocotomy]]<ref>{{Cite web |date=13 September 2018 |title=Medical Directive |url=https://www.austintexas.gov/sites/default/files/files/Medical_Director/Medical_Directive_18-08_Revision_of_the_Clinical_Operating_Guidelines_New_Version_10.01.18.pdf |url-status=live |archive-url=https://web.archive.org/web/20211022195948/https://www.austintexas.gov/sites/default/files/files/Medical_Director/Medical_Directive_18-08_Revision_of_the_Clinical_Operating_Guidelines_New_Version_10.01.18.pdf |archive-date=22 October 2021 |website=AustinTexas.gov}}</ref> (if trained and credentialed)

===Emergency pharmacology===
Paramedics carry and administer a wide array of emergency [[medications]]. 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:
[[File:Patient Care.jpg|right|thumb|A paramedic preparing an intravenous infusion for a patient]]
* [[Analgesic]] medications such as [[aspirin]], [[ketorolac]] and [[paracetamol|paracetamol (acetaminophen)]], used to relieve pain or decrease nausea and vomiting
* [[Narcotic]]s like [[morphine]], [[pethidine]], [[fentanyl]], and [[methoxyflurane]], used to treat severe pain. 
* Beta and calcium channel blockers such as [[diltiazem]], [[metoprolol]] and [[verapamil]] used to slow down excessively high [[heart rate]]s or severe [[hypertension]]
* [[Parasympatholytic]] drug such as [[Atropine]], also known as anticholinergic drugs, used to speed up slow [[bradycardia|bradycardic]] heart rates
* [[Sympathomimetics]]<ref>{{cite journal | author = De Backer D | year = 2011 | title = Treatment of shock | journal = Acta Clinica Belgica | volume = 66 | issue = 6| pages = 438–442 | doi = 10.2143/ACB.66.6.2062611 | doi-broken-date = 1 November 2024 | pmid = 22338308 | id = {{ProQuest|1002208084}} }}</ref> such as [[dopamine]], [[dobutamine]], [[norepinephrine (drug)|norepinephrine]], and [[epinephrine]] used for [[cardiac arrest]], severe [[hypotension]] (low blood pressure), [[Shock (circulatory)|shock]] and [[sepsis]]. These are often known as "vasoactive" agents. 
*[[Dextrose]] (often D50W, a solution of 50% dextrose in water), used to treat [[hypoglycemia]] (low blood sugar)
* [[Sedative]]s like [[midazolam]], [[lorazepam]], [[etomidate]], and [[ketamine]]<ref name="Metcalf2018">{{cite journal|last1=Metcalf|first1=Matthew|title=Ketamine administration by HART paramedics: a clinical audit review|journal=Journal of Paramedic Practice|volume=10|issue=10|year=2018|pages=430–437|issn=1759-1376|doi=10.12968/jpar.2018.10.10.430|s2cid=57321666}}</ref><ref name="SvensonBiedermann2011">{{cite journal|last1=Svenson|first1=James|last2=Biedermann|first2=Marc|title=Ketamine: a unique drug with several potential uses in the prehospital setting|journal=Journal of Paramedic Practice|volume=3|issue=10|year=2011|pages=552–556|issn=1759-1376|doi=10.12968/jpar.2011.3.10.552}}</ref> used to reduce the irritability or agitation of patients, to relieve symptoms of seizure, or provide procedural sedation
* [[Paralytic]]s such as [[succinylcholine]], [[rocuronium]], and [[vecuronium]], used when an emergency procedure such as [[Rapid sequence induction|rapid sequence intubation (RSI)]] is required<ref name="DurhamWesthead2020">{{cite journal|last1=Durham|first1=Mark|last2=Westhead|first2=Pete|last3=Griffiths|first3=David|last4=Lyon|first4=Richard|last5=Lau-Walker|first5=Margaret|title=Prehospital neuromuscular blockade post OHCA: UK's first paramedic-delivered protocol|journal=Journal of Paramedic Practice|volume=12|issue=5|year=2020|pages=202–207|issn=1759-1376|doi=10.12968/jpar.2020.12.5.202|s2cid=219044909}}</ref>
* [[Antipsychotic]]s like [[haloperidol]] or [[ziprasidone]], used to sedate combative patients
* Respiratory medications such as [[albuterol]] and [[ipratropium bromide]] used to treat conditions such as asthma and acute bronchitis
* Steroids such as [[hydrocortisone]] and [[methylprednisolone]] used to treat inflammatory respiratory conditions and [[adrenal crisis]]
* Cardiac medications such as [[nitroglycerin]] and aspirin are used to treat cardiac ailments such as angina and myocardial infarctions
* Diuretic medications such as [[furosemide]] to treat [[congestive heart failure]] and severe hypertension
* [[Antiarrhythmics]] such as [[amiodarone]], [[adenosine]], [[lidocaine]] and [[magnesium sulfate]] used to treat [[arrhythmia|abnormal heart rhythms]] such as [[ventricular tachycardia]] and [[ventricular fibrillation]]
* [[Antiemetics]] such as [[promethazine]] or [[ondansetron]] used for nausea and vomiting
* [[Antidotes]] for a variety of [[toxins]] such as [[naloxone]] (opioids), [[pralidoxime]] ([[organophosphate]]s), sodium bicarbonate (tricyclic antidepressants), and [[hydroxocobalamin]] (cyanide). 
*[[Blood transfusion|Blood products]] and [[tranexamic acid]] in cases of [[Shock (circulatory)|hemorrhagic shock]]
* Broad spectrum [[antibiotics]] such as [[ceftriaxone]] or [[vancomycin]] for cases of [[sepsis]]
* Hormones like [[oxytocin]] to control post-partum bleeding

===Skills by certification level===
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 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.

