The Paramedic must be a confident leader who can accept the challenge and high degree of responsibility
entailed in the position. The Paramedic must have excellent judgment and be able to prioritize decisions
and act quickly in the best interest of the patient, must be self-disciplined, able to develop patient rapport,
interview hostile patients, maintain safe distance, and recognize and utilize communication unique to
diverse multicultural groups and ages within those groups. Must be able to function independently at
optimum level in a non-structured environment that is constantly changing.
Even though the Paramedic is generally part of a two-person team generally working with a lower skill
and knowledge level Basic EMT, it is the Paramedic who is held responsible for safe and therapeutic
administration of drugs including narcotics. Therefore, the Paramedic must not only be knowledge about
medications but must be able to apply this knowledge in a practical sense. Knowledge and practical
application of medications include thoroughly knowing and understanding the general properties of all
types of drugs including analgesics, anesthetics, anti-anxiety drugs, sedatives and hypnotics, anti-convulsants, central nervous stimulants, psychotherapeutics which include antidepressants, and other
anti-psychotics, anticholerginics, cholergenics, muscle relaxants, anti-dysrythmics, anti-hypertensives,
anticoagulants, diuretics, bronchodilators, opthalmics, pituitary drugs, gastro-intestinal drugs, hormones,
antibiotics, antifungals, antiinflammatories, serums, vaccines, anti-parasitics, and others.
The Paramedic is personally responsible, legally, ethically, and morally for each drug administered, for
using correct precautions and techniques, observing and documenting the effects of the drugs
administered, keeping one’s own pharmacological knowledge base current as to changes and trends in
administration and use, keeping abreast of all contraindications to administration of specific drugs to
patients based on their constitutional make-up, and using drug reference literature.
The responsibility of the Paramedic includes obtaining a comprehensive drug history from the patient that
includes names of drugs, strength, daily usage and dosage. The Paramedic must take into consideration
that many factors, in relation to the history given, can affect the type medication to be given. For example,
some patients may be taking several medications prescribed by several different doctors and some may
lose track of what they have or have not taken. Some may be using nonprescription/over the counter
drugs. Awareness of drug reactions and the synergistic effects of drugs combined with other medicines
and in some instances, food, is imperative. The Paramedic must also take into consideration the possible
risks of medication administered to a pregnant mother and the fetus, keeping in mind that drugs may
cross the placenta.
The Paramedic must be cognizant of the impact of medications on pediatric patients based on size and
weight, special concerns related to newborns, geriatric patients and the physiological effects of aging such
as the way skin can tear in the geriatric population with relatively little to no pressure. There must be an
awareness of the high abuse potential of controlled substances and the potential for addiction, therefore,
the Paramedic must be thorough in report writing and able to justify why a particular narcotic was used
and why a particular amount was given. The ability to measure and re-measure drip rates for controlled
substances/medications is essential. Once medication is stopped or not used, the Paramedic must send
back unused portions to proper inventory arena.
The Paramedic must be able to apply basic principles of mathematics to the calculation of problems
associated with medication dosages, perform conversion problems, differentiate temperature reading
between centigrade and Fahrenheit scales, be able to use proper advanced life support equipment and
supplies ( i.e. proper size of intravenous needles ) based on patient’s age and condition of veins, and be
able to locate sites for obtaining blood samples and perform this task, administer medication
intravenously, administer medications by gastric tube, administer oral medications, administer rectal
medications, and comply with universal pre-cautions and body substance isolation, disposing of
contaminated items and equipment properly.
The Paramedic must be able to apply knowledge and skills to assist overdosed patients to overcome
trauma through antidotes, and have knowledge of poisons and be able to administer treatment. The
Paramedic must be knowledgeable as to the stages drugs/medications go through once they have entered
the patient’s system and be cognizant that route of administration is critical in relation to patient’s needs
and the effect that occurs.
The Paramedic must also be capable of providing advanced life support emergency medical services to
patients including conducting of and interpreting electrocardiograms (EKGs), electrical interventions to
support the cardiac functions, performing advanced endotracheal intubations in airway management and
relief of pneumothorax and administering of appropriate intravenous fluids and drugs under direction of
off-site designated physician.
The Paramedic is a person who must not only remain calm while working in difficult and stressful
circumstances, but must be capable of staying focused while assuming the leadership role inherent in
carrying out the functions of the position. Good judgment along with advanced knowledge and technical
skills are essential in directing other team members to assist as needed. The Paramedic must be able to
provide top quality care, concurrently handle high levels of stress, and be willing to take on the personal
responsibility required of the position. This includes not only all legal ramifications for precise
documentation, but also the responsibility for using the knowledge and skills acquired in real lifethreatening emergency situations.
The Paramedic must be able to deal with adverse and often dangerous situations which include
responding to calls in districts known to have high crime and mortality rates. Self-confidence is critical, as
is a desire to work with people, solid emotional stability, a tolerance for high stress, and the ability to
meet the physical, intellectual, and cognitive requirements demanded by this position.
Aptitudes required for work of this nature are good physical stamina, endurance, and body condition that
would not be adversely affected by frequently having to walk, stand, lift, carry, and balance at times, in
excess of 125 pounds. Motor coordination is necessary because over uneven terrain, the patient’s, the
Paramedic’s, and other workers’ well-being must not be jeopardized.
The Paramedic provides the most extensive pre-hospital care and may work for fire departments, private
ambulance services, police departments or hospitals. Response times for nature of work are dependent
upon nature of call. For example, a Paramedic working for a private ambulance service that transports
the elderly from nursing homes to routine medical appointments and check-ups may endure somewhat
less stressful circumstances than the Paramedic who works primarily with 911 calls in districts known to
have high crime rates. Thus, the particular stresses inherent in the role of the Paramedic can vary,
depending on place and type of employment.
However, in general, in the analyst’s opinion, the Paramedic must be flexible to meet the demands of the
ever-changing emergency scene. When emergencies exist, the situation can be complex and care of the
patient must be started immediately. In essence, the Paramedic in the EMS system uses advanced training
and equipment to extend emergency physician services to the ambulance. The Paramedic must be able
to make accurate independent judgments while following oral directives. The ability to perform duties
in a timely manner is essential, as it could mean the difference between life and death for the patient.
Use of the telephone or radio dispatch for coordination of prompt emergency services is required, as is a
pager, depending on place of employment. Accurately discerning street names through map reading, and
correctly distinguishing house numbers or business addresses are essential to task completion in the most
expedient manner. Concisely and accurately describing orally to dispatcher and other concerned staff,
one's impression of patient's condition, is critical as the Paramedic works in emergency conditions where
there may not be time for deliberation. The Paramedic must also be able to accurately report orally and
in writing, all relevant patient data. At times, reporting may require a detailed narrative on extenuating
circumstances or conditions that go beyond what is required on a prescribed form. In some instances, the
Paramedic must enter data on computer from a laptop in ambulance. Verbal skills and reasoning skills
are used extensively.
Source: USDOT 1998 National Standard Paramedic Curriculum