Emergency medical technician
Encyclopedia
Emergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
. Common obsolete terms include ambulance driver, ambulance orderly, ambulance attendant and ambulanceman.
The precise meaning of the term varies by jurisdiction, but in many countries EMTs respond to emergency calls, perform certain medical procedures and transport patients to hospital in accordance with protocols and guidelines established by physician medical directors. They may work in an ambulance
Ambulance
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...
service (paid or voluntary), as a member of technical rescue
Technical rescue
Technical rescue refers to those aspects of saving life or property that employ the use of tools and skills that exceed those normally reserved for fire fighting, medical emergency, and rescue. These disciplines include rope rescue, swiftwater rescue, confined space rescue, ski rescue, cave rescue,...
teams/squads, or as part of an allied service such as a fire
Firefighter
Firefighters are rescuers extensively trained primarily to put out hazardous fires that threaten civilian populations and property, to rescue people from car incidents, collapsed and burning buildings and other such situations...
or police
Police
The police is a personification of the state designated to put in practice the enforced law, protect property and reduce civil disorder in civilian matters. Their powers include the legitimized use of force...
department.
EMTs are trained to assess a patient's condition, and to perform such emergency medical procedures as are needed to maintain a patent airway
Airway
The pulmonary airway comprises those parts of the respiratory system through which air flows, conceptually beginning at the nose and mouth, and terminating in the alveoli...
with adequate breathing and cardiovascular circulation until the patient can be transferred to an appropriate destination for advanced medical care. Interventions include cardiopulmonary resuscitation
Cardiopulmonary resuscitation
Cardiopulmonary resuscitation is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive...
, defibrillation
Defibrillation
Defibrillation is a common treatment for life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator...
, controlling severe external bleeding
Bleeding
Bleeding, technically known as hemorrhaging or haemorrhaging is the loss of blood or blood escape from the circulatory system...
, preventing shock, body immobilization to prevent spinal damage, and splinting of bone fractures.
Paramedics in Canada
In Canada the scope of practice of Paramedics is described by the National Occupational Competency Profile (NOCP) for Paramedics document developed by the Paramedic Association of Canada. Most providers that work in ambulances will be identified as 'Paramedics'. However, in many cases, the most prevalent level of emergency prehospital care is that which is provided by the Emergency Medical Responder (EMR). This is a level of practice recognized under the National Occupational Competency Profile, although unlike the next three successive levels of practice, the EMR is not specifically considered a Paramedic, per se. The high number of EMRs across Canada cannot be ignored as contributing a critical role in the chain of survival, although it is a level of practice that is least comprehensive (clinically speaking), and is also generally not consistent with any medical acts beyond advanced first-aid, with the exception of automated external defibrillation (which is still considered a regulated medical act in most provinces in Canada).Of considerable relevance to understanding the nature of Canadian Paramedic practice, the reader must appreciate the considerable degree of inter-provincial variation. Although a national consensus (by way of the National Occupational Competency Profile) identifies certain knowledge, skills, and abilities as being most synonymous with a given level of Paramedic practice, each province retains ultimate authority in legislating the actual administration and delivery of emergency medical services within its own borders. For this reason, any discussion of Paramedic Practice in Canada is necessarily broad, and general. Specific regulatory frameworks and questions related to Paramedic practice can only definitively be answered by consulting relevant provincial legislation, although provincial Paramedic Associations may often offer a simpler overview of this topic when it is restricted to a province-by-province basis.
Regulatory frameworks vary from province to province, and include direct government regulation (such as Ontario's method of credentialing its practitioners with the title of A-EMCA, or Advanced Emergency Medical Care Assistant) to professional self-regulating bodies, such as the Alberta College of Paramedics. Though the title of Paramedic is a generic description of a category of practitioners, provincial variability in regulatory methods accounts for ongoing differences in actual titles that are ascribed to different levels of practitioners. For example, the province of Alberta
Alberta
Alberta is a province of Canada. It had an estimated population of 3.7 million in 2010 making it the most populous of Canada's three prairie provinces...
uses the title "Emergency Medical Technician", or 'EMT' for the Primary Care Paramedic and 'Paramedic' only for those qualified as Advanced Care Paramedics Advanced Life Support
Advanced Life Support
Advanced Life Support is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation .-Components of ALS:These include:...
