February 20, 2014 at 11:21 PM

Dr. Clark, what do I need to know to keep it real when writing about paramedics who stabilize and transport patients? Specifically, what can and can’t be done by paramedics? Treatments? Pitfalls? Authority?

Joyce G.
Austin, TX


February 20, 2014 at 11:26 PM
Joyce, thanks for your question. Here are a few pearls to help you when writing about paramedics. First, you need to be careful of terms. The term “paramedic” is often mistakenly used to refer to all emergency medical personnel who respond to events outside of a hospital setting. In the USA there are generally three types of Emergency Medical Technicians (EMTs): basic, intermediate, and paramedic. As you might guess, paramedics are the most highly trained type of EMT, and usually serve as team leaders in the field. Besides managing the EMT team, paramedics diagnose and triage victims, analyze EKGs and perform resuscitation (CPR) and advanced life support (ALS), defibrillate, give dozens of medications, intubate airways and support breathing, establish IV access, give IV fluids, bandage injuries to control bleeding, immobilize spinal fractures, splint fractures, and sometimes use needles and tubes to decompress lungs, and if needed, deliver babies. They may perform additional procedures in some jurisdictions when directed by a physician via telemetry and a remote voice link. In those situations, paramedics may function as the eyes, ears, and hands of a doctor who is managing the scene from a remote base, usually a hospital ER. A paramedic will function as the “captain of the ship” and assume the ultimate authority at the scene, unless otherwise being directed remotely by a physician.

There are many life saving drugs and procedures that are not available to paramedics in the field, and delay for treatment in the field must be weighed against the need for rapid transport to a better-equipped facility. Paramedics often make life or death executive decisions to delay treatment in order to get to the ER fast, a practice referred to as “scoop and run.” Due to the recent, widespread use of blood thinners, accident victim survival times have decreased up to 20% in some studies, due to blood loss. This is a hot topic for paramedics today. Paramedics are not able to give blood transfusions in the field, and IV fluids alone are often not adequate to sustain life in trauma victims.

If you are writing a mystery or crime story, remember that in most cases paramedics will not enter a conflict zone or crime scene until it has first been secured by the police. Also, paramedics will usually be careful to minimize contamination of a crime scene and preserve the chain of evidence.

H.S. Clark, MD
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