{| class="wikitable" | style="margin: 1em auto 1em auto; style="text-align: left"
|+
! style="width:13%;"|Treatment issue
! style="width:29%;"|Basic Life Support (BLS) Provider
Emergency Medical Technician – United States (120–200 hours education)

Emergency Medical Responder – Canada (80 hours education)

! style="width:29%;"|[[Intermediate Life Support]] (ILS) Provider
[[Advanced EMT]] – United States (3–6 months education)

Paramedic – Australia ([[Bachelor's degree|Bachelor's Degree]])

Primary Care Paramedic – Canada (2–3 year education)
! style="width:29%;"| Advanced Life Support (ALS) Provider
Paramedic – United States
(1–2 year education)

Intensive Care Paramedic – Australia 
([[Master's degree|Master's Degree]])

Advanced Care Paramedic – Canada 
(4 year education)
|-
|- valign="top"
| Airway management
| Assessment, manual repositioning, [[oropharyngeal]] and [[nasopharyngeal]] airway adjuncts, manual removal of obstructions, suctioning
| Use of supraglottic airway devices such as the I-Gel or King-LT airway
| [[Endotracheal intubation]], [[cricothyrotomy]] (surgical airway), delayed and [[rapid sequence induction]] (in some jurisdictions), use of magill forceps, airway suctioning.
|-
|- valign="top"
| Breathing
| Assessment (rate, effort, symmetry, skin color), obstructed airway maneuver, supplemental [[oxygen]] administration by nasal cannula, rebreathing and non-rebreathing mask, positive pressure ventilation by [[Bag valve mask|bag valve mask (BVM)]]. 
| [[CPAP]] 
| Decompression of tension pneumothorax by needle or incision [[thoracostomy]], [[BIPAP]], use of mechanical transport ventilators.
|-
|- valign="top"
| Circulation
| Control of [[hemorrhage]] using direct and indirect pressure, [[tourniquets]], wound packing and [[hemostatic agents]], basic shock management and hypothermia prevention, pelvic binding. 
| IV [[fluid resuscitation]].
| [[Intraosseous|Intraosseous (IO)]] [[cannulation]] (placement of needle into marrow space of a large bone), central venous access (using central venous catheter by way of external jugular or subclavian), [[pericardiocentesis]]. 
|-
|- valign="top"
| [[Cardiac arrest]]
| [[Cardiopulmonary resuscitation]], basic airway adjuncts, suctioning, BVM ventilation, semi-automatic defibrillation. 
| Expanded resuscitation skills including supraglottic airway placement, monitoring of capnography, administration of epinephrine/adrenaline (in some jurisdictions). 
| Expanded drug therapy options (epinephrine, anti-arrhythmics), ECG interpretation, manual [[defibrillation]], intubation, ultrasound.
|-
|- valign="top"
| Cardiac Monitoring
| Placement of [[electrocardiogram|ECGs]] electrodes and ability to transmit to hospital for interpretation. 
| Twelve lead ECG monitoring and interpretation
| Advanced ECG interpretation
|-
|- valign="top"
| Drug administration
| Oral, [[nebulized]], and [[intramuscular]] injection of a limited list of drugs
| limited list of drugs for [[intramuscular]], [[subcutaneous injection|subcutaneous]], intravenous injection ([[bolus (medicine)|bolus]]), [[intravenous therapy|intravenous drip]], and [[transdermal]].
| [[Infusion pump]] and [[intraosseous]] access. 
|-
|- valign="top"
| Drug types permitted
| Low-risk and immediate requirements, e.g., aspirin and nitroglycerin (chest pain), oral glucose and [[glucagon]] (hypoglycemia), [[epinephrine]] (anaphylaxis or respiratory failure), [[albuterol]] (asthma), and [[naloxone]] (narcotic overdose). 
| Intravenous fluids, dextrose infusion (hypoglycemia), and symptom relief medications such as ondansetron (nausea), [[dipenhydramine]] ([[pruritus]]), and non-narcotic pain management ([[nitrous oxide]], [[methoxyflurane]], ketorolac, acetaminophen). 
| Significantly expanded drug list, most commonly [[narcotics]], [[sedatives]], [[vasopressors]], [[antidotes]], [[neuromuscular blockers]], and advanced cardiac and respiratory medications. In some jurisdictions, paramedics may also permitted to administer [[blood products]], [[tranexamic acid]], and [[antibiotics]]. 
|-
|- valign="top"
| Patient assessment
| Basic physical assessment, [[vital signs]], history taking, lung [[auscultation]], [[pulse oximetry]]. 
| More detailed physical assessment and history, [[capnography]]. 
| Advanced assessment, 4 and 12-lead ECG interpretation, [[Prehospital ultrasound|ultrasound]],<ref>{{Cite web|url=http://www.paramedicultrasound.com/|title=Prehospital Ultrasound|website=www.paramedicultrasound.com}}</ref> point-of-care blood chemistry interpretation (glucose, lactate, hemoglobin, troponin). 
|-
|- valign="top"
| Other procedures 
| Splinting of bone fractures, uncomplicated and complicated childbirth. 
| 
| Wound closure ([[butterfly stitches]], [[suturing]]), fracture/dislocation reduction, umbilical venous access, chemically facilitated extrication, emergency surgical procedures such as [[escharotomy]] or field [[amputation]] (in some jurisdictions).
|}