(ALS) providers - but almost all provinces are gradually moving to adopting the new titles, or have at least recognized the NOCP document as a benchmarking document to permit inter-provincial labour mobility of practitioners, regardless of how titles are specifically regulated within their own provincial systems. In this manner, the confusing myriad of titles and occupational descriptions can at least be discussed using a common language for comparison sake.
Primary care paramedics
Primary care paramedics (PCP) are the entry-level of paramedic practice in Canadian provinces. The scope of practiceScope of Practice
Scope of Practice is a terminology used by national and state/provincial licensing boards for various professions that defines the procedures, actions, and processes that are permitted for the licensed individual. The scope of practice is limited to that which the law allows for specific education...
includes performing semi-automated external defibrillation
Automated external defibrillator
An automated external defibrillator or AED is a portable electronic device that automatically diagnoses the potentially life threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient, and is able to treat them through defibrillation, the application of...
, interpretation of 4-lead or 12 lead ECG's depending on the area, administration of Symptom Relief Medications
Symptom Relief Medications
Symptom relief medications are medications that paramedics in Ontario are certified to administer under a base hospital physician's license. The Ministry of Health and Long Term Care has established a minimum standard of care for the province, however, base hospitals can add medications at their...
for a variety of emergency medical conditions (these include oxygen
Oxygen
Oxygen is the element with atomic number 8 and represented by the symbol O. Its name derives from the Greek roots ὀξύς and -γενής , because at the time of naming, it was mistakenly thought that all acids required oxygen in their composition...
, epinephrine
Epinephrine
Epinephrine is a hormone and a neurotransmitter. It increases heart rate, constricts blood vessels, dilates air passages and participates in the fight-or-flight response of the sympathetic nervous system. In chemical terms, adrenaline is one of a group of monoamines called the catecholamines...
, glucagon
Glucagon
Glucagon, a hormone secreted by the pancreas, raises blood glucose levels. Its effect is opposite that of insulin, which lowers blood glucose levels. The pancreas releases glucagon when blood sugar levels fall too low. Glucagon causes the liver to convert stored glycogen into glucose, which is...
, salbutamol
Salbutamol
Salbutamol or albuterol is a short-acting β2-adrenergic receptor agonist used for the relief of bronchospasm in conditions such as asthma and chronic obstructive pulmonary disease. It is marketed as Ventolin among other brand names....
, ASA
Aspirin
Aspirin , also known as acetylsalicylic acid , is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. It was discovered by Arthur Eichengrun, a chemist with the German company Bayer...
(aspirin) and nitroglycerine), performing trauma immobilization (including cervical immobilization), and other fundamental basic medical care. Primary Care Paramedics may also receive additional training in order to perform certain skills that are normally in the scope of practice of Advanced Care Paramedics. This is regulated both provincially (by statute) and locally (by the medical director), and ordinarily entails an aspect of medical oversight by a specific body or group of physicians. This is often referred to as Medical Control, or a role played by a base hospital. For example, in the province of Ontario
Ontario
Ontario is a province of Canada, located in east-central Canada. It is Canada's most populous province and second largest in total area. It is home to the nation's most populous city, Toronto, and the nation's capital, Ottawa....
many paramedic services allow Primary Care Paramedics to perform 12-lead ECG
Electrocardiogram
Electrocardiography is a transthoracic interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached to the outer surface of the skin and recorded by a device external to the body...
interpretation, or initiate intravenous therapy
Intravenous therapy
Intravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals...
to deliver a few additional medications, such as 50% Dextrose.
Training
Paramedic training in Canada is intense, as paramedics are seen as health professionals, equal in importance to nurses, respiratory therapists, cardiac perfusionists and others. Nevertheless, the nature of training and how it is regulated, like actual paramedic practice, varies from province to province. Training varies regionally, for example, the Primary Care Paramedic training may be six months (British Columbia) to three years (Quebec) in length.Ireland
Emergency Medical Technician is a legally defined title in the Republic of IrelandRepublic of Ireland
Ireland , described as the Republic of Ireland , is a sovereign state in Europe occupying approximately five-sixths of the island of the same name. Its capital is Dublin. Ireland, which had a population of 4.58 million in 2011, is a constitutional republic governed as a parliamentary democracy,...
based on the standard set down by the Pre-Hospital Emergency Care Council (PHECC). Emergency Medical Technician is the entry-level standard of practitioner for employment within the ambulance service
HSE National Ambulance Service
The HSE National Ambulance Service is the statutory public ambulance service in the Republic of Ireland. The service is operated by the National Hospitals Office of the Health Service Executive, the Irish national healthcare authority.- History :...
