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February 7, 1986

The Usefulness of Urban Paramedics-Reply

Author Affiliations

Emergency Medical Service City and County of San Francisco Department of Public Health
University of California at Davis Sacramento

JAMA. 1986;255(5):612. doi:10.1001/jama.1986.03370050047013

In Reply.—  Prehospital care evolved from the original model of a "mobile cardiac care unit." Initially, only a defibrillator was present on the ambulance. Now in California over 40 different IV medications can be employed for the treatment of multiple medical and surgical emergencies.A fundamental assumption has been made that what can be treated in the hospital will respond to prehospital interventions. The above letters reflect that hypothesis. However, there is little proof that this assumption is valid.We believe prehospital care is uniquely different from hospitalbased treatment. The prehospital rescuers are limited to only four hands. Each therapeutic intervention must be performed in sequence rather than in parallel, as is often the case in the emergency department. In addition, with a multitude of emergencies to treat, the paramedics are required to become diagnosticians, yet their diagnostic equipment consists of only a stethoscope, a sphygmomanometer, and an electrocardiographic monitor.