Close But No Cigar: A Comparison of Paramedics and PAs

Welcome to my fourth installment in a series of guest editorials. My goal for these articles is to shake up and change the EMS establishment for the better. To do this, I need your help. Here’s one way you can participate: Drop me a line and let me know how you would change EMS as a career field. No area is sacred and all your ideas and opinions count. You can reach me at Docbeaker@aol.com. Put “Solutions for the Future” in the subject line.

Should paramedics be physician assistants (PAs)? Should we be PAs in the field? I broached this topic once before as related to nurses: Should paramedics be reclassified as Prehospital Emergency Nurses? Many of the responses to the nurse issue bordered on, “Yes, but please tell me there’s a better solution.” Maybe this is it. Maybe turning medics into PAs would be a good idea. Read on and I’ll try to convince you.

First, a little more about PAs, straight from the source—the American Academy of Physician Assistants (AAPA): Physician assistants are healthcare professionals licensed to practice medicine with physician supervision…PAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive healthcare, assist in surgery, and in virtually all states can write prescriptions. This definition comes from the Information About PAs and the PA Profession section at www.aapa.org. As I outline the comparisons, I think you’ll see that as far as two careers in the healthcare field go, we aren’t that different.

Paramedics are also healthcare professionals licensed or certified to practice medicine with physician supervision. I know some people say we don’t practice medicine, but we do. We practice medicine under our medical control physician’s license. We conduct physical exams, except we call them patient assessments.

We also diagnose and treat illnesses. I was taught in various EMS classes that paramedics do not diagnose. If that is true, then how do we know what to treat for? If I have a patient with pain, diaphoresis and ECG changes in all the right places, I’m going to diagnose a myocardial infarction and treat accordingly. The truth is that we diagnose illnesses and injuries every day we work on an ambulance.

Here’s one where we upstage the PAs: We don’t order and interpret tests; we choose the tests we run and interpret them ourselves. Regular-duty medics run ECGs every day and interpret the strips. We run fancy tests with names like pulse oximetry, capnography and blood glucose on a regular basis. Extended-practice medics test blood gases.

We also counsel on preventive healthcare. When we have long transports or the call isn’t an emergency, we often sit beside the stretcher and talk to our patients. I’ve spoken to patients about smoking and obesity. I’ve encouraged new mothers and young babysitters to attend infant/child CPR classes. Paramedics are usually the first line in preventive healthcare, although we seldom realize it.

While certainly regular-duty paramedics don’t assist in surgery, interns in paramedic school are frequently allowed to view surgeries. Some paramedics actually perform surgical procedures as part of their job. Surgical cricothyroidotomies, chest tubes, central catheters, postmortem cesarean sections and field amputations are only some of the surgical skills that many paramedics in the United States are authorized to perform.

PAs do not even have us on the prescription medicine issue. Webster’s Dictionary defines a medical prescription as a designation or order for the use of a treatment or medicine. We are prescribing every time we give aspirin, epinephrine, morphine and so on, are we not? While we may not write prescriptions to fill at a pharmacy, we do prescribe medicines.

What about the differences between medics and PAs? The two main ones I see are education and salary.