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What EMTs and Paramedics Do

EMTs and paramedics use special equipment, including backboards and restraints, to immobilize patients and secure them in the ambulance for transport.

Emergency medical technicians (EMTs) and paramedics care for the sick or injured in emergency medical settings. People’s lives often depend on their quick reaction and competent care. EMTs and paramedics respond to emergency calls, performing medical services and transporting patients to medical facilities.

A 911 operator sends EMTs and paramedics to the scene of an emergency, where they often work with police and firefighters. For more information, see the profiles on police and detectives and firefighters.

Duties
EMTs and paramedics typically do the following:

  • Respond to 911 calls for emergency medical assistance, such as cardiopulmonary resuscitation (CPR) or bandaging a wound
  • Assess a patient’s condition and determine a course of treatment
  • Follow guidelines that they learned in training and that they receive from physicians who oversee their work
  • Use backboards and restraints to keep patients still and safe in an ambulance for transport
  • Help transfer patients to the emergency department of a healthcare facility and report their observations and treatment to the staff
  • Create a patient care report; documenting the medical care they gave the patient
  • Replace used supplies and check or clean equipment after use

When taking a patient to the hospital, one EMT or paramedic may drive the ambulance while another monitors the patient’s vital signs and gives additional care. Some paramedics work as part of a helicopter’s flight crew to transport critically ill or injured patients to a hospital.

EMTs and paramedics also take patients from one medical facility to another. Some patients may need to be transferred to a hospital that specializes in treating their injury or illness or to a facility that provides long-term care, such as a nursing home.

If a patient has a contagious disease, EMTs and paramedics decontaminate the interior of the ambulance and may need to report these cases to the proper authorities.

The specific responsibilities of EMTs and paramedics depend on their level of training and the state they work in. The National Registry of Emergency Medical Technicians (NREMT) provides national certification of EMTs and paramedics at four levels: EMT-Basic, EMT-Intermediate (which has two levels, respectively called 1985 and 1999), and Paramedic. Some states, however, have their own certification programs and use different titles.

An EMT-Basic, also known as an EMT, cares for patients at the scene and while taking patients by ambulance to a hospital. An EMT-Basic has the emergency skills to assess a patient’s condition and manage respiratory, cardiac, and trauma emergencies.

An EMT-Intermediate (1985 or 1999), also known as Advanced EMT, has completed the training required at the EMT-Basic level, as well as training for more advanced skills, such as the use of intravenous fluids and some medications.

Paramedics provide more extensive prehospital care than do EMTs. In addition to carrying out the procedures that EMTs use, paramedics can give medications orally and intravenously, interpret electrocardiograms (EKGs)—used to monitor heart function—and use other monitors and complex equipment.

The specific tasks or procedures EMTs and paramedics are allowed to perform at any level vary by state.

Work Environment
Emergency medical technicians (EMTs) and paramedics work both indoors and outdoors, in all types of weather. Their work is physically strenuous and can be stressful, sometimes involving life-or-death situations and patients who are suffering.

How to Become an EMT or Paramedic
All EMTs and paramedics must complete a formal training program. All states require EMTs and paramedics to be licensed; requirements vary by state.

Pay
The median annual wage of EMTs and paramedics was $30,360 in May 2010.

Job Outlook
Employment of EMTs and paramedics is expected to grow by 33 percent from 2010 to 2020, much faster than the average for all occupations.

Read the entire article here.


Sick again: Older patients suffer post-hospital syndrome

By Linda Carroll

The stress and chaos patients experience in the hospital may make them prone to a new illness — and landing back in the hospital.

Nearly one in five seniors discharged from the hospital will be re-admitted within 30 days with a completely different ailment from the one that originally landed them in a hospital bed, according to a report published Wednesday in the New England Journal of Medicine.

The phenomenon has even been given a name: post-hospital syndrome.

The point of the new report “is not to trash hospitals,” says the author Dr. Harlan Krumholz, a cardiologist and a professor of medicine at the Yale School of Medicine. “But, it’s to say maybe we haven’t adequately recognized the potential toxicities that can occur during the course of a hospital stay.”

After a hospital stay, patients are often weak from lack of exercise, sleep deprivation or malnutrition. The first 30 days after discharge “are a transient period when the patient is at great risk and is susceptible to many things,” according to Krumholz, but patients are rarely informed how to take care of themselves.

“I kept watching people come back to the hospital with a variety of different problems,” Krumholz says. “I started thinking about what we might be doing in the hospital that weakened people, making them at greater risk when they went home.”

