Dear EMS practitioners,
I apologize in advance if some of this is indelicate, but it is one person’s opinion and is intended to advance the profession.
Yours truly,
Joe Clark

Prehospital care is medical treatment and care that is given by ambulance personnel, often in an ambulance. EMTs and paramedics provide a wide range services to the acutely injured patient. Often this care occurs in the very acute phase of an injury or disease when time is critical.

I think most people consider ambulance personnel as valued members of society and the medical care paradigm. These people are professionals. There is one group of people who, I think, do not consider EMTs and paramedics as medical professionals and that group is the EMTs and paramedics themselves.

This is a contentious statement but intended with the utmost of respect. I think that ambulance personnel are to a certain extent self deprecating and poor at self promotion such that they are selling themselves short. When I worked on the ambulance I aligned myself with the police and fire personnel on the streets and felt I was handing off the patient to another world, the white collar world in the hospital. The hospital personnel could never appreciate what happened on scene, but the police and fire personnel did because we were often there together.

When I hear my professional colleagues talk about, “wild times” in the emergency room, I smile discreetly and say nothing as I recall out of control scenes of violent fights with more victims than EMTs and the cops not yet there to help, while in the emergency room, there were lots of people and security backup. I relate to the police, fire and ambulance.

The ambulance personnel are without question medically trained and qualified despite often being pigeonholed as field personnel. A paramedic can have 1000 to 3000 hours of training (depending upon regional differences) and will often be able to give his or her full attention to one patient at a time for extended periods during transport. This is a unique setting where quality care and advanced care can be given. But, did you know that ambulance personnel are not allowed to “diagnose?”

I think it is sad. Truthfully it is silly semantics, but it does diminish the ability of ambulance personnel to perform their job.

I know and understand that paramedics and EMTs do not have X-ray machines or MRIs, but they do have eyes and ears. So they can see if an arm has a bunch of muscle and blood protruding from the skin, they should be able to say or diagnose a laceration and treat it. I would go farther than that. I believe that EMTs and paramedics should be able to treat and release.

There I said it. We need EMS practitioners.

Say for example, a farmer has a laceration that needs to be cleaned and bandaged. The ambulance personnel should be able to make a “house call” and bandage that arm so that the farmer can finish his/her chores. The patient could follow up with a physician for antibiotics or further treatment if needed. But now, the farmer will hesitate to call the ambulance because it means that they are committed to an ambulance ride and time lost in the hospital. So they get no care or very delayed care leading to increased morbidity when trained medical personnel are only a phone call away.

I fully support and recommend an educational component to EMT and paramedic training similar to a nurse practitioner’s degree where they can provide stand alone care to some patients. They can bill for said services and refer patients to physicians as needed. This will help decrease transport of walking wounded to overflowing emergency rooms and provide care to people who might otherwise not seek it.

Finally, and importantly, it is about time that EMTs and paramedics who seem to have a blue collar persona be empowered to be the medical practitioners they deserve to be. An EMT-practitioner or paramedic-practitioner designation will go a long way to up the ante for ambulance personnel.