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U.S.C.G. corpsmen are usually EMT-B's. But their scope of practice is well beyond that of civilian EMT-B's, duties include dispensing of many drugs at the level of nurses and performing minor surgeries.
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"American paramedics were originally specially trained military medical technicians who were first utilized during the Korean war. In many cases, these specialists were parachuted into locations where they were urgently needed: hence, the term para-medic (a medical corpsman who was also a parachutist).
Today the term is used to signify personnel who function as subsidiaries or supplements to [nurses] and physicians (the prefix para now is taken to mean "closely resembling; beside")." (Grolier)
"In 1966 Congress created the National Highway
Safety Administration, which was charged with
issuing guidelines for state emergency medical
systems and formulating an emergency medical
technician (EMT) training program.
Professional requirements for EMT's were established,
and their capabilities were expanded well beyond
the functions of earlier ambulance personnel.
Today, emergency medical transport is largely the responsibility of community fire departments, private ambulance and municipal health department services."
The equipment of U.S. ambulances are regulated by federal law. A minimum set of basic life support
equipment must be carried on an ambulance. These
include ventilation devices (for manual and artificial
ventilation), oxygen, suction units, immobilization
devices for trauma patients (such as c-colars and backboards), a childbirth package, bandages,
dressings and other first aid supplies. Ambulances
may be operated by simple drivers, but there must be
at least one EMT-B (Basic) present for the vehicle to be legally an ambulance.
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Many EMT's of all levels also work in Hospitals in close conjunction with Nurses and Physicians.
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The training of the EMT-B requires the completion of
at least 110 hours of classroom and 50 practical clinical instructions. After obtaining the EMT-B
certification, either from the state or the national
registry, and further clinical experience (usually one year), an EMT-B may extend training in
pharmacology, cardiology, and advandced airway management to the level of EMT-P (paramedic). This advanced training consists of an additional
700-1000 class hours and an extensive clinical.
Paramedics "carry out some of the more routine duties
of a physician" (Grolier). In addition to the basic
duties of an EMT-B - taking case histories, giving medical examinations, attempting causes and providing basic medical and live saving procedures - the
paramedic may set IV's, read and analyze cardiograms, and may take necessary steps in order to correct trauma or illness with medication or defibrillation.
A few U.S. states have levels that are in-between the EMT-B and EMT-P. These are frequently called EMT-A (advanced), EMT-I (intermediate) or EMT-D (defibrillate). The national association of EMT's is encouraging one national standard and recognizes only the EMT-Basic, Intermediate, and Paramedic levels.
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German paramedic (Rettungsassistentin) N. Kohler posing in front of her station in Neuss.
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In Germany
In Germany, young men who wish
to substitute mandatory military
obligations, have the opportunity
to work in health care settings.
"Zivis" (Zivildienstleistende=
civilian servants), are trained
as EMT-B's and function mainly
in non emergency transports or to
assist professional paramedics;
Rettungsassistenten).
The training of the German EMT-P (paramedic) lasts
two full years of in-class training with extensive
Anatomy and Biology classes, a minimum of 40 hrs. clinicals each in ER (Emergency Room), ICU (Intensive
Care Unit), Labor & Delivery, Anaestheology, Operating "theater" etc. are also a required minimum.
Another 160 hrs. are dedicated to working with increasing levels of responsibilities on a rescue station. Finally, 40 hrs. are reserved for the preparation of the exam.
The main difference of German EMS to American EMS is that 911 calls (112 in Germany) are mainly responded by emergency physicians. The ER-physician is driven to the scene by a separate vehicle and assisted by the paramedic unit. If the patient is stable (class III patient), the paramedic unit is given authority over the patient for transport to the hospital without further presence of the physician.
German paramedic students (as all students in professional training) get compensated about
40-60% of entrly level pay.
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A historical aspect
Cardio Pulmonary Resuscitation 5000 years ago: German anesthesiologist, Andreas Ocklitz, claims that several frequently used emergency medical precedures and techniques are not the modern inventions we like them to believe.
According to him, the evidence for his theory is a peculiar 20 cm long instrument found in ancient Egypt tombs: the Netjerti. The material it has been manufactured from is high in nickel content. Similar to modern surgical instruments, it hardly rosts.
It has proven to function very well as a laryngoscope (a modern instrument used in EMS and Anaesthiology to
intubate a patient in respiratory failure or arrest). According to Eberhard Otto (a Historian), injuries in the oral/trachael area of examined mummies are consistent
with intubation attempts. Other procedures, such as the use of golden intubation sockes in ancient Arabia and mouth-to-mouth resuscitation of newborns by Hebrew midwifes, has been described and evidenced. (Der Spiegel
Magazine 17/1997)
LINKS:
Trauma practice guide (for physicians)
Basic EMS pharmacology
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