Ambulance Attendants and Other Paramedical Occupations - What They Do

Workers in paramedical occupations administer pre-hospital emergency medical care to patients with injuries or medical illnesses and transport them to hospitals or other medical facilities for further medical care. They are employed by private ambulance services, hospitals, fire departments, government departments and agencies, manufacturing firms, mining companies and other private sector establishments. Paramedics who are supervisors are included in this unit group.

Job duties

This group performs some or all of the following duties:

Assess extent of injuries or medical illnesses of trauma victims, patients with respiratory disease and stress, overdose and poisoning victims, industrial accident victims and other ill or injured individuals to determine emergency medical treatment
Administer pre-hospital emergency care to patients such as oxygen therapy, cardiopulmonary resuscitation (CPR), spinal immobilization, bandaging and splinting
Establish and maintain intravenous treatment (IV), apply adjunctive equipment for ventilation and circulation complications, administer medications and provide other advanced emergency treatment to patients
Transport patients by air, land or water to hospital or other medical facility for further medical care
Collaborate with ambulance dispatch centres, hospital staff, police, firefighters and family members to ensure relevant information is collected and proper treatment is administered
Document and record nature of injuries and illnesses and treatment provided
Assist hospital personnel with provision of medical treatment, if necessary
Maintain emergency care equipment and supplies
May train and supervise other workers in this unit group
May assist with triage of emergency patients.

Job titles

paramedic emergency medical technician
emergency medical technician, paramedic
emergency medical technologist - paramedic (EMT-P)
supervisor, ambulance services
emergency medical technician (EMT)
paramedic
ambulance attendant
emergency medical attendant (EMA)
advanced care paramedic
critical care paramedic
primary care paramedic

Employment Requirements

This is what you typically need for the job:

Completion of a one- to three-year college, hospital-based or other recognized paramedical or emergency medical technology program is required.
Licensing by a regulatory body is required in all provinces.
Those operating emergency vehicles require an appropriate class of licence.

Essential Skills

Reading

Read notes, medical files and patient charts: to become aware of the condition of the patient(EMR)(2), to initiate a treatment plan as per medical direction and/or protocol (PCP)(2), to make a working diagnosis and initiate a treatment plan, (ACP, CCP)(2). (2)
Read Do Not Resuscitate (DNR) orders: to be aware of what is to be done for a patient who is subject to these orders. (EMR, PCP)(2) in order to apply directives, using medical discretion in regard to pain relief and palliative measures, (ACP, CCP)(3). (2)
Read memos from management, co-workers and other medical professionals: to gain an understanding of new procedures, (EMR)(2) to interpret, evaluate and apply the information read, (PCP, ACP, CCP)(3). (2)
Read specialized material: (example: The Compendium of Pharmaceutical Specialties) to obtain one or two pieces of very specific information, such as the names of medications. (EMR)(2) to integrate and synthesize information with information gained from other sources in order to expand their understanding of the care they will apply. (PCP) (4) to do an in-depth analysis so that they may contribute to and develop protocols to bring about changes and improvements in procedures, (ACP, CCP) (5). (2)
Read training manuals to review policies and training subject matter. (3)
Read a variety of trade magazines, journals and other professional literature to be aware of current practices. (3)
Read Standing Orders from medical directors. These orders govern the standard of treatment provided to a patient. Besides being lengthy, they are written in a legal parlance which requires interpretation. (4)
Read and research abstracts and manuscripts, making inferences and using background knowledge. Critical Care Paramedics also evaluate the quality of the text, (EMR) (N/A) (PCP, ACP, CCP). (4)
Read a variety of federal and provincial acts and their regulations, as well as municipal bylaws. These may include the Highway Traffic Act, the Child Welfare Act, the Criminal Code, the Narcotic Control Act and parking bylaws. They integrate information from various sections and interpret them as they pertain to paramedic duties. (4)
Read medical text books, e.g., pharmacology, and product monographs to expand their knowledge base and gain new insights. This task may require synthesizing information from complex and lengthy text, (EMR) (N/A) (PCP, ACP, CCP). (4)