After scrutinizing Medicare data, Krumholz found that the majority of patients being readmitted to the hospital had a different illness from their original diagnosis. Someone who had been treated for pneumonia might be back in the hospital with an infection, heart failure or wounds from a car accident or fall, for example.

“We tend to be in battlefield mode fighting the acute cause of admission,” Krumholz says. “And everything else is pushed to the side while we focus on that issue to the potential detriment of the patient’s overall well-being. Sleep, doesn’t matter when we’re dealing with your pneumonia.”

Read the entire article here.


5 health resolutions you can actually keep

Easier life changes, grounded in recent research
By Elizabeth O’Brien

Let’s see a show of hands: How many people made New Year’s resolutions for this year? And how are they working out, a week into 2013? For those who have kept their resolutions so far, kudos. For those who have lapsed, well, we know it’s hard. But it doesn’t always have to be.

Sometimes keeping a smart resolution can be—dare we say it?—easy. Or at least manageable. We’ve rounded up five health resolutions of particular interest to baby boomers. All are based on medical research that’s come out within the past year. None should leave you with any guilt or remorse.

Exercise in moderation
Exercising tops many lists of New Year’s resolutions, and there’s no doubt that physical activity helps ward off common baby boomer ailments like heart disease and diabetes. Here’s the good news: “You don’t have to join a gym or put on spandex,” said A. Alan Reisinger III, a doctor of internal medicine in Catonsville, Md. who is affiliated with MDVIP, a national network of physicians. Even 10 to 15 minutes of physical activity a day can make a difference, Reisinger said.

Indeed, recent analyses indicate that people who ran farther and faster lived no longer than those who ran more moderately. (Both were published in the British journal Heart; for a breakdown of the reports in layman’s terms, click here .) One analyzed the habits of more than 50,000 people for 30 years. The runners in the group had a 19% lower death rate than non-runners. Yet among the runners, those who ran more than 20 to 25 miles a week lost that “mortality advantage.” The other analysis noted that those who ran faster than 8 miles per hour didn’t outlive their slower peers. And extreme athletes, while healthier overall than sedentary people, can be prone to cardiac abnormalities that cause strokes.

To be sure, the research isn’t conclusive. And for plenty of folks the goal is not a super long life, but a healthier one. To achieve that, experts say, it’s important to stay active, but active doesn’t necessarily mean breaking a big sweat.” For example, you could spend a half-hour a day walking, gardening, or even doing housework. In fact, in a study out this month in Medicine & Science in Sports & Exercise, Boston researchers found that exercisers may benefit from physical activity in bouts of less than 10 minutes—as long as those short bursts add up to 150 minutes a week.

Consider the “alternatives”
Gone are the days when most mainstream doctors viewed acupuncture as voodoo. The needle therapy, which has Eastern origins, has grown in acceptance over the years, along with other alternative treatments. “We’re in a different world than we were a decade ago,” said Dr. Victoria Maizes, executive director of the Arizona Center for Integrative Medicine and a professor of medicine and public health at the University of Arizona. Maizes and her peers in integrative medicine practice a treatment that proponents say combines the best of traditional medicine and so-called alternative therapies.

Last year, acupuncture took an even bigger step into the mainstream with a study that found that the treatment can ease arthritis and other common forms of chronic pain. The major study, financed by the National Institutes of Health and published in JAMA Internal Medicine (formerly the Archives of Internal Medicine), was a meta-analysis of randomized controlled trials that tested the outcomes of patients given true acupuncture, sham acupuncture, and no acupuncture. True acupuncture got better results than the faux needle-pokes, indicating that acupuncture is more than a placebo. Massage also received a clinical nod last year, with a study out of Emory University showing that weekly massages can lower levels of stress hormones and boost immunity.

Watch your “D”
Patients ask Dr. Darrell Rigel about vitamin D all the time. One of the most common question the New York City dermatologist fields is whether sunblock will interfere with vitamin D conversion (since sunlight converts vitamin D to a form that the body can use). It’s a good question. After all, vitamin D is important for bone health, and getting the right amount can help keep osteoporosis at bay; it’s also thought to boost mood. His answer: unprotected sun exposure only increases your risk of skin cancer, so it’s better to get your vitamin D exposure through supplements.

But that said, don’t overdo it. A recent study out of the University of Copenhagen, published in the Journal of Clinical Endocrinology & Metabolism, disputes the notion that you can’t get enough vitamin D. Researchers studied blood samples from nearly 250,000 Danes and found higher mortality rates in those with low levels of vitamin D and those with high levels of vitamin D.

