Paramedic Fireline

The Paramedic Fireline incumbent provides emergency medical care on an active fireline, division or other physically challenging assignment.  This resource may also provide care in the medical unit and/or at other locations as directed by the Incident Commander or representative.

Introduction

The Paramedic Fireline (EMPF) provides advanced emergency medical care for injured and sick persons.  The position has the knowledge associated with, and is expected to be competent in all of the skills of the EMT and AEMT.  A Paramedic completes a more thorough course of education, which in some states requires the completion of an Associate’s degree.  The paramedic has an in-depth understanding of human anatomy, physiology and pathophysiology which allows them to perform more advanced skills and a broader spectrum of medications than either an EMT or AEMT.  These skills carry a greater risk for the patient if improperly or inappropriately performed, are more difficult to attain and maintain competency in, and require significant background knowledge in basic and applied sciences.

While all Paramedics receive essentially the same training, the specific procedures that each individual Paramedic is authorized to perform vary depending on the Paramedic’s scope of practice.  A Paramedic’s scope of practice contains only those procedures for which he or she is educated, certified (by passing an exam), credentialed (medical director grants “permission” to practice), and licensed by a state to perform.  Therefore, the scope of practice of a Paramedic will vary by individual.

The EMPF will be required to work on the fireline or other remote areas of an incident.  The EMPF would be expected to lead, or at a minimum participate in the evacuation of a sick or injured person from this environment.  The EMPF would also be expected to perform these lifesaving skills with the equipment available to them on the fireline, which is significantly less than those EMTPs in the medical unit or typical urban EMS system.  The EMPF may be the only medical provider on scene for an extended period of time in less than ideal conditions.  The EMPF may direct the others on scene in providing care on critically injured or sick patients and will generally have the role of team leader in these situations.

Skills, Knowledge, and Abilities

The following are the minimum psychomotor skills of the Paramedic:

• Airway and Breathing
  • Perform endotracheal intubation
  • Perform percutaneous (not to include ‘surgical’ access using a scalpel) cricothyrotomy
  • Decompress the pleural space of the chest cavity
  • Perform gastric decompression
  • Monitor and interpret Patient oxygen and carbon dioxide levels
• Pharmacological interventions include
  • Insert an intraosseous (IO) cannula
  • Enteral and parenteral administration of approved prescription medications
  • Access indwelling catheters and implanted central IV ports for fluid and medication administration
  • Administer medications by intravenous (IV), intraosseous, intramuscular, intranasal, sublingual, and subcutaneous routes
  • Maintain an infusion of blood or blood products
• Medical/Cardiac Care
  • Perform cardioversion, manual defibrillation, and transcutaneous packing
  • Perform and interpret the results of Electrocardiogram (EKG) including 12-lead
• Evacuation/Transportation
  • Evacuation of a sick or injured patient using purpose made and improvised litters
  • Appropriate triage of sick or injured patients in order to assist with the formulation of an evacuation plan

Position Knowledge and/or Requirements

• Current Paramedic license (must be issued by the Paramedic’s home-state EMS licensing authority)
• Introduction to ICS (I-100)
• NIMS:  An Introduction (IS-700)
• Firefighter Training (S-130)
• Introduction to Wildland Fire (S-190)
• Annual Fireline Safety Refresher (RT-130)
• Human Factors in the Wildland Fire Service (L-180)
• An arduous physical fitness level has been established for this position

Other Training Supporting Development of Knowledge and Skills

• Intermediate Wildland Fire Behavior (S-290)
• Basic Air Operations (S-270)
• Helicopter Crewmember (S-271)
• Advanced Cardiac Life Support (if not required for state licensure)