The Star of Life, a global symbol of emergency medical service.
|Names||Emergency medical technician|
|Medical degree and EMT training course|
Emergency medical technician (EMT) and ambulance technician are terms used in some countries to denote a health care provider of emergency medical services. EMTs are clinicians, trained to respond quickly to emergency situations regarding medical issues, traumatic injuries and accident scenes. Under the British system and those that are influenced by it, they are referred to as ambulance technicians (often shortened to techs), while in the American system and its influenced countries, they are referred to as emergency medical technicians.
EMTs are most commonly found working in ambulances, but should not be confused with "ambulance drivers" or "ambulance attendants" – ambulance staff who in the past were not trained in emergency care or driving. EMTs are often employed by private ambulance services, governments, and hospitals, but are also often employed by fire departments (and seen on fire apparatus), in police departments (and seen on police vehicles), and there are many firefighter/EMTs and police officer/EMTs. EMTs operate under a limited scope of practice. EMTs are normally supervised by a medical director, who is a physician.
Some EMTs are paid employees, while others (particularly those in rural areas) are volunteers.
There is considerable degree of inter-provincial variation in the Canadian Paramedic practice. 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.
In Canada, the levels of paramedic practice as defined by the National Occupational Competency Profile are: Emergency Medical Responder (EMR), Primary Care Paramedic, Advanced Care Paramedic, and Critical Care Paramedic.
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 has legally adopted 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 (ALS) providers. Only someone registered in Alberta can call themselves an EMT or Paramedic in Alberta, the title is legally protected. Almost all other 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.
Emergency Medical Responder
Main article: Emergency Medical Responder
Most providers that work in ambulances will be identified as 'Paramedics' by the public. 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 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 and oxygen therapy,administration of ASA and oral glucose and administration of narcan with the exception of automated external defibrillation (which is still considered a regulated medical act in most provinces in Canada).
Primary Care Paramedics
Primary Care Paramedics (PCP) are the entry-level of paramedic practice in Canadian provinces. The scope of practice includes performing semi-automated external defibrillation, interpretation of 4-lead ECGs, administration of Symptom Relief Medications for a variety of emergency medical conditions (these include oxygen, epinephrine, dextrose, glucagon, salbutamol, ASA 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 provinces of Ontario and Newfoundland and Labrador, many paramedic services allow Primary Care Paramedics to perform 12-lead ECG interpretation, or initiate intravenous therapy to deliver a few additional medications.
Advanced Care Paramedics
The Advanced Care Paramedic is a level of practitioner that is in high demand by many services across Canada. However, still not all provinces and jurisdictions have ACPs (Quebec, New Brunswick). The ACP typically carries approximately 20 different medications, although the number and type of medications may vary substantially from region to region. ACPs perform advanced airway management including intubation, surgical airways, intravenous therapy, place external jugular IV lines, perform needle thoracotomy, perform and interpret 12-lead ECGs, perform synchronized and chemical cardioversion, transcutaneous pacing, perform obstetrical assessments, and provide pharmacological pain relief for various conditions. Several sites in Canada have adopted pre-hospital fibrinolytics and rapid sequence induction, and prehospital medical research has permitted a great number of variations in the scope of practice for ACPs. Current programs include providing ACPs with discretionary direct 24-hour access to PCI labs, bypassing the emergency department, and representing a fundamental change in both the way that patients with S-T segment elevation myocardial infarctions (STEMI) are treated, but also profoundly affecting survival rates, as well as bypassing a closer hospitals to get an identified stroke patient to a stroke centre.
Critical Care Paramedic
Critical Care Paramedics (CCPs) are paramedics who generally do not respond to 9-1-1 emergency calls, with the exception of helicopter "scene" calls. Instead they focus on transferring patients from the hospital they are currently in to other hospitals that can provide a higher level of care. CCPs often work in collaboration with registered nurses and respiratory therapists during hospital transfers. This ensures continuity of care. However, when acuity is manageable by a CCP or a registered nurse or respiratory therapist is not available, CCPs will work alone. Providing this care to the patient allows the sending hospital to avoid losing highly trained staff on hospital transfers.