. Currently, EMTs are authorised to work on non-emergency ambulances only as the standard for emergency (999
999 (emergency telephone number)
999 is an official emergency telephone number in a number of countries which allows the caller to contact emergency services for urgent assistance....
) calls is a minimum of a two-paramedic crew. EMTs are a vital part of the voluntary and auxiliary services where a practitioner must be on board any ambulance in the process of transporting a patient to hospital.
| PHECC Responder Levels | ||
| Responder Title | Abbr | Level of Care |
| CARDIAC FIRST RESPONDER Community first responder A Community First Responder , is a person available to be dispatched by an ambulance control centre to attend medical emergencies in their local area... |
CFR | Trained in BLS Basic life support Basic life support is the level of medical care which is used for patients with life-threatening illnesses or injuries until the patient can be given full medical care at a hospital. It can be provided by trained medical personnel, including emergency medical technicians, paramedics, and by... with emphasis on CPR and the Automated External Defibrillator Automated external defibrillator An automated external defibrillator or AED is a portable electronic device that automatically diagnoses the potentially life threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient, and is able to treat them through defibrillation, the application of... |
| OCCUPATIONAL FIRST AIDER First aid First aid is the provision of initial care for an illness or injury. It is usually performed by non-expert, but trained personnel to a sick or injured person until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care... |
OFA | Trained as CFR with additional training in management of bleeding, fractures etc. particularly in the workplace |
| EMERGENCY FIRST RESPONDER | EFR | Extensive first aid and BLS training with introduction to Oxygen therapy Oxygen therapy Oxygen therapy is the administration of oxygen as a medical intervention, which can be for a variety of purposes in both chronic and acute patient care... and assisting practitioners with care |
| PHECC Practitioner Levels | ||
| Practitioner Title | Abbr | Level of Care |
| EMERGENCY MEDICAL TECHNICIAN Emergency medical technician Emergency Medical Technician or Ambulance Technician are terms used in some countries to denote a healthcare provider of emergency medical services... |
EMT | Entry-level EMS Healthcare professional. Trained in BLS Basic life support Basic life support is the level of medical care which is used for patients with life-threatening illnesses or injuries until the patient can be given full medical care at a hospital. It can be provided by trained medical personnel, including emergency medical technicians, paramedics, and by... , Anatomy Anatomy Anatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy , and plant anatomy... , Pharmacology Pharmacology Pharmacology is the branch of medicine and biology concerned with the study of drug action. More specifically, it is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function... , ECG Monitoring and Spinal Immobilization |
| PARAMEDIC Paramedic A paramedic is a healthcare professional that works in emergency medical situations. 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... |
P | Emergency Ambulance Practitioner. Trained in advanced Pharmacology, advanced Airway management Airway management In cardiopulmonary resuscitation, anaesthesia, emergency medicine, intensive care medicine and first aid, airway management is the process of ensuring that:# there is an open pathway between a patient’s lungs and the outside world, and... etc. |
| ADVANCED PARAMEDIC Advanced paramedic Advanced Paramedic is the highest clinical level in pre-hospital care in the Republic of Ireland based on the standards set down by PHECC, the Irish regulatory body for pre-hospital care and ambulance services... |
AP | Trained to Paramedic level plus IV & IO Intraosseous infusion Intraosseous infusion is the process of injection directly into the marrow of a bone. This technique is used in emergency situations to provide fluids and medication when intravenous access is not available or not feasible.-History:... access, a wide range of Medications, tracheal intubation Tracheal intubation Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs... , Manual Defib etc. |
United Kingdom
Emergency Medical Technician is a term that has only recently been introduced into the ambulance service in the United KingdomUnited Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
. A number of National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
ambulance services are running EMT conversion courses for staff who were trained by the Institute of Healthcare Development (IHCD) as Ambulance Technicians and Assistant Ambulance Practitioners. Ambulance trusts such as the London Ambulance Service
London Ambulance Service
The London Ambulance Service NHS Trust is the largest "free at the point of contact" emergency ambulance service in the world. It responds to medical emergencies in Greater London, England, with the ambulances and other response vehicles and over 5,000 staff at its disposal.It is one of 12...