Document use

Read house numbers on civic address signs. (1)
Complete checklists, such as the vehicle readiness form, and record brief entries on deficiencies, such as warning lights that are not functioning or items which are either missing or too low in number. (1)
Complete daily logs, time sheets and overtime forms. (1)
Create tables such as quality assurance reports. (1)
Create and complete their own diagrams. Diagrams may indicate the location of injuries, the position of vehicles at an accident site or the position of bodies at a suspected crime scene. (1)
Fill in the use of narcotics on a narcotics control form. (2)
May complete accident, incident or occurrence report forms, for example, if the ambulance has a collision on the way to a response location. (2)
Read labels, including tables, on medicine bottles and pill packages to assess the patient's medical history and to understand the cumulative effect of taking medications. (2) Advanced care and critical care paramedics use this information to assist in the development of a treatment plan. (3) (2)
Read maps to pinpoint the location where emergency response is required and to plan the quickest route to a targeted address. They must read the maps carefully so as not to confuse a road and a street with the same name. (3)
Interpret scale drawings such as those shown on CAD dispatch systems in ambulances. (3)
Plot onto graphs information that they have collected - e.g., call volumes in specific sectors of urban or rural areas. They plot differences between ALS / BLS call volumes, (3)(ACP, CCP). (3)
Read a variety of charts and tables, such as the table showing dopamine dosages of adults by weight, the Glasgow Coma Scale, the Trauma Severity Score (TSS) and the Pre-hospital Index (PHI). Familiarity with this document type is required to interpret it. (3)
Interpret assembly drawings of new equipment such as ventilators, manual suction devices and bag-valve-masks. (3 or 4 depending on the complexity of the equipment and the diagram) (3)
Refer to bar graphs and pie charts in training materials to gain insight on emergency response statistics. For instance, a pie chart may show the proportion of cases in various categories such as trauma and cardiac, while a bar graph may record the survival rate over various time periods, EMR (3)(PCP, ACP, CCP)(4). (3)
Determine and fill in codes on Ambulance Call Reports (ACRs). Codes relate to priorities, procedures, drugs and assessment. Codes may be alphabetic, numeric or colour. They also fill in other information. (See Writing.) (4)

Writing

Write brief notes to co-workers, co-ordination supervisors or management staff to remind them about supplies that are needed or to request the repair of a broken instrument. (1)
Complete patient care records to document medical histories, allergies, the results of the patient examination and details of the treatment provided. It is important that correct medical terms be used in this report. Primary care, advanced care and critical care paramedics include subjective and objective information relating to the patient's condition, synthesizing and summarizing information and applying technical writing skills, (EMR)(2)(PCP, ACP, CCP)(3). (2)
Complete incident reports to highlight key information from a crime scene in which serious injuries or a suspicious death occurred. Entries are generally brief, but there is a high need for accuracy and precision. (3)
May write memos or reports to appropriate personnel to explain a request or to convince them of the benefits of a specific training opportunity or work assignment. (3)
May write a comparison of several pieces of equipment, recording strengths and weaknesses of each and making recommendations for purchase. (4)
May write a research report on an issue related to paramedicine for publication in a trade journal, (EMR) (N/A) (PCP, ACP, CCP)(4 or 5 depending on the subject and depth of the research). (4)

Numeracy

Measurement and Calculation Math

Calculate the time taken to perform a given task, such as the time spent travelling to a site and gaining access to the patient. (1)
Measure the length of endotracheal and nasotracheal tubes by reading a ruler printed on the side of the tubes. The ruler is in centimetres and is used to assess if the tube is set at the right depth inside the patient's throat or nose and to monitor tube movements. A tube size calculation formula is also used. (2)
Calculate the time between patient treatments, based on their assessment of the patient's condition and specific criteria. (2)
Convert between measurement systems, such as millilitres to grams in administering medication, or convert between degrees Fahrenheit and degrees Celsius when taking a patient's temperature. (2)
Measure the amount of sugar in a patient's blood using a glucometer; measure pulse using a stethoscope or electrocardiogram; measure blood pressure using a blood pressure cuff, and joules using a defibrillator. (3)
Use formulae to determine children's weight. This calculation is important when determining how much medication to administer or when choosing an endotracheal tube of an appropriate size. It is also important when determining joules for defibrillation. (3)
Calculate how long oxygen tanks will last at various flow rates, based on a set ratio between tank volume and litres used per minute. (3)
Calculate a medication dosage, such as Lidocaine. For example, paramedics measure the medication by the number of drops of Lidocaine per minute. The Lidocaine calculation involves numerous measurement conversions, multiplication calculations and the use of ratios. It is calculated in stressful circumstances within urgent time constraints. (4)

