THE MISSING LINK IN THE NIGERIAN HEALTH SECTOR

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 trained and where are they found in Nigeria Presently?

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.
But down the line. The institute of health technology UBTH Benin city Edo state Nigeria. Established the school of Paramedics in the year 2008.with a United states of America (US) curriculum Running till date the. School trains paramedics and other states have started to key into this. 2014 was actually a great year for the profession the Nigeria ministry of health keyed into this and created a national diploma curriculum and encouraged the need for more schools to be created.

WHAT DO PARAMEDICS DO? OR WHAT THEIR EMPLOMENT STRUCTURE PRESENTLY IS IN NIGERIA AND THE WORLD AT LARGE?
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. But in Nigeria the profession is quite new and some. Agencies haven’t keyed into this. Except Lagos state Emergency Management Agency(LASEMA) who actually have employed. The graduates from the institute of Health Technology UBTH and likewise University of Benin Teaching hospital (Ubth)Also. but Presently UBTH got Trained Paramedics working in Hospital. Instead of out of hospital #the_nigerian_factor. They are actually not aware of its importance.

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. Para sympatholytic drug such as Atropine, used to speed up slow bradycardia heart rates. Sympathomimetic [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. Antiarrhythmic such as amiodarone, lidocaine and magnesium sulfate used to treat cardiac arrhythmias such as ventricular tachycardia and ventricular fibrillation. Antiemetic 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, paramedics 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 paramedics’ 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 PARAMEDICS 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 paramedics 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 paramedics activities in the case of emergency responses. In which have been tested over time that the so called coordinator general of NEMA is not even a PARAMEDIC. The_NIGERIAN_FACTOR.

For clarity’s sake, based on history and on the realities on ground in Nigeria:
Paramedics 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 paramedic 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”.
Finally, I call on all comrades across the nation to stand their ground, on the paramedic profession, to improve and modernize medical practice and not to be subdued by it while we also inform and educate the people. I won’t end this article without mentioning the BODY who has striven so well to keep the paramedic dream ALIVE in Nigeria
(The fountain of living waters). An NGO who has actually. Trained paramedics both home and abroad.