CCPs are able to provide all of the care that PCPs and ACPs provide. That being said, CCPs significantly lack practical experience with advanced skills such as IV initiation, peripheral access to cardiovascular system for fluid and drug administration, advanced airway, and many other techniques. Where an PCP and ACP may run 40–50 medical codes per year a CCP may run 1–2 in an entire career. IV/IO starts are nearly non-existent in the field and for this reason CCPs are required to attend nearly double the amount of time in classroom situations or in hospital to keep current. In addition to this they are trained for other skills such as medication infusion pumps, mechanical ventilation and arterial line monitoring.
CCPs often work in fixed and rotary wing aircraft when the weather permits and staff are available, but systems such as the Toronto EMS Critical Care Transport Program work in land ambulances. ORNGE Transport operates both land and aircraft in Ontario. In British Columbia, CCPs work primarily in aircraft with a dedicated Critical Care Transport crew in Trail for long-distance transfers and a regular CCP street crew stationed in South Vancouver that often also performs medevacs, when necessary.
Paramedic training in Canada varies regionally; for example, the training may be eight months (British Columbia) or two to four years (Ontario, Alberta) in length. The nature of training and how it is regulated, like actual paramedic practice, varies from province to province.
Main article: PHECC
Emergency Medical Technician is a legally defined title in the Republic of Ireland 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. Currently, EMTs are authorised to work on non-emergency ambulances only as the standard for emergency (999) 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 practitioner levels|
|Practitioner title||Abbr||Level of care|
|Emergency Medical Technician||EMT||Entry-level EMS healthcare professional. Trained in BLS, anatomy/physiology, pathophysiology, pharmacology, ECG monitoring, advanced airway management (supraglottic airways) and spinal immobilization|
|Paramedic||P||Emergency Ambulance Practitioner. Trained in advanced Pharmacology, advanced Airway management etc.|
|Advanced Paramedic||AP||Trained to Paramedic level plus IV & IO access, a wide range of medications, tracheal intubation, manual defibulator, etc.|
Main article: Emergency medical personnel in the United Kingdom
Emergency Medical Technician is a term that has existed for many years in the United Kingdom. Some National Health Service 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 and the North West Ambulance Service are in the process of converting existing Ambulance Technicians into Emergency Medical Technician grades 1, 2, 3 or 4, based on their level of experience; in many cases providing a similar level of care to that of a Paramedic.
Emergency Medical Technicians are still widely deployed in private ambulance companies with IHCD NHS trained Emergency Technicians being particularly sought after. There are also many newer EMT training courses available. IHCD Ambulance Technicians and Assistant Ambulance Practitioners still exist within other UK ambulance services with Emergency Care Assistants employed in some areas as support, however, this grade of staff is now being phased out and replaced with a much lower qualified Emergency care assistants. The exception to this is the East of England Ambulance Service, who have actively stopped training Emergency Care Assistants, and is upskill training them to Emergency Medical Technician level. With the intention being to convert EMTs to Paramedics, thus up-skilling the entire workforce.
Examples of skills that may be had by an Emergency Medical Technician in the UK are:
- Administration of selected drugs (usually not IV medications)
- Intermediate life support, including manual defibrillation and superglottic airway adjuncts
- Ability to discharge patient to different care pathways
- IV cannulation (usually hospital EMT skill).
See also: Emergency medical services in the United States
The concept of modern-day Emergency Medical Services (EMS) care is widely noted to begin with the academic paper, "Accidental Death and Disability: The Neglected Disease of Modern Society", (or "White Paper") in 1966, according to EMS textbooks and relevant academia in the field. This paper detailed the statistics of highway accidents resulting in injury and death in the mid-1960s, as well as other causes of injury and death, and used the statistics to confirm that reform was needed in the United States, especially concerning public education and the amount of CPR and BLS/First Aid training received by police officers, firefighters, and ambulance services at the time.
The EMT program in the United States began as part of the "Alexandria Plan" in the early 1970s, 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 1970s, 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 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 nation's first EMTs 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 nation's first ECTs/EMTs: David Stover, Larry Jackson, and Kenneth Weaver.
In the United States, EMTs are certified according to their level of training. Individual states 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's (NHTSA) standards for curriculum. The National Registry of Emergency Medical Technicians (NREMT) is a private organization which offers certification exams based on NHTSA education guidelines and has been around since the 1970s. Currently, NREMT exams are used by 46 states as the sole basis for certification at one or more EMT certification levels. A NREMT exam consists of skills and patient assessments as well as a written portion.
