14/04/2016
DEAR PHYSICIANS, ALL OF YOU IN
HEALTHCARE ARE PARAMEDICS EXCEPT
THE MED LAB SCIENTIST
By Secret Reporter
Posted on Apr 14, 2016
RELATED ITEMS:
I have always read with keen interest all your publications about all that
happens in the health sector in Nigeria. I have concluded that you are a
verbose writer lacking the substance of truth; full of a self-styled ideology. I
also concluded that you are like a website watchdog for pathologists (those
who have lost the sense of direction of their professional career). I write with
every sense of seriousness to avail fellow Nigerians the opportunity to know
who paramedics are, how they are trained, what they do or employment
structure, where they are found and where are they found in Nigeria?
WHO IS A PARAMEDIC?
The paramedic is a healthcare professional who works in emergency medical
situations. A paramedic may be more formally defined as a medical
professional who provides medical care to sustain life in the pre-hospital
environment, usually in an emergency, at the point of illness or injury. This
includes an initial assessment of the patient after a particular health crisis.
Treatment can also be continued en route to a hospital if more definitive care
for the patient is required. Paramedics provide advanced levels of care for
medical emergencies and trauma. The majority of paramedics are based in the
field, in ambulances, emergency response vehicles, or in specialist mobile
units such as cycle response. Paramedics provide out-of-hospital treatment
and minor diagnostic services, although some may undertake hospital-based
roles, such as in the treatment of injuries.
TRAINING OF PARAMEDICS.
In the United States, paramedic training is considered vocational. Paramedic
education programs typically follow the US Department of Transportation’s
Emergency Medical Technician-Paramedic: National Standard Curriculum.
While many regionally accredited colleges and universities offer paramedic
programs, only a handful require a formal degree component prior to
completion. Course minimum required hours vary from state to state but range
between 700 – 1300 didactic and clinical hours. Calendar length can vary from
between six months to upwards of two years.
The disparity of educational requirements and lack of an academic degree
contribute to overall lower wages and less respect amongst other allied health
care providers in the US.
In the United Kingdom, ambulances became largely municipal services shortly
after the end of World War II. Training was frequently conducted internally,
although national levels of coordination led to more standardization of staff
training. As of 2010 public ambulance services were operated by regional
entities, most often trusts, under the authority of the National Health Service,
with significant standardization of training and skills. The UK model utilizes
two levels of ambulance staff: internally trained Ambulance Technicians,
which are similar to EMTs in the US, and paramedics with advanced life
support skills.
Initially paramedics were mainly trained internally, with experienced ambulance
technicians often progressing to the role of paramedic. Increasingly, however,
university qualifications are being expected for paramedics, with the entry
level being an Honours Bachelor of Science degree in Pre-Hospital or
Paramedic Care. Some British paramedics have gone on to become Paramedic
Practitioners, a role that practices independently in the pre-hospital
environment in a capacity similar to that of a nurse practitioner, but with more
of an acute care orientation.
Canada, for example, attempted a pilot paramedic training program at Queen’s
University, Kingston, Ontario, in 1972. The program, which intended to upgrade
the then mandatory 160 hours of training for ambulance attendants, was found
to be too costly and premature. The program was abandoned after two years,
and it was more than a decade before the legislative authority for its
graduates to practice was put into place. An alternative program which
provided 1,400 hours of training at the community college level prior to
commencing employment was then tried, and made mandatory in 1977, with
formal certification examinations being introduced in 1978. Also in Canada,
Advanced Care Paramedics were not introduced until 1984, when Toronto
trained its first group internally, before the process spread across the country.
By 2010 the Ontario system involved a two year community college based
program, including both hospital and field clinical components, prior to
designation as a Primary Care Paramedic, although it is starting to head
towards a university degree-based program.
WHAT DO PARAMICS DO? OR WHAT IS THEIR EMPLOYMENT STRUCTURE?
Paramedics are employed by a variety of different organizations, and the
services provided by paramedics may occur under differing organizational
structures, depending on the part of the world. A new and evolving role for
paramedics involves the expansion of their practice into the provision of
relatively basic primary health care and assessment services.