and the North West Ambulance Service
North West Ambulance Service
The North West Ambulance Service NHS Trust was formed on 1 July 2006 as part of Health Minister Lord Warner's plans to reduce the number of NHS ambulance service trusts operating in the United Kingdom....
are in the process of converting existing Ambulance Technicians into new roles as Emergency Medical Technician 1,2,3 or 4 based on their level of experience. IHCD Ambulance Technicians and Assistant Ambulance Practitioners still exist within other UK ambulance services, providing a similar level of care to the EMT with Emergency Care Assistants
Emergency care assistant
Emergency Care Assistants , are a new role in the frontline staff on NHS emergency ambulances within the United Kingdom, introduced as part of modernisation of the NHS ambulance services to cut costs...
employed in some areas as support.
History
The modern EMT program in the United States began as part of the "Alexandria Plan" in the early 70's, in addition to a growing issue with injuries associated with car accidents. Emergency medicine (EM) as a medical specialty is relatively young. Prior to the 1960s and 70s, hospital emergency departments were generally staffed by physicians on staff at the hospital on a rotating basis, among them general surgeons, internists, psychiatrists, and dermatologists. Physicians in training (interns and residents), foreign medical graduates and sometimes nurses also staffed the Emergency Department (ED). EM was born as a specialty in order to fill the time commitment required by physicians on staff to work in the increasingly chaotic emergency departments (EDs) of the time. During this period, groups of physicians began to emerge who had left their respective practices in order to devote their work completely to the ED. The first of such groups was headed by Dr. James DeWitt Mills who, along with four associate physicians; Dr. Chalmers A. Loughridge, Dr. William Weaver, Dr. John McDade, and Dr. Steven Bednar at Alexandria Hospital, VA established 24/7 year round emergency care which became known as the "Alexandria Plan". It was not until the establishment of American College of Emergency Physicians (ACEP), the recognition of emergency medicine training programs by the AMA and the AOA, and in 1979 a historical vote by the American Board of Medical Specialties that EM became a recognized medical specialty. The nations first EMT's were from the Alexandria plan working as Emergency Care Technicians serving in the Alexandria Hospital Emergency Room. The training for these technicians was modeled after the established "Physician Assistant" training program and later restructured to meet the basic needs for emergency pre-hospital care. On June 24, 2011, The Alexandria Hospital Celebrated the 50th Anniversary of the Alexandria Plan. In attendance were three of the nations first ECTs/EMTs: David Stover, Larry Jackson,and Kenneth WeaverCertification
In the United StatesUnited States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, EMTs are certified according to their level of training. Individual states
U.S. state
A U.S. state is any one of the 50 federated states of the United States of America that share sovereignty with the federal government. Because of this shared sovereignty, an American is a citizen both of the federal entity and of his or her state of domicile. Four states use the official title of...
set their own standards of certification (or licensure, in some cases) and all EMT training must meet the minimum requirements as set by the National Highway Traffic Safety Administration
National Highway Traffic Safety Administration
The National Highway Traffic Safety Administration is an agency of the Executive Branch of the U.S. government, part of the Department of Transportation...
's (NHTSA) standards for curriculum. The National Registry of Emergency Medical Technicians
National Registry of Emergency Medical Technicians
The National Registry of Emergency Medical Technicians is a US certification agency covering prehospital medical providers.- History :NREMT was established in 1970 in response to President Lyndon Johnson's Committee on Highway Traffic Safety recommended a national certifying agency for Emergency...
(NREMT) is a private organization which offers certification exams based on NHTSA education guidelines. Currently, NREMT exams are used by 46 states as the sole basis for certification at one or more EMT certification levels.
Levels of EMTs
The NHTSA recognizes four levels of EMTs:- EMT-B (Basic)
- EMT-I/85 (Intermediate)
- EMT-I/99 (Intermediate)
- EMT-PParamedics in the United StatesThe paramedic is an allied health professional whose primary focus is to provide advanced emergency medical care for critical and emergent patients who access the emergency medical system. This individual possesses the complex knowledge and skills necessary to provide patient care and...