In order to apply for the NREMT Certification applicants must be 18 years of age or older. A few states allow 16- and 17-year olds. Applicants must also successfully complete a state-approved EMT course that meets or exceeds the NREMT Standards within the past 2 years. Those applying for the NREMT Certification must also complete a state-approved EMT psychomotor exam.
The Veteran Emergency Medical Technician Support Act of 2013, H.R. 235 in the 113th United States Congress, would amend the Public Health Service Act to direct the Secretary of Health and Human Services to establish a demonstration program for states with a shortage of emergency medical technicians to streamline state requirements and procedures to assist veterans who completed military EMT training while serving in the Armed Forces to meet state EMT certification and licensure requirements. The bill passed in the United States House of Representatives, but has not yet been voted on in the United States Senate.
See also: Emergency medical responder levels by U.S. state and Paramedics in the United States
The NHTSA recognizes four levels of Emergency Medical Technician:
- EMR (Emergency Medical Responder)
- EMT (Emergency Medical Technician)
- AEMT (Advanced Emergency Medical Technician)
Some states also recognize the Advanced Practice Paramedic or Critical Care Paramedic level as a state-specific licensure above that of the Paramedic. These Critical Care Paramedics generally perform high acuity transports that require skills outside the scope of a standard paramedic. In addition, EMTs can seek out specialty certifications such as Wilderness EMT, Wilderness Paramedic, Tactical EMT, and Flight Paramedic.
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 EMS 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/85), and Paramedic (replacing EMT-Intermediate/99 and EMT-Paramedic). Education requirements in transitioning to the new levels are substantially similar.
EMR (Emergency Medical Responder) is the first, most basic level of EMS. EMRs, many of whom are volunteers, provide basic, immediate lifesaving care including bleeding control, manual stabilization of extremity fractures and suspected cervical spine injuries, eye irrigation, taking vital signs, supplemental oxygen administration, oral suctioning, positive pressure ventilation with a bag valve mask, cardio-pulmonary resuscitation (CPR), automated external defibrillator (AED) usage, assisting in a normal childbirth, and administration of certain basic medications such as epinephrine auto-injectors and oral glucose. Due to the opioid crisis, an increasing number of EMRs are now being trained in and allowed to administer intranasal naloxone. An EMR can assume care for a patient while more advanced resources are on the way, and then can assist EMTs and Paramedics when they arrive. Training requirements and treatment protocols vary from area to area.
EMT is the next level of EMS. The procedures and skills allowed at this level include all EMR skills as well as nasopharyngeal airway, pulse oximetry, glucometry, splinting, use of a cervical collar, traction splinting, complicated childbirth delivery, and medication administration (such as epinephrine auto-injectors, oral glucose gel, aspirin (ASA), nitroglycerin, and albuterol). Some areas may add to the scope of practice for EMT's, including intranasal nalaxone administration, use of mechanical CPR devices, administration of intramuscular epinephrine and glucagon, insertion of additional airway devices, and CPAP. Training requirements and treatment protocols vary from area to area.
Advanced EMT is the level of training between EMT and Paramedic. They can provide limited advanced life support (ALS) care including obtaining intravenous/intraosseous access, use of advanced airway devices, limited medication administration, and basic cardiac monitoring.
Paramedics represent the highest level of EMT and, in general, the highest level of prehospital medical provider, though some areas utilize physicians as providers on air ambulances or as a ground provider. Paramedics perform a variety of medical procedures such as endotracheal intubation, fluid resuscitation, drug administration, obtaining intravenous access, cardiac monitoring (continuous and 12-lead), cardioversion, transcutaneous pacing, cricothyrotomy, manual defibrillation, chest needle decompression, and other advanced procedures and assessments.
An ambulance with only EMTs is considered a Basic Life Support (BLS) unit, an ambulance utilizing AEMTs is dubbed an Intermediate Life Support (ILS), or limited Advanced Life Support (LALS) unit, and an ambulance with Paramedics is dubbed an Advanced Life Support (ALS) unit. Some states allow ambulance crews to contain a mix of crews levels (e.g. an EMT and a Paramedic or an AEMT 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 an EMT). An emergency vehicle with only EMRs or a combination of both EMRs and EMTs is still dubbed a Basic Life Support (BLS) unit. An EMR must be overseen by an EMT or higher to work on an ambulance.