Data Analysis Math

Compare electrocardiogram printout readings at different points to determine changes in the status of a patient's cardiac rhythm. Data must be interpreted. (1)
Compare blood glucose readings at different points to determine changes in the status of a patient's blood sugar level in order to determine appropriate Tx intervention. (2)
Interpret the capnography or oxymetry graphs to adjust the patient treatment plan. The consequences of interpretation are significant. (4)

Numerical Estimation

Estimate by sight the size of an injury, such as the area or length of cuts, abrasions, lacerations or swelling to determine which care to apply to the patient. (1)
Estimate the weight of an adult patient. This helps to determine how to proceed in treating and transporting the patient. (1)
Estimate the area and depth of burns and use formulae, such as the Parkland Formula, to determine appropriate patient care. (2)
Estimate the length of time it will take to arrive at an emergency location using different routes. The estimation may have significant impact on patient outcomes. (3)
Estimate the amount of blood loss that a patient has experienced, taking into account numerous factors such as blood on objects and trails of blood as well as observation of the patient himself/herself. Information about significant factors that make up the estimate may be uncertain. (4)

Oral communication

Obtain assignments orally from dispatchers. (2)
Inform patients what procedures they are using when treating them. They convert medical terminology to commonly understood layperson language. (2)
Interact with trainers or manufacturer representatives to: 1. learn how to use a new piece of equipment (EMR); 2. to evaluate the effectiveness of a new piece of equipment (PCP, ACP, CCP)(3). (2)
Discuss job responsibilities and changes to procedures with colleagues and instructors at training sessions. (3)
Speak to colleagues and other appropriate personnel to report a situation, such as a vehicle accident involving an ambulance. (3)
Provide immediate emotional support to colleagues, patients and families through their professional interactions and through both verbal and non-verbal communication. (3)
Discuss with colleagues the actions taken during assignments in order to evaluate the effectiveness of their response. They also comfort colleagues after particularly difficult assignments. (3)
Co-ordinate job tasks with colleagues. Communication must be clear, direct and conveyed quickly and accurately. (3)
Request information from or give direction to police, fire department and medical staff. For example, paramedics may direct care during an extrication. (3)
Persuade a health care institution to accept their patient, based on the nature of their patient's condition. (3)
Perform an advocacy role to educate patients and family members regarding the provision of paramedicine. This involves ensuring that the treatment plan explained has been understood and advising family members about future risks regarding an emergency situation, e.g., when a patient declines service. (3)
May orient and train new staff. (3)
May make presentations in formal contexts, such as providing public education about paramedicine at a school. (3)
Question patients, using language which is appropriate to the patient's age, gender and culture and using non-technical terminology. They listen with intent to bystanders, family members and patients' accounts of an occurrence. Paramedics require the ability to interpret these accounts, which may be abstract or incomplete. (4)

Thinking

Problem Solving

Face critical time delays when traffic is heavy or when they are responding to vague directions. They must find an alternate route quickly in order to get to the patient. (2)
Encounter difficult emergency situations, such as a patient wedged between the toilet and the bathtub or a patient in a high rise building with an elevator too small for a stretcher. Paramedics take into account a number of factors to solve the problem, such as whether one or two paramedics are required to lift the patient and whether the patient can move at all on his or her own. (3)
May encounter one or more patients with a variety of injuries, such as broken legs or third degree burns. They may also treat poisoned patients, patients in cardiac arrest and those who have attempted suicide. They use their experience and training to respond to the diverse needs of patients. (3)
Find medications that patients are taking conceal the patient's underlying condition. They use their experience, creativity and assessment skills to narrow down the problem with the patient. (3)
Make a working diagnosis of a patient's condition, based on notes, medical files, patient charts and their own observations. If information on the charts is inconsistent with their observations, they use their judgment to initiate an appropriate treatment plan. (4)
Deal with various issues relating to the safe transport of patients. For example, a patient with a grossly angulated fracture may require special positioning. Paramedics adjust their transporting techniques to move the patient to the ambulance. (4)
Encounter situations where circumstances overwhelm the available resources. For example, in a case of a car accident in which four persons have sustained injuries, they must determine who needs help first, based on multiple factors such as the condition of the patients, their survivability and backup assistance available. There are no predetermined policies to deal with mass casualty incidents (MCI) since each situation is unique. (4)

