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From one practitioner to another and from one jurisdiction to another there is significant variability in titles and job descriptions of paramedics. The titling or identification of paramedics in Canada has been greatly improved through the Paramedic Association of Canada’s National Occupational Competency Profile. This identification standard is now used by the Canadian Medical Association in paramedic education program accreditation, and by the Canadian Organization of Paramedic Regulators in assessing and facilitating credential reciprocity. 

Typical descriptors of the functions or roles of paramedics include Emergency Medical Services (EMS), Emergency Health Services (EHS), and Prehospital Care. More recently these descriptors have expanded to include Mobile Health Services (MHS), Retrieval Medicine and Transport Medicine. Literally translated, each of these is different and although each may involve paramedics, they are not specific to paramedics, nor do they comprehensively describe the full potential of paramedics.

EMS or EHS literally means the services and systems that care for medical emergencies. This group does include paramedics, however, also includes first responder groups (i.e., firefighters), emergency medical dispatchers, emergency medical responders and all in-hospital services such as emergency medicine colleagues like physicians and nurses. EMS/EHS includes paramedics involved in field response to medical emergencies (i.e., the mobile emergency response arm of health care and the health arm of community public safety emergency response). Paramedics currently practice in many capacities beyond traditional EMS/EHS and have the potential to evolve even further into the health care spectrum. In his 2010 review of emergency care in Nova Scotia, “The Patient Journey Through Emergency Care in Nova Scotia – A Prescription for New Medicine,” Dr. John Ross, medical advisor on Emergency Care, noted:

“Paramedics are an excellent example of a well trained, multi-task, generalist. They are agile health-care workers that can be utilized both inside and outside the hospital setting.” 

The terms EMS or EHS do not adequately describe the full breadth of practice and potential of—nor are they terms specific to—paramedics. What about some of the other terminology often used to describe paramedics? Prehospital care literally means care prior to hospital. This term would include EMS/EHS, and could be expanded to include the novel incorporation of paramedics into the primary or community health care continuum. Prehospital care does not include inter-hospital care or intra-hospital care, two areas where a large number of paramedics currently practice. 

What about descriptors such as Mobile Health Services (MHS), Retrieval Medicine or Transport Medicine?

• MHS refers to any care provided in a mobile environment. It is easy to see that this includes EMS/EHS and community paramedicine, but again excludes paramedics practicing in non-mobile environments. Similar to EMS/EHS, MHS is not a realm that is unique to paramedics. In some settings nurses work in mobile environments such as community care, and even laboratory health services are now provided in mobile environments, as well as some diagnostic imaging services are now being delivered in an out-of-hospital and mobile environment.

• Retrieval Medicine is a new term being used in the search and rescue arena and essentially refers to the practice and care of patients during retrieval/search and rescue missions. This descriptor could be applied to the traditional EMS/EHS operation in the context of response and transport to definitive medical care, however, falls short in its application to other aspects of paramedic care. Plus Retrieval Medicine is not unique to just paramedics.

• Transport Medicine is care and transport of patients in the transport environment. Transport medicine is a significant part of what paramedics can do—it forms essential core components of our education programs. Indeed transport medicine is one of the unique characteristics of paramedic education that separates paramedics from other health and public safety professionals and is truly where the paramedic profession was born. Transport medicine as an umbrella term can easily encompass EMS/EHS, MHS, retrieval medicine and can be expanded to include all of the additional roles paramedics perform with patient transport in non-primary medical emergencies. Although Transport Medicine seems like a great contender as a catch-all descriptor of the function of paramedics, it unfortunately falls short as a descriptor for the non-transport duties of paramedics. In addition, transport medicine is not a unique area of practice for paramedics, as registered nurses, physicians, and in some systems respiratory therapists are involved in transport medicine.

This leaves one final obvious term—Paramedicine. Paramedicine is a relatively new term and remains largely unused by many paramedics. Paramedicine should not be considered synonymous with “paramedical services” which by definition in many insurance policies include physiotherapists and like services. Paramedicine is a term that uniquely applies to paramedics and satisfactorily encompasses all the potential roles of paramedics including EMS/EHS, prehospital care, MHS, retrieval medicine and transport medicine. In addition, Paramedicine encompasses many less traditional roles filled by paramedics including primary health care, in-hospital care, research, education, administration, industrial or military medicine. Just as nurses are nurses—practicing nursing, and physicians are physicians—practicing medicine, regardless of where they work or in what specialty, and likewise with police officers and firefighters, paramedics can simply be paramedics regardless of their place of work and area of practice. Truly it should be what a paramedic can do that defines the profession, not what is being done, nor where it is being done (i.e., think out of the ambulance). 