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, EMRs receive at least 40–80 hours of classroom training, EMTs receive at least 120–180 hours of classroom training. AEMTs generally have 200–500 hours of training, and Paramedics are trained for 1,000–1,800 hours or more. In addition, a minimum of continuing education (CE) hours is required to maintain certification. For example, to maintain NREMT certification, EMTs 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 EMTs 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 associate degree program. In addition to each level's didactic education, clinical rotations may also be required (especially for levels above EMT). 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, emergency medicine, surgery, psychiatry) 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.
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 physicianmedical director, 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. 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) and are generally rare or high risk procedures (e.g. rapid sequence induction or cricothyrotomy). In addition, when multiple levels can perform the same procedure (e.g. AEMT-Critical Care and 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. The NHTSA curriculum is the foundation Standard of Care for EMS providers in the US.
EMTs and Paramedics are employed in varied settings, mainly the prehospital environment such as in EMS, fire, and police agencies. They can also be found in positions ranging from hospital and health care settings, to  industrial and entertainment positions. The prehospital environment is loosely divided into non-emergency (e.g. patient transport) and emergency (9-1-1 calls) services, but many ambulance services and EMS agencies operate both non-emergency and emergency care.
In many places across the United States, it is not uncommon for the primary employer of EMRs, EMTs, and Paramedics to be the fire department, with the fire department providing the primary emergency medical system response including "first responder" fire apparatus, as well as ambulances. In other locations, such as Boston, Massachusetts, emergency medical services are provided by a separate, or “third-party”, municipal government emergency agency (e.g. Boston EMS). 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 some states of the US, 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.
References and notes
- ^ abcd"Emergency Medical Technicians and Paramedics". United States Department of Labor, Bureau of Labor Statistics. Retrieved 2008-03-10.
- ^Emergency Medical Technician (EMT) (Speedy Study Guide). Speedy Publishing LLC. 2014. p. 1. ISBN 9781635011951.
- ^Handbook for EMS Medical Directors, United States Department of Homeland Security Office of Health Affairs and U.S. Fire Administration.
- ^Christopher Page; Keila Vazquez; Majd Sbat; Zeynep Deniz Yalcin (April 25, 2013). "Analysis of Emergency Medical Systems Across the World"(PDF). Worcester Polytechnic Institute. Archived from the original(PDF) on 2017-12-24. Retrieved November 24, 2017.
- ^ abc"National Standard Curriculum". National Highway Transportation Safety Administration. Archived from the original on 2008-09-16. Retrieved 2008-03-10.
- ^Abram, T. "Legal Opinion: Certification v. Licensure". National Registry of Emergency Medical Technicians. Archived from the original on 2007-10-27. Retrieved 2008-03-10.
- ^"About NREMT Examinations". National Registry of Emergency Medical Technicians. Archived from the original on 2007-10-27. Retrieved 2008-03-10.
- ^"History of EMS". wvde.state.wv.us. Retrieved 2016-11-02.
- ^"State Office Information". National Registry of Emergency Medical Technicians. Archived from the original on 2007-10-26. Retrieved 2008-03-10.
- ^"NREMT - EMT". www.nremt.org. Retrieved 2015-04-27.
- ^"H.R. 235 - Congress.gov". United States Congress. Retrieved April 1, 2013.
- ^"Advanced Practice Paramedic". Retrieved 2011-09-18.
- ^"Tennessee Critical Care Paramedic"(PDF). Retrieved 2011-09-18.
- ^"Critical Care Emergency Medical Transport Program". Archived from the original on 21 June 2008. Retrieved 11 May 2014.
- ^"National EMS Scope of Practice Model"(PDF). NHTSA. September 2006. Retrieved 2011-09-18.
- ^"EMT Recertification Cheat Sheet and Information Recertification Cheat Sheet". Retrieved 2016-06-14.
- ^"Emergency Medical Technician-Basic National Standard Curriculum"(PDF). National Highway Transportation Safety Administration. Retrieved 2008-03-10.
- ^"EMT (1) Regulations"(PDF). California EMSA. pp. 6–7, 11–23. Archived from the original(PDF) on June 20, 2007. Retrieved 2008-03-10.
- ^"SC EMT Skills"(PDF). South Carolina Department of Health and Environmental Control. Retrieved 2008-03-10.
- ^"NREMT - Advanced Psychomotor Exam". www.nremt.org. Retrieved 2015-12-02.
- ^"EMS Fellowship Overview". Morristown Memorial Hospital Emergency Medicine Residency. Archived from the original on 2008-10-13. Retrieved 2008-06-12.