Decision Making

Decide what resources meet the clinical needs of patients, based on their professional judgment. For example, they decide which hospital to take a patient to, based on their background knowledge of hospitals and their services. (1)
Decide on routes of extrication - i.e., methods of removing patients from entrapment. For example, they may decide whether to take the patient out through the roof or window of an overturned car. (2)
Decide on the routes of response to incidents, taking into account traffic and pedestrian volumes and considering whether the shortest route is indeed the quickest and safest. (3)
When responding to an incident in which the need exceeds the resources available, will decide whether to call for backup from other paramedic crews or other support services, such as police or fire services. This decision takes significant judgment and once taken is irreversible. (4)
Decide what treatment plan best meets the patient's needs, based on the patient's chief complaint, past medical history, reports from family and assessment findings. Errors in judgment may affect patient outcomes. (4)
Decide whether it is safe to enter a crime scene without a police officer, such as when responding to an assault case. Significant judgment is required in making this decision. (4)

Critical Thinking

Critical Thinking information was not collected for this profile.

Job Task Planning and Organizing

Paramedics receive their assignments from dispatchers. Paramedics generally do not set their own work schedules. Paramedics have significant variety in their work activities, as every incident is unique. Once given their assignment, short-term planning is used to best accomplish each task. Paramedics have some latitude to sequence tasks within set guidelines established by the profession. This prioritizing must be done quickly and efficiently. (4)

There are many disruptions in the course of duty. For example, conditions may deteriorate, resulting in an abrupt change in the patient's treatment plan. Shift changeover may be very short due to a high volume of assignments. Work is always integrated with the work plans of others, such as colleagues, Paramedics on the next shift and medical staff. While many tasks require short term planning, some tasks require planning several months in advance - e.g., operational and administrative duties relating to the overall functioning of the paramedic service. (4)

Significant Use of Memory

Remember significant details of an event for a short period of time - e.g., the addresses of assignments, the position of vehicles and skid marks, and factors contributing to injuries.
Memorize key aspects of standing orders and current patient management guidelines for long-term retention of the information.
Memorize which medications best suit a variety of patient needs, based on the types of conditions which may be present.
Remember the appropriate sequence of treatment for a given type of situation.
Remember unique situations, such as height restrictions at building entrances or access regulations which could restrict the ambulance's access to a patient.

Finding Information

Obtain information about patients by viewing patient charts obtained from hospitals or nursing home staff. (1)
Phone other services to request information, such as phoning medical control or poison control staff. (1)
Request advice regarding a situation from peers, supervisors or allied health care professionals. (1)
Locate destinations through multiple sources, such as maps, landmarks and verbal directions. T his may be a multi-step process, with the answer to one information search leading to another. (2)
Find information about patient medications by conducting an actual search, such as looking on night tables and in refrigerators for pills, insulin, etc. (2)
Conduct literature searches through electronic and paper sources. (3)
Interview clients to obtain information about their medical history and their current condition. (3)

Digital technology

Prepare quality assurance reports and professional correspondence. (1)
Use computer-operated machines, such as cardiac monitors or telemetry devices. This involves interpreting readings from these monitors and calibrating them. (1)
Use computer-aided dispatch systems, including portable radio systems and pagers. (1)
They enter information from patient care records. (2)
They use Excel, Quattro Pro for scheduling and inventory. (2)
They send and receive e-mail and use fax modems. (2)

Other Essential Skills:

Working with Others

Paramedics generally work with a partner throughout the course of their duties. They may work independently while treating a patient at the scene of an accident, yet always co-ordinate work with others at the scene, working in a multi-disciplinary context to ensure that patients' holistic needs are met. Paramedics may work alone in a field situation or when they are completing administrative responsibilities, such as staff scheduling and supply co-ordination. Paramedics work with others in training sessions to update their credentials, learn new materials and explore issues. They are required to provide leadership throughout the course of their professional duties.

Continuous Learning

Paramedics attend mandatory sessions to train, receive new information on equipment and take, update or maintain certifications. They learn through attending conventions, seminars and conferences sponsored by their own professional associations or by related medical bodies. Further learning is acquired through on-the-job experience and consulting colleagues and other allied health care professionals. They also learn by reviewing current journals, magazines and research trends. They may also learn through mentorship and preceptorship of students through evaluation, grading or through participating in research studies on subjects such as cardiac arrest and survival rates in pre-hospital settings.