Some paramedics have begun to specialize their practice, frequently in
association with the environment in which they will work. Some early examples
of this involved aviation medicine and the use of helicopters, and the transfer
of critical care patients between facilities. While some jurisdictions still use
physicians, nurses, and technicians for transporting patients, increasingly this
role falls to specialized senior and experienced paramedics. Other areas of
specialization include such roles as tactical paramedics working in police units,
marine paramedics, hazardous materials (Hazmat) teams, Heavy Urban Search
and Rescue, and paramedics on offshore oil platforms, oil and mineral
exploration teams, and in the military.
The majority of paramedics are employed by the municipal emergency medical
service for their area, although this employer could itself be working under a
number of models, including a specific autonomous public ambulance service,
a fire department, a hospital based service or a private company working under
contract. There are also legions of paramedics who volunteer for backcountry
rescue teams, small town rescue squads, and the like.
The provision of municipal ambulance services, and paramedics, can vary by
area, even within the same country or state. For instance, in Canada, the
province of British Columbia operates a province-wide service (the British
Columbia Ambulance Service) whereas in Ontario, the service is provided by
each municipality, either as a distinct service, linked to the fire brigade, or
contracted out to a third party.
SKILLS OF PARAMEDICS IN THE HOSPITAL SETTING.
It will interest Nigerians to know the following: While there are varying degrees
of training and expectations around the world, a general set of skills shared by
essentially all paramedics and EMTs (EMERGENCY MEDICAL TECHNICIANS)
includes:
Advanced cardiac life support, or ACLS, treats areas involving cardiac injury or
compromise; the most common is cardiac arrest. Since the heart and nervous
system begin to degrade in as little as 4-6 minutes, early recognition and
treatment in the prehospital setting is very effective in life saving treatments.
Using many devices and treatment modalities, such as Cardiac Monitors,
Defibrillators, and cardiac medications, the chief objective is to stop and
reverse the effects of lack of cardiac output.
Spinal injury management, including immobilization and safe transport.
Fracture management, including assessment, splinting, and use of traction
splints where appropriate. Obstetrics, including assessment, assisting with
uncomplicated childbirth, and recognition of and procedures for obstetrical
emergencies such as breech presentation, cord presentation, and placental
abruption.
Management of burns, including classification, estimate of surface area,
recognition of more serious burns, and treatment.
Advanced airway management techniques including surgical airways.
Triage of patients in a mass casualty incident.
Assessment and evaluation of general incident scene safety.
Effective verbal and written reporting skills (charting).
Routine medical equipment maintenance procedures.
Routine radio operating procedures.
Emergency vehicle operation.
MEDICATIONS ADMINISTERED BY PARAMEDICS.
Paramedics in most jurisdictions administer a variety of emergency
medications. The specific medications they are permitted to administer vary
widely, based on local standards of care and legal restrictions, and physician
or medical director preferences. For an accurate description of permitted
drugs or procedures in a given location, it is necessary to contact that
jurisdiction directly. A representative list of medications may commonly
include:
Analgesic medications such as aspirin, ketorolac and paracetamol, used to
relieve pain or decrease nausea and vomiting.
Narcotics like morphine, pethidine, fentanyl, and dilaudid, used to treat severe
pain, such as with burns and fractures.
Adenosine, calcium channel blockers Diltiazem and Verapamil used to slow
down excessively high heart rates.
Parasympatholytic drug such as Atropine, used to speed up slow bradycardia
heart rates.
Sympathomimetics[6] such as dopamine, dobutamine, norepinephrine, and
epinephrine used for severe hypotension (low blood pressure), cardiogenic
shock and septicemia.
D50W (a solution of 50% dextrose in water), used to treat hypoglycemia (low
blood sugar).
Sedatives like midazolam, lorazepam, and etomidate, used to reduce the
irritability or agitation of patients.
Paralytics such as succinylcholine, rocuronium, and vecuronium, used when an
emergency procedure such as rapid sequence intubation (RSI) is required.
Antipsychotics like haloperidol or ziprasidone, used to sedate combative
patients.