Once paramedics truly understand their profession this will naturally progress toward respect of their professional colleagues. Often paramedics define themselves by call volume, or number of procedures they perform. This fixation on quantitative accounting does a disservice to and results in false credentialing and unfortunately internal competition amongst paramedics. This results in a misleading and confusing portrayal of the profession to those external to it and results in a lack of support and recognition. After understanding the profession and demonstrating mutual professional respect for all paramedics a sense of unity and camaraderie can be developed. Such a unified and positive culture will then be projected and perceived externally and ultimately result in return reward and recognition to the profession.

The next challenge for paramedics is selling or marketing the profession. It sounds strange to use these terms but it fits well with Habit #5 – “Seek first to understand, then to be understood.” According to Stephen Covey, this marketing has the potential to result in a “win/win” situation. 

• In the context of Paramedicine, one of these “wins” must be professional recognition and full realization of the potential of paramedics in health and public safety. 

• The other “win” then must go towards the public/patients/professionals from which paramedics are seeking recognition. That group would win through reaping the full benefits and potential of paramedics in health care and public safety services.

To create the win/win, Paramedicine must be understood and marketed, or sold to the customer. Once paramedics understand themselves in the present, as well as their potential, time must be dedicated to determining what the health care and public safety system needs, and how paramedics may be able to fill these voids. It is at this point that marketing becomes important to sell the solution (i.e., Paramedicine) to the customer. As Stephen Covey notes, to diagnose before you prescribe is the mark of all true professionals, and that an amateur salesman sells products whereas the professional salesman sells solutions to needs and problems. 

This is where the hard work lies—once the solution is identified, “selling” the solution requires consistency, quality, teamwork and commitment. Examples of selling the solution abound in your everyday life; many that you may not even be aware exist. When you turn the tap on in your house you expect a certain quality of water. In your home or place of work you expect a certain standard of building construction. When you travel from hotel to hotel you demand a certain level of service quality. Even on the roads you travel or the car you drive, you have a base assumption of quality and service. All of these have a foundation of a “solution” or standard that has been developed and “sold” in society. A few more obvious corporate examples are Coke, or Tim Horton’s. Each of these companies have developed a product with certain standards and have marketed or sold it back to you and have ensured quality and consistency of that product to meet your “need” regardless where you purchase or use their product throughout the world. Besides the obvious financial reward you provide in return for those products, you also demonstrate loyalty and support to the brand or service. 

An example that you may more easily relate to in terms of professional growth is firefighting. Fire services have done an excellent job at Habit #5. Firefighters understand their profession and respect each other. The fire services have done an exceptional job at diagnosing what the public needed and very successfully sold them the solution to their needs through the development and widespread adaptation of the National Fire Protection Agency standards. Many paramedics wish they had the respect and stature of firefighters and the fire service. It is not some secret formula, nor divine intervention that explains why fire services are where they are today: “Seek first to understand, then to be understood.” The general public can clearly articulate what a firefighter is and what they expect in terms of fire service protection and prevention activities. This demonstrates that the fire service has achieved their goal. It is likely that more people know what to do if their clothes catch fire (stop, drop, roll) then what to do if a loved one stops breathing, or experiences chest pain.

Paramedics need to embrace “Paramedicine”; develop it, own it, create it, understand it, sell it, and most importantly, maintain it through standards and quality. This is not easy and requires each individual within the profession to commit to it, every day and in every interaction that you have so that what seems like another mundane inconsequential transactional interaction actually sparks and/or becomes a transformational interaction that collectively leads to much greater things for Paramedicine. You are a paramedic regardless of where or in what area you practice, and you are practicing Paramedicine regardless of what scope/volume or services you provide. You are a paramedic—be proud of it and respect your fellow paramedic as we are a unique group of health professionals and a unique group of public safety professionals. Be proud that you are a paramedic, and proud to profess that your profession is Paramedicine. Remember, the P-word is not a bad word, and the more we use it the more it will be understood and respected: Paramedicine.