(Paramedic)
Some states also recognize the Advanced Practice Paramedic or Critical Care Paramedic level as a state-specific licensure above that of the paramedic. In addition, EMTs can seek out specialty certifications such as Wilderness EMT
Wilderness emergency medical technician
Wilderness Emergency Medical Technician, or WEMT, is the second highest level of wilderness emergency medical training available in the USA , or other courses for advanced providers such as AWLS, and RMAP...
, Wilderness Paramedic and Flight Paramedic
Air medical services
Air medical services is a comprehensive term covering the use of air transportation to move patients to and from healthcare facilities to improve their level of care...
.
Transition to new levels
In 2009, the NREMT posted information about a transition to a new system of levels for emergency care providers developed by the NHTSA with the National Scope of Practice project. By 2014, these "new" levels will replace the fragmented system found around the United States. The new classification will include emergency medical responder (replacing first responder), emergency medical technician (replacing EMT-Basic), advanced emergency medical technician (replacing EMT-Intermediate 1985), and paramedic (replacing EMT-Intermediate 1999 and EMT-Paramedic).EMT-B
Emergency medical technician-basic
Emergency Medical Technician-Basic is the entry level of Emergency Medical Technician in the United States....
is the entry level of EMS. The procedures and skills allowed at this level are generally non-invasive such as bleeding control, positive pressure ventilation with a bag valve mask
Bag valve mask
A bag valve mask is a hand-held device used to provide positive pressure ventilation to a patient who is not breathing or who is breathing inadequately. The device is a normal part of a resuscitation kit for trained professionals, such as ambulance crew...
, oropharyngeal airway
Oropharyngeal airway
An oropharyngeal airway is a medical device called an airway adjunct used to maintain a patent airway. It does this by preventing the tongue from covering the epiglottis, which could prevent the person from breathing...
, nasopharyngeal airway
Nasopharyngeal airway
In medicine, a nasopharyngeal airway, also known as an NPA or a nasal trumpet because of its flared end, a type of airway adjunct, is a tube that is designed to be inserted into the nasal passageway to secure an open airway. When a patient becomes unconscious, the muscles in the jaw commonly relax...
, supplemental oxygen administration, and splinting (including full spinal immobilization). Training requirements and treatment protocols vary from area to area.
Intermediate levels of EMT
EMT-Intermediates are the levels of training between basic (EMT-B) and paramedicParamedic
A paramedic is a healthcare professional that works in emergency medical situations. 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...
(EMT-P). There are two intermediate levels that are tested for by the NREMT, the EMT-I/85 and the EMT-I/99, with the 1999 level being the more advanced of the two. The standard curriculum for EMT-I from 1998 is defined by the NHTSA, but each state may not have implemented or approved this program. Many states have stopped issuing new Intermediate licensure, instead focusing on maintaining the current lists of intermediates they have, and encouraging the Basic to Paramedic program philosophy.
Outside of the NHTSA framework, some states have instituted their own intermediate EMT levels using a variety of names (e.g. Advanced EMT in California or the levels of Advanced EMT-Intermediate and Advanced EMT-Critical Care in New York).
EMT-I/85
EMT-I/85 is a level of training that will typically allow several more invasive procedures than are allowed at the basic level, including IV therapy, the use of multi-lumen airway devices (even endotracheal intubation in some states), and provides for enhanced assessment skills.
EMT-I/99
The EMT-I/99 represents a higher level than the EMT-I/85 with an expanded scope of practice, such as cardiac monitoring and the administration of additional pharmaceutical interventions, as well as additional training time.
EMT-P
EMT-ParamedicsParamedics in the United States
The paramedic is an allied health professional whose primary focus is to provide advanced emergency medical care for critical and emergent patients who access the emergency medical system. This individual possesses the complex knowledge and skills necessary to provide patient care and...
, who are commonly referred to as simply "paramedics", represents the highest level of EMT, and in general, the highest level of prehospital medical provider, though some areas utilize physicians as providers on air ambulance
Air ambulance
An air ambulance is an aircraft used for emergency medical assistance in situations where either a traditional ambulance cannot reach the scene easily or quickly enough, or the patient needs to be transported over a distance or terrain that makes air transportation the most practical transport....
s or as a ground provider. Paramedics perform a variety of medical procedures such as fluid resuscitation, pharmaceutical administration, obtaining IV access, cardiac monitoring (continuous and 12-lead), and other advanced procedures and assessments.
