Paramedicine is the unique domain of practice that represents the intersection of health care, public health, and public safety. While discussed for many years, the concept of paramedicine was first formally described in the EMS Agenda for the Future. Paramedicine represents an expansion of the traditional notion of emergency medical services as simply an emergency response system. Paramedicine is the totality of the roles and responsibilities of paramedics and represents the highest level of the practice of out of hospital medicine by non-physicians.