Eat well, but don’t spend a fortune
Forty-three percent of baby boomers said they were willing to pay more for natural/organic products, according to a study last year by investment bank Jefferies and AlixPartners, a business advisory firm. (By comparison, 58% of Millennials, those born between 1982 and 2001, reported a willingness to pay up for natural/organic products.)

Of course, some older boomers face a challenge that millennials don’t: While eating well is key to maintaining good health, the costs of fresh food—especially organics—can be a turnoff for people trying to carefully manage how they spend their nest eggs. Depending on the product, organic foods can range from 10% to more than 100% pricier than conventional foods.

A study out of Stanford last year, published in the Annals of Internal Medicine, questions whether organic foods are really healthier than conventional foods. The meta-analysis of 237 other studies “did not find strong evidence that organic foods are more nutritious or carry fewer health risks than conventional alternatives,” the researchers reported. They noted that “the consumption of organic foods can reduce the risk of pesticide exposure,” but added that the pesticide levels of all foods generally fall within allowable safety limits, so it’s not clear that organics’ edge translates into health benefits.

The decision to eat organic should go beyond individual health concerns, some experts say. “I personally think the benefits of buying organic are more population-based than individual-based,” said Dr. John Santa, director of the Consumer Reports Health Ratings Center. For example, organic meats come from livestock that haven’t been fed antibiotics, a popular practice in conventional meat production. Antibiotic use in animal feed has contributed to the existence of “superbugs” that are resistant to one or more antibiotics and can be fatal in humans. And the fact that organic produce is raised without pesticides makes it better for the overall planet, even if the direct health benefits for humans remain unclear.

Eat less, but not that much less
Many people begin each New Year vowing to lose that last, elusive 10 pounds. Like a sedentary lifestyle, obesity contributes to heart disease and other health risks—although research has shown that obese people who exercise regularly can be protected from many of the negative consequences of being overweight. Few would argue with the proposition that Americans eat too much, and cutting back is a worthy goal.

Recent research shows that cutting calories is indeed beneficial, but not to the extent some anticipated. Last summer, Nature published the results of a long-term study on caloric restriction in rhesus monkeys, which are genetically similar to humans. Earlier research had shown that mice eating 10 % to 40 % fewer calories than the average diet outlived than those who ate normally. Some people adopted the practice in hopes of similar outcomes. Yet the Nature study did not replicate those longevity results in monkeys. The study drew a distinction between mortality and morbidity: eating much less won’t help you live longer, but it will keep you healthier.

You don’t have to count calories to eat healthily, experts say. One tip is to eat one handful of protein, two handfuls of veggies, and a half a handful of complex carbohydrates such as whole grains, lentils, or low-fat yogurt, five times a day, Dr. Reisinger of MDVIP said. It doesn’t sound like a lot, but if you eat slowly and deliberately, it’ll fill you up. Reisinger tells his patients to treat every single bite as if it’s a sip from a $150 bottle of Cabernet Sauvignon.

Read the entire article here.


A January Tradition: Keep Resolutions Realistic

By Shannon M. Nass

Tips to succeed
For those who do want to commit to keeping their resolutions in 2013, Mr. Scheier has advice.

  • Make sure that it’s something that you really want to change or accomplish. “It has to be a personal goal,” he said.
  • Keep it real. “You have to make the difficulty of the resolution consistent with what you are able to do,” Mr. Scheier said. “That way your confidence in being able to do it is increased, which motivates follow-through and doesn’t lead to discouragement.”
  • Re-prioritize goals to focus on what’s important. “The person who smoked for 20 years should be aware that there’s going to be some unpleasantness and it may make them grumpy and interfere with their work and other things,” he said.
  • Develop a behavioral strategy. “It’s nice to have a goal, but what we really need are behavioral prescriptions to get there,” Mr. Scheier said. “If you’re going to walk for 30 minutes three times a week, or you’re going to not have an extra glass of wine at dinner, you need to have a behavior strategy.” Without commitment and behavioral strategy, Mr. Scheier said it’s hard to follow through a resolution. When it comes to resolutions, Mr. Scheier said he tries not to make them, but when he does, he makes sure they are easy to accomplish, such as walking 12 extra steps each day. “Every year I think about things I should change and then I think about how disruptive they will be to my life and what I have to do and I think well, maybe next year,” he said.

Read the entire article here.

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