Staffing levels
An ambulanceAmbulance
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...
with only EMT-Bs is considered a basic life support
Basic life support
Basic life support is the level of medical care which is used for patients with life-threatening illnesses or injuries until the patient can be given full medical care at a hospital. It can be provided by trained medical personnel, including emergency medical technicians, paramedics, and by...
(BLS) unit, an ambulance utilizing EMT-Is is dubbed an intermediate life support (ILS) unit, and an ambulance with paramedics is dubbed an advanced life support
Advanced Life Support
Advanced Life Support is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation .-Components of ALS:These include:...
(ALS) unit. Some states allow ambulance crews to contain a mix of crews levels (i.e. a basic and a paramedic or an intermediate and a paramedic) to staff ambulances and operate at the level of the highest trained provider. There is nothing stopping supplemental crew members to be of a certain certification, though (e.g. if an ALS ambulance is required to have two paramedics, then it is acceptable to have two paramedics and a basic).
Education and training
EMT training programs for certification vary greatly from course to course, provided that each course at least meets local and national requirements. In the United States, EMT-Bs receive at least 110 hours of classroom training, often reaching or exceeding 120 hours. EMT-Is generally have 200–400 hours of training, and EMT-Ps are trained for 1,000 hours or more. In addition, a minimum number of continuing education (CE) hours are required to maintain certification. For example, to maintain NREMT certification, EMT-Bs must obtain at least 48 hours of additional education and either complete a 24 hour refresher course or complete an additional 24 hours of CEs that would cover, on an hour by hour basis, the same topics as the refresher course would. Recertification for other levels follows a similar pattern.EMT training programs vary greatly in calendar length (number of days or months). For example, fast track programs are available for EMT-Bs that are completed in two weeks by holding class for 8 to 12 hours a day for at least two weeks. Other training programs are months long, or up to 2 years for paramedics in an associates degree program. In addition to each level's didactic education, clinical rotations may also be required (especially for levels above EMT-Basic). Similar in a sense to medical school clinical rotations, EMT students are required to spend a required amount of time in an ambulance and on a variety of hospital services (e.g. obstetrics
Obstetrics
Obstetrics is the medical specialty dealing with the care of all women's reproductive tracts and their children during pregnancy , childbirth and the postnatal period...
, emergency medicine
Emergency department
An emergency department , also known as accident & emergency , emergency room , emergency ward , or casualty department is a medical treatment facility specialising in acute care of patients who present without prior appointment, either by their own means or by ambulance...
, surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
, psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
) in order to complete a course and become eligible for the certification exam. The number of clinical hours for both time in an ambulance and time in the hour vary depending on local requirements, the level the student is obtaining, and the amount of time it takes the student to show competency.
EMT training programs take place at numerous locations, such as universities, community colleges, technical schools, hospitals or EMS academies. Every state in the United States has an EMS lead agency or state office of emergency medical services that regulates and accredits EMT training programs. Most of these offices have web sites to provide information to the public and individuals who are interested in becoming an EMT.
Medical direction
In the United States, an EMT's actions in the field are governed by state regulations, local regulations, and by the policies of their EMS organization. The development of these policies are guided by a physicianPhysician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
medical director
Medical director
As laboratory director,means that you are responsible for the overall operation and administration of the laboratory, including the employment of competentqualified personnel. Even though you have the option to delegate some...
, often with the advice of a medical advisory committee.
In California, for example, each county's Local Emergency Medical Service Agency (LEMSA) issues a list of standard operating procedures or protocols, under the supervision of the California Emergency Medical Services Authority
California Emergency Medical Services Authority
The California Emergency Medical Services Authority is an agency of California State government. The California EMS Authority is one of the thirteen departments within the California Health and Human Services Agency. The director is required to be a physician with substantial experience in...
. These procedures often vary from county to county based on local needs, levels of training and clinical experiences. New York State has similar procedures, whereas a regional medical-advisory council ("REMAC") determines protocols for one or more counties in a geographical section of the state.
