Foundations and History

What you should know

  • World Wars I and II saw the development of ambulance corps to rapidly care for and remove injured soldiers from the battlefields.
  • During the Korean and Vietnam Wars, wounded soldiers could be saved by using helicopters to rapidly remove them from the battlefields to a medical unit.
  • In 1966 the National Academy of Science and the National Research Council released a “White Paper” outlining 10 critical points.

–  From these points the National Highway Safety Act was instituted in 1966.

–  The US Department of Transportation was also created.

  • Paramedics are required to be licensed. This may also be called certification or credentialing. Performing functions as a paramedic prior to licensure is unlawful.
  • The standards for prehospital emergency care and the people who provide it are governed by the laws in each state and are typically regulated by a state office of EMS.
  • There are four levels of training: emergency medical responder, emergency medical technician, advanced emergency medical technician, and paramedic. At the paramedic level, personnel may perform invasive procedures under the direction of medical control.
  • Paramedics may be involved in a variety of types of transports, including transports to specialty centers that focus on specific types of care of specific populations. They may also perform interfacility transports.
  • Paramedics work with other health care providers and other public safety agencies. Becoming familiar with the roles and responsibilities of these parties will be beneficial when on EMS calls.
  • Continuing education programs expose paramedics to new research findings and refresh their skills and knowledge.
  • Each EMS system has a physician medical director who authorizes the providers in the service to provide medical care in the field. Medical control is off-line (indirect) or online (direct).
  • The paramedic profession contains expected standards and performance parameters as well as a code of ethics.
  • Professional attributes that a paramedic is expected to have include integrity, empathy, self-motivation, confidence, communication skills, teamwork, respect, patient advocacy, injury prevention efforts, careful delivery of service, time management skills, and administrative skills.
  • Some of the primary paramedic responsibilities include preparation, response, scene management, patient assessment and care, management and disposition, patient transfer and report, documentation, and return to service.
  • Quality control and continuous quality improvement are tools paramedics use to evaluate the care they provide to patients.
  • Research helps bring together the findings of many professionals involved in EMS and brings forth a consensus of what EMS personnel should or should not do. Types of research include quantitative and qualitative research.
  • There are many ethical considerations in conducting medical research. Researchers must obtain consent from all subjects, fully inform them of the research parameters, and ensure that the rights and welfare of subjects are protected.
  • Paramedics must know how to evaluate medical research. Become familiar with criteria for determining the quality of the research, including how to recognize peer-reviewed literature, and how to use the Internet for finding quality research articles.
  • Evidence-based practice is becoming an integral part of functioning as an EMS provider. Engage in reviewing medical literature as it becomes available, and make efforts to stay on top of changing guidelines related to your practice of paramedicine.


Common Elements of this topic seen on exams.


EMS: Emergency Medical System. Components are defined by the Nat’l Highway Traffic Safety Administration

  • Fire service-based
  • Third service
  • Private ambulance service
  • Hospital-based
  • Volunteer systems

EMD: Emergency Medical Dispatcher, assigns call based on distance to the call, time of day, level of care needed
First Rule of Patient Care: do no harm
Training and Certification: the National Standard Curriculum serves as the foundation for training EMT-I’s. Reciprocity:   Mutual exchange of privileges or licenses by two certifying agencies
Licensure:      process by which an agency grants permission to an individual to engage in a profession/occupation because they meet the minimum competency/qualifications
Certification: action by which an agency grants recognition to an individual who has met its qualifications.
Medical Direction: medical supervision of an EMS system and the field performance of the EMTs
Protocols:       Written instructions, developed by the medical director, for the care of patients with specific conditions, illnesses or injuries
Standing Orders: Field interventions that are completed before contacting medical direction
Continuous Quality Improvement: Evaluation of services provided and the results achieved as compared with accepted standards

  • Delineate system-wide problems
  • Elaborate on the causes of the problem
  • Develop remedies
  • Lay out a plan to implement the remedies
  • Enforce the plan on correction
  • Reexamine the problem
  • Ethics: the discipline of dealing with what is good and what is bad


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