6.4 Prehospital Medicine Settings

Besides the provision of emergency (911) responses, paramedics and EMT’s (including AEMT’s) may work in other capacities. Community Paramedics working as part of a mobile integrated healthcare network provide non-emergency services within the community. These specialty trained paramedics provide focused care to the community that the patients may not be able to obtain on their own. For instance, community paramedics regularly visit the homeless, to provide follow ups on their medical conditions and to ensure compliance with the prescribed medication regimes. Psychological interventions are also part of the roles of community paramedics. Early interventions are key to these interactions. In some areas community paramedics follow up with recently discharged patients, many of them elderly. Hospitals of today are discharging patients as early as possible after surgery or treatments for medical issues. Many of these patients may not have the needed family resources to continue their recovery. For instance, a patient who is discharged to home after surgery will have limited mobility outside of the house for a week. How can they get their medications refilled, obtain groceries and other essential activities. The patient may also need home health services, which the paramedic can assist in arranging. While the community paramedics won’t necessarily provide these services, they have avenues to make sure these essential functions take place. Community Paramedics will also perform an exam on the patient, should anything be found outside the norm, the physician will be contacted and appropriate actions taken. This may include a change in medications, scheduling an early follow up appointment with the provider, or a change in rehabilitation schedule. The goal of these interventions is to speed the patient’s recovery and keep them from being readmitted to the hospital.

EMTs, AEMT’s and Paramedics may work in industrial settings. These settings can vary from a large construction site in an urban area to an offshore oil platform fifteen miles off the coast. While the EMS providers in these situations provide much of the care that would normally be seen working on an ambulance, they also provide more primary care medicine. This is especially true of paramedics who can administer medications. In these environments where transporting a worker to the closest Emergency Department can take up to 24 hours, the ability to care for minor wounds and treat simple medical issues is essential. In these situations paramedics may suture simple lacerations or dispense certain medication for things like nausea and diarrhea, usually after consulting a physician via a telemedicine link.

EMT’s and Paramedics also work in more traditional medical environments. For many years EMTs have been used as aids in Emergency Departments assisting nursing and medical staff with the care of patients. In recent years Paramedics have been utilized in Emergency Departments to the full scope of their practice, providing advanced care as an extension of the nursing and medical staff. During the COVID pandemic Paramedics were tasked in many areas to provide backup and relief services in extended care facilities as emergency staff needs arose.