Treatments and procedures administered by paramedics fall under one of two categories, off-line medical orders (standing orders) or on-line medical orders. On-line medical orders refers to procedures that must be explicitly approved by a base hospital physician or registered nurse through voice communication (generally by phone or radio
Radio
Radio is the transmission of signals through free space by modulation of electromagnetic waves with frequencies below those of visible light. Electromagnetic radiation travels by means of oscillating electromagnetic fields that pass through the air and the vacuum of space...
) and are generally rare or high risk procedures (e.g. rapid sequence induction
Rapid sequence induction
Rapid Sequence Induction is a medical procedure involving the expeditious induction of general anesthesia and subsequent intubation of the trachea. RSI is generally used in an emergency setting or for patients who have an increased risk of aspirating stomach contents into the lungs...
or cricothyrotomy
Cricothyrotomy
A cricothyrotomy is an incision made through the skin and cricothyroid membrane to establish a patent airway during certain life-threatening situations, such as airway obstruction by a foreign body, angioedema, or massive...
). In addition, when multiple levels can perform the same procedure (e.g. AEMT-Critical Care and EMT-Paramedics in New York), a procedure can be both an on-line and a standing order depending on the level of the provider. Since no set of protocols can cover every patient situation, many systems work with protocols as guidelines and not "cook book" treatment plans. Finally, systems also have policies in place to handle medical direction when communication failures happen or in disaster situations.
Employment of EMTs
EMTs are employed in varied settings ranging from industrial and entertainment first aid positions to hospital and health care settings, and the prehospital environment. The prehospital environment is loosely divided into non-emergency (e.g. hospital discharges) and emergency (9-1-19-1-1
9-1-1 is the emergency telephone number for the North American Numbering Plan .It is one of eight N11 codes.The use of this number is for emergency circumstances only, and to use it for any other purpose can be a crime.-History:In the earliest days of telephone technology, prior to the...
calls) services, but many ambulance services operate both non-emergency and emergency care.
In many places across the United States, it is not uncommon for the primary employer of EMTs (both EMT-Ps and EMT-Bs) to be the fire department
Fire department
A fire department or fire brigade is a public or private organization that provides fire protection for a certain jurisdiction, which typically is a municipality, county, or fire protection district...
, with the fire department providing the primary emergency medical system response. In other locations, such as Boston
Boston
Boston is the capital of and largest city in Massachusetts, and is one of the oldest cities in the United States. The largest city in New England, Boston is regarded as the unofficial "Capital of New England" for its economic and cultural impact on the entire New England region. The city proper had...
, Massachusetts
Massachusetts
The Commonwealth of Massachusetts is a state in the New England region of the northeastern United States of America. It is bordered by Rhode Island and Connecticut to the south, New York to the west, and Vermont and New Hampshire to the north; at its east lies the Atlantic Ocean. As of the 2010...
, emergency medical services are provided by a separate, or “third-party”, government agency. In still other locations, emergency medical services are provided by volunteer agencies. College and university campuses may provide emergency medical responses on their own campus using students.
In NJ (and other states), many EMS agencies are run by Independent Non-Profit Volunteer First Aid Squads that are their own corporations set up as separate entities from fire departments. In this environment, volunteers are "hired" to fill certain blocks of time to cover emergency calls. These volunteers have the same state certification as their paid counterparts.
See also
- Combat medicCombat medicCombat medics are trained military personnel who are responsible for providing first aid and frontline trauma care on the battlefield. They are also responsible for providing continuing medical care in the absence of a readily available physician, including care for disease and battle injury...
- Emergency medical servicesEmergency medical servicesEmergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
- Emergency Medical Services in the United StatesEmergency medical services in the United StatesEmergency Medical Services in the United States, provide out-of-hospital acute medical care and/or transport to definitive care for those in need...
- Emergency medical services in the United Kingdom
- Paramedics in CanadaParamedics in CanadaIn Canada the paramedic is a health professional, providing pre-hospital assessment and medical care to the victims of illnesses or injuries. The term is generally limited to include those who work on emergency and non-emergency patient transport service environment ambulances...
- Wilderness EMTWilderness emergency medical technicianWilderness Emergency Medical Technician, or WEMT, is the second highest level of wilderness emergency medical training available in the USA , or other courses for advanced providers such as AWLS, and RMAP...