Respiratory medications such as salbutamol, Ipratropium bromide and
methylprednisolone, used to treat conditions such as asthma and acute
bronchitis.
Cardiac medications such as nitroglycerin, aspirin, and morphine, fentanyl used
to treat cardiac ailments such as angina and heart attacks.
Antiarrhythmics such as amiodarone, lidocaine and magnesium sulfate used to
treat cardiac arrhythmias such as ventricular tachycardia and ventricular
fibrillation.
Antiemetics such as promethazine or ondansetron used for nausea and
vomiting.
Naloxone used to treat opioid drug overdose and flumazenil.
In the Nigerian health system, the fight for superiority, and the fear for the
sudden emergence of the Medical Laboratory Scientist has evolved into
unbridled calumny and the use of such words as mediocrity, paramedical as a
weapon of PROFESSIONAL WARFARE by the NMA and her allies to attack
other noble professions in the health sector in Nigeria. It is pertinent to note
that a close look at the history of paramedical professionals, shows that every
other health professional like doctors, nurses, pharmacists, radiographers can
function perfectly well as a paramedic, EXCEPT the MEDICAL LABORATORY
SCIENTIST. The evidence is clear as stated above based on the duration of
training, certificate obtained, general skills as well as medications
administered by paramedics. So in Nigeria, the term PARAMEDICAL is
misinterpreted and misapplied because of selfishness and arrogance. In
Nigeria today, based on what happens in the UK, US, Canada, Australia, I
cannot see any form of paramedical activity established by law through the
act of legislation in our hospitals. It is very important to mention that NEMA is
in the fore front of coordinating paramedical activities in the case of
emergency responses.
For clarity’s sake, based on history and on the realities on ground in Nigeria:
Para medics are pre-hospital in function, they are community, district or state
based. They perform some procedures that physicians are supposed to do if
their workload allows. According to the Britannica, “these paramedical workers
perform routine diagnostic procedures such as the taking of blood samples
and therapeutic procedures such as administering injections, or suturing
wounds; they also relieve physicians of making routine health assessments
and taking medical histories”.
A Medical Laboratory Scientist in Nigeria is not a paramedic, he/she is a
medical degree holder and is licensed to practice independently without
interference and is said to be medically qualified. The NICN judgment is very
clear.
The functions of a Medical Laboratory Scientist cannot be undermined as a
key player in the health industry, whether as a private practitioner or a
government staff. For those calling for the use of private laboratory
practitioners in government hospitals; they should realize that it is still one and
only MEDICAL LABORATORY FAMILY, regulated by MLSCN established by Act
11 2003.
The Nigerian Medical Association NMA, must realize that it is highly criminal
to take clinical decisions without medical laboratory investigations.
NMA should realize that it is an act of quackery and stealing punishable by
law for another professional to append his/her signature on a piece of work
done by another professional, Pathologists take note.
NMA should quickly withdraw the statement and apologize to Nigerians for the
statements that imply that they intend to treat Nigerians without LABORATORY
INVESTIGATIONS; this is medical genocide, the Judiciary should take note.
NMA should stop crying over spilled milk, the NICN judgment has come to stay
and there is no going back.
Nigerians should know that the core departments in healthcare are not Para
medicals. For reference check Britannica which says Paramedical Personnel
also called Paramedics are healthcare workers who provide clinical services to
patients under the supervision of a physician. The term generally
encompasses nurses, therapists, technicians and other ancillary personnel
involved in medical care but is frequently applied specifically to highly trained
persons who share with physicians the direct responsibility for patient care.
This category includes nurse practitioners, physician’s assistants, and
emergency medical technicians… For the record, these are not established
disciplines in Nigeria. Perhaps, the time has come for the training of
paramedical personnel like nurse practitioners, physician assistants et al to
start.
Finally, I call on all comrades across the nation to stand their ground, because
MLSs are here to improve and modernize medical practice and not to be
subdued by it while we also inform and educate the people.
Com. Anyanwu, Francis E. 08030907860.08180082590,
lamour_aug11@yahoo.com
