What we do isn’t paramedicine.

It is medicine.

If we want a real seat at the table, we need to get comfortable with the idea that we provide medical care to patients, not anything else, and certainly not anything less. What we do as paramedics may be via a delegated practice model but make no mistake, we are in the business of providing medicine while transporting.

We provide medical care, not paramedical care.

Calling what we do “paramedicine” is meaningless sugar coating in an attempt at deference and trying to not step on toes. Saying we practice “paramedicine” is mitigated speech because we don’t have the guts to say what we do – medicine.
paramedicine

Why do we have such a collective problem saying what we do is medicine –  the same medicine that nurse, doctors and mid-level providers deal with? Until we can look other healthcare providers straight in the eye and say that we are medical providers and we provide medical care maybe we don’t deserve that seat at the table. Maybe we can just sit at the para-table.

Until a leadership organization comes along and is willing to support this notion, I do not support any of them. Most associations seem to waste an inordinate amount of time trying to pin down meaningless semantics and worrying about what we should be called and hypothetical hierarchies. Trying to divide us from other health care providers is not going to reap any benefits – the future lies in collaboration and integration.

I am a paramedic; I provide medical care. While the term “practicing medicine” may have specific legal connotations that are specific to each state (usually reserved for doctors) I would be remiss if I did not point out we as paramedics have a specific scope of practice. A scope. Of. Practice.

We engage in at least a limited form of the practice of medicine as the term scope of practice implies exactly that – the scope of our practice. I am not comparing us to doctors, we are not doctors, not even close, but let us not mitigate what it is we do by adopting non-sensical terms that are divisive between us and other health care professionals.

If an organization wants to say what paramedics do is not medicine, but rather paramedicine, they have lost touch with reality and lost my support. Paramedics are starting vasoactive medications in the field, setting up ventilators, interpreting lab values, starting blood transfusions, and deciding who goes to the cath lab. That is medicine and we damn well better get good at it.

What we do is medicine, not anything less.

One thought on “

  1. I get that when you apply the Greek etymology of para that “Paramedicine” would mean “around medicine” as though it was a separate field related to medicine. Or para as used to describe “abnormal” would again make it a field different from “regular medicine”.
    Even more fun would be using the Persian etymology of “a part” or “portion” so that Paramedicine would describe a small section of medicine (which might be more painfully accurate than we care to acknowledge).
    But, this blog ignores the actual history of the word. It (paramedic) is literally derived from “parachuting medic”. Describing both field medics and doctors who parachuted into combat zones to deliver emergency care.
    It isn’t so much a description of the type of care being delivered but the method of the delivery. Whether the level of care is a BLS ambulance that can’t do much beyond bleeding control and ventilation, or the most advanced MICU ambulance staffed with a paramedic who has multiple college degrees and critical care certifications along with a trauma surgeon, they are delivering Paramedicine.
    The best equipped ambulance in the world with the best trained crew will still have to adapt care based on the resources and space limitations they face. It doesn’t preclude that they will deliver subpar care, just that it has to be evaluated in terms of their environment.
    Plenty of professional medical fields practice medicine without referring to their specialty as “medicine”. An anesthesiologist practices medicine, arguably the most artistic and intuition based medicine, but they refer to their field as anesthesiology. An OB practices medicine in the field of obstetrics.
    I get where you are coming from. I understand that the goal is put the field of “Paramedicine” on the same level as other fields. Perhaps “prehospital emergency medicine” is more descriptive, but at the same time if the field isn’t willing to change what does the name matter in persuading other professions that we are equals?
    We vehemently oppose the same education requirements as LVNs/LPNs, medical lab specialists, ultrasound technicians, etc.
    Just because you slap a Shelby Cobra badge on a Ford Pinto no one is going to stand in awe of your car. Expect, perhaps, in disbelief of the delusions of self worth and grandeur.
    We can strive to be better at the field of Paramedicine. Maybe one day it would even be worth changing the name, but why taint a new name with our current self imposed dangerously poor minimum standards?
    We don’t have an epidemic of providers who think they can’t “diagnose” because we’re in the field of Paramedicine. We have it because we allow instructors who have no specialty in the field they’re teaching. We don’t have legal experts teach our medicolegal education, we have someone whose only education is the same slide show they are teaching from. We’ve let medical law become an imaginary boogieman with stories of lawsuits and HIPAA violations. The instructor can’t be bothered to read the fairly concise and specific information related to privacy set forth in HIPAA.
    We have “professionals” in our field that think the first amendment protects them from a private employer firing them for violating a social media policy they didn’t read before signing.
    Practicing medicine should be our goal but currently most of our field barely practices Paramedicine. We don’t teach the importance of continuity of care, the lifespan of care for a patient.
    Just this week I got to see the age old argument against prehospital antibiotics rear it’s ugly head.
    “Well it won’t do any good while I have them”, and when we don’t teach the national door to ABX time sits at about 90-180 minutes that argument makes sense.
    We have a whole field that doesn’t understand anything about chronic pain management. Instead they were taught narcan should be applied to sufficiently send a patient into withdrawals, but right outside the ER. People claim narcan is dangerous because the patient wakes up dangerous and combative as though it’s a badge of their wisdom, instead of being a warning sign of ignorance.
    We argue that no amount of danger to the public warrants not transporting every call code. Instead people argue “well in the city it might save ten minutes”, except most of those patients are going to spend an hour getting a round of antibiotics and imaging before a surgeon is willing to slice into them. If we wanted to move patients into surgery faster there are plenty of interventions we could do. Of course hanging a bag of rocephin, getting them gowned, shaving and cleaning the surgical site is nowhere near as sexy as driving at break neck speed, in oncoming traffic, ignoring due regard so that the patient can lay in the trauma bay for an hour.
    The argument of whether we practice Paramedicine or medicine seems less important when, as a profession, we don’t practice medicine, and barely practice Paramedicine.

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