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Paramedicine is the unique domain of practice that represents the intersection of health care, public health, and public safety. While discussed for many years, the concept of paramedicine was first formally described in the EMS Agenda for the Future.^[1] Paramedicine represents an expansion of the traditional notion of emergency medical services as simply an emergency response system. Paramedicine is the totality of the roles and responsibilities of individuals trained and credentialed as EMS practitioners. These practitioners have been referred to as various levels of Emergency Medical Technician (EMTs).^[2] In the United States paramedics represent the highest practitioner level in this domain. Additional practitioner levels in this domain within the U.S. include Emergency Medical Responders (EMRs), Emergency Medical Technicians (EMTs) and Advanced Emergency Medical Technicians (AEMTs).^[3]

Paramedicine is a health profession focused on assisting individuals, families, and communities in attaining, re-attaining, and maintaining optimal health, often following acute or sudden onset of medical or traumatic events. Paramedicine is practiced predominantly in the out of hospital setting. The practice of paramedicine is based on the sciences of human anatomy, physiology, and pathophysiology. The goal of paramedicine is to promote optimal quality of life, as defined by persons and families, throughout their life experiences, from birth to care at the end of life.
The practice of paramedicine includes tasks such as independent decision making, often in the face of incomplete, ambiguous and conflicting information. Examples of such decision making include response readiness, scene management, patient assessment, clinical problem solving, emergency vehicle operations, leadership, planning, therapeutic communications, disposition decisions, patient education and resource coordination. The practice of paramedicine involves the application of concepts of medical care under challenging, uncontrolled, and austere conditions.^{[citation needed]}
In addition to the independent portion of practice, paramedicine involves the performance of medical skills and tasks which are regulated by law. In the United States such regulated tasks (i.e. starting an IV, administering a medication, performing invasive tasks, etc.), the practice of paramedicine is performed under the direction of a licensed physician (MD/DO). In some states, such as Texas, a paramedic is considered an unlicensed assistive personnel in the clinic, hospital or out-patient care setting, whilst in the United Kingdom, paramedics have complete autonomy, and can practice as independent clinicians, able to confirm death, administer controlled drugs and prepare treatments for patients as they deem fit. UK paramedics practice under their own licence, as regulated by the Health and Care Professions Council ^[4] Various governments have different rules regulating the overall responsibility, delegation of tasks and the role of the paramedic outside of the field.

Paramedicine is based on the emerging concept of paramedic theory which is the study and analysis of how the three pillars of paramedicine (health care/medicine, public health, and public safety) interact and intersect. As stated in the IoM Report EMS at the Crossroads (2006), EMS is currently highly fragmented and largely separated from the overall health care system.^[5] A major emphasis of paramedic theory is the integration of emergency medical services, both intra-professionally and extra-professionally. Intra-professional integration is the study of resource allocation, distribution, deployment and efficiency. Extra-professional study involves the integration of EMS with the nation's existing (and future) emergency care and health care system.
Other areas of inquiry in paramedic theory are: emergency response, response planning, community education, transport medicine, disaster preparedness/response, emergency management, pandemic and epidemic, emergency response planning, special operations, medical aspects of rescue, etc.

See also

• Emergency Medical Services in the United States
• Paramedics in Canada
• Paramedics in Australia
• Health science

Paramedicine is the unique domain of practice that represents the intersection of health care, public health, and public safety...

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