paramedic paramedic a paramedic is a healthcare professional who responds to emergency calls for medical help outside of a hospital. paramedics mainly work as part of the emergency medical services (ems), most often in ambulances. the scope of practice of a paramedic varies among countries, but generally includes autonomous decision making around the emergency care of patients. not to be confused with emergency medical technician. paramedics of the australian capital territory ambulance service during trainingoccupationnamesparamedicoccupation typeprofessionactivity sectorshealth caredescriptionfields ofemploymentambulance; hospital; pre-hospital; transportrelated jobsemergency medical technician 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 emergency medical technicians (or emergency care assistants), in which paramedics have additional educational requirements and scope of practice. duties and functions the paramedic role is closely related to other healthcare positions, especially the emergency medical technician, 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). the role of a paramedic varies widely across the world, as ems providers operate with many different models of care. 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 first aid. in other versions of the franco-german model, such as germany, paramedics do exist. their role is to support a physician in the field, in a role more akin to a hospital nurse, rather than operating with clinical autonomy. 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 hospitalisation entirely and, through practitioners, are able to prescribe certain medications, or undertaking 'see and refer' visits, where the paramedic directly refers a patient to specialist services without taking them to hospital. occupational hazards 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 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. infectious disease has become a major concern, in light of the covid-19 pandemic. in response, the u.s. centers for disease control and prevention and other agencies and organizations have issued guidance regarding workplace hazard controls for covid-19. 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. history early history 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 imperial legions of rome, where aging centurions, no longer able to fight, were given the task of organizing the removal of the wounded from the battlefield and providing some form of care. such individuals, although not physicians, were probably among the world's earliest surgeons by default, being required to suture wounds and complete amputations. a similar situation existed in the crusades, with the knights hospitaller of the order of st. john of jerusalem filling a similar function; this organisation continued, and evolved into what is now known throughout the commonwealth of nations as the st. john ambulance and as the order of malta ambulance corps in the republic of ireland and various countries. early ambulance services while civilian communities had organized ways to deal with prehospitalisation care and transportation of the sick and dying as far back as the bubonic plague in london between 1598 and 1665, such arrangements were typically ad hoc and temporary. in time, however, these arrangements began to formalize and become permanent. during the american civil war, jonathan letterman devised a system of mobile field hospitals employing the first uses of the principles of triage. 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. german red cross paramedics training in 1931 ambulance of the magen david adom in israel, 6 june 1948 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 funeral directors 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 toronto police ambulance service receiving a mandatory five days of training from st. john as early as 1889. prior to world war i 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 world war ii and the korean war battlefield medics administered painkilling narcotics 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 helicopters to evacuate the wounded from forward positions to medical units, leading to the rise of the term "medevac". these innovations would not find their way into the civilian sphere for nearly twenty more years. prehospital emergency medical care by the early 1960s experiments in improving medical care had begun in some civilian centres. one early experiment involved the provision of pre-hospital cardiac care by physicians in belfast, northern ireland, in 1966. this was repeated in toronto, canada in 1968 using a single ambulance called cardiac one, which was staffed by a regular ambulance crew, along with a hospital intern 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 defibrillator and heart monitor was powered by lead-acid car batteries, and weighed around 45 kilograms (99 lb). emts caring for a collapsed woman in new york in 1966, a report called accidental death and disability: the neglected disease of modern society—commonly known as the white paper—was published in the united states. this paper presented data showing that soldiers who were seriously wounded on the battlefields during the vietnam war had a better survival rate than individuals who were seriously injured in motor vehicle accidents on california's freeways. 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 fluid replacement and airway management. as a result of the white paper, 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) pilot units across the us including paramedic programs. the success of these units led to a rapid transition to make them fully operational. freedom house ambulance service was the first civilian emergency medical service in the united states to be staffed by paramedics, 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 harbor–ucla medical center, under the medical direction of j. michael criley, md and james lewis, md. in 1969, the seattle "medic 1" paramedic program was developed in conjunction with the harborview medical center 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 paramedic programs following the passage of the wedsworth-townsend act 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. in the military, however, the required telemetry and miniaturization technologies were more advanced, particularly due to initiatives such as the space program. 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 european countries and latin america. public notability while doing background research at los angeles' ucla harbor medical center for a proposed new show about doctors, television producer robert a. cinader, working for jack webb, happened to encounter "firemen who spoke like doctors and worked with them". this concept developed into the television series emergency!, 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 technical advisor, james o. page, was a pioneer of paramedicine 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 journal of emergency medical services (jems). the jems magazine creation resulted from page's previous purchase of the paramedics international magazine. ron stewart, the show's medical director, 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