What skills should a paramedic (Emergency Medical Technician - EMT) be 100% competent in?

From the Guidelines

A paramedic should be 100% competent in early defibrillation using automated external defibrillators (AEDs) as stated in the 2004 ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction 1. This critical skill involves assessing the need for defibrillation, operating the AED, and providing high-quality cardiopulmonary resuscitation (CPR) when necessary. Paramedics must master techniques including:

• Recognizing the signs and symptoms of cardiac arrest
• Operating the AED to deliver a shock when indicated
• Providing CPR with a ratio of 30 chest compressions to 2 breaths
• Using the AED to analyze the heart rhythm and deliver subsequent shocks as needed They should be proficient with the use of AEDs in various settings, including in-hospital and out-of-hospital environments. Competency must extend to managing cardiac arrest in patients of all ages, from neonates to adults. Early defibrillation is critical because it can significantly improve survival rates from cardiac arrest, and paramedics play a key role in providing this life-saving intervention. Paramedics must maintain these skills through regular practice, simulation training, and continuing education to ensure competency in this life-saving skill, as recommended by the 2021 joint position statement on recommended essential equipment for basic life support and advanced life support ground ambulances 1. Additionally, the 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care also emphasize the importance of early defibrillation in cardiac arrest management 1. The 2020 resource and infrastructure-appropriate management of ST-segment elevation myocardial infarction in low- and middle-income countries also highlights the need for paramedics to be trained in early defibrillation 1. Overall, early defibrillation using AEDs is a critical skill that paramedics must master to provide high-quality care to patients with cardiac arrest.

From the Research

Paramedic Competency

To be 100% competent, a paramedic should possess skills in:

• Cardiopulmonary resuscitation (CPR) procedures 2, 3
• Use of automated external defibrillators (AEDs) 2, 3, 4, 5, 6
• Defibrillation techniques, including early lay defibrillation 4
• Management of out-of-hospital cardiac arrests (OHCA) 3, 5, 6

Key Skills

Some key skills that a paramedic should be competent in include:

• Prompt defibrillation of shockable rhythms, such as ventricular fibrillation and pulseless ventricular tachycardia 5
• Use of AEDs in public places and at home 2, 3, 6
• Optimization of AED placement and accessibility to increase bystander defibrillation and survival rates 6

Importance of Competency

The importance of paramedic competency in these skills is highlighted by the fact that:

• Survival from cardiac arrest decreases by approximately 7 to 10% per minute of ventricular arrhythmia 2
• Early defibrillation can increase survival rates from OHCA 4, 6
• Accessible AEDs can triple the chance of bystander defibrillation and nearly double 30-day survival rates 6