- ^"BLS/ALS Procedures". Orange County EMS Agency. Archived from the original on 2011-09-29. Retrieved 2011-09-18.
- ^"Recertification Policies and Procedures". National Registry of Emergency Medical Technicians. Retrieved 2016-06-14.
- ^"Recertification Brochures". National Registry of Emergency Medical Technicians. Retrieved 2016-06-14.
- ^"2008 EMT-Basic Course Schedule". Link 2 Life. Archived from the original on 2008-03-10. Retrieved 2008-03-10.
- ^"Emergency Medical Services Program". Drexel University. Retrieved 2008-03-10.
- ^"About us". Orange County EMS Agency. Archived from the original on 2011-09-03. Retrieved 2011-09-18.
- ^"EMS Authority's Mandates Summary". California Emergency Medical Services Authority. Archived from the original on July 11, 2007. Retrieved 2008-03-11.
- ^"What is the Bureau of Emergency Medical Services". New York State Department of Health. Retrieved 2008-03-11.
- ^"Treatment Guidelines". Orange County EMS Agency. Archived from the original on 2008-10-12. Retrieved 2008-03-11.
- ^"AAREMS 2007 Regional ALS Treatment Protocols". Adirondack - Appalachian Regional Emergency Medical Services Council. Retrieved 2011-09-18.
- ^"Patient Care Policy (ALS)"(PDF). Riverside County Emergency Medical Services Agency. p. 1. Archived from the original(PDF) on 2008-07-24. Retrieved 2008-03-11.
- ^"Advanced Life Support Treatment In Communication Failure or Without Base Hospital contact"(PDF). Orange County Emergency Medical Services Agency. Archived from the original(PDF) on 2008-08-17. Retrieved 2008-03-11.
- ^"Job Openings". Medics On The Ball, Inc. Retrieved 2016-06-14.
- ^"Emergency Medical Services". City of Santa Ana. Archived from the original on 2014-05-23. Retrieved 2008-03-13.
- ^"Boston EMS". Archived from the original on 2008-03-25. Retrieved 2008-03-13.
- ^"National Collegiate Emergency Medical Services Foundation, Groups Listed by Region". Retrieved 2016-12-25.
- ^"NJ State First Aid Council". NJ State First Aid Council. Archived from the original on 2010-03-27. Retrieved 2010-05-21.
Undergraduate: Tulane University, Class of 2012
Major: Anthropology and public health
Medical School: Virginia Commonwealth University School of Medicine, Class of 2016
Undergraduate: Bates College, Class of 2007
Major: English literature and creative writing
Post-baccalaureate: University of Vermont
Medical School: Virginia Commonwealth University School of Medicine, Class of 2016
What does an EMT do?
Christina: EMTs are health care professionals who work on ambulances to respond to 911 calls. Emergency calls can range from lifethreatening issues, such as cardiac arrests or gun shot wounds, to minor complaints, such as sore throats or sprained ankles. These calls bring EMTs to a wide variety of locations, including patients’ homes, businesses, and even out on the street. Once on scene with the patient, EMTs efficiently treat any life-threating issues, such as difficulty breathing or major bleeding. Subsequently, they discern the major health complaint through meticulous completion of a history and physical exam. Depending on level of training, EMTs may intubate patients in the field, acquire and read an EKG, and treat patients with myriad medications while en route to the hospital.
Kyle: In rural areas, EMTs are a crucial link between the hospital and a widely distributed population. In urban areas, EMTs act in concert with police and fire to coordinate life-saving care with major hospital centers.
How do EMTs interact with other health professions workers?
Christina: In the field, EMTs work closely with firefighters and police. Firefighters are wonderful assets to EMTs as they assist with difficult extractions on the scene of motor vehicle collisions and can also provide medical care to the patient should the EMS unit require additional assistance. Once the team has arrived at the hospital, EMTs interact directly with nurses and emergency medical physicians to transfer patient care. EMTs provide doctors and nurses with vital background information on the patient by relaying pertinent history and physical exam findings.
What was it like to work as an EMT?
Christina: Working as an EMT is extremely rewarding. EMTs have incredibly personal interactions with patients and their families. Moreover, you have a phenomenal ability to have a positive impact in your community and to truly serve those in need.
How do you become an EMT?
Kyle: There are several different levels of training:
1. Basic EMT (also called EMT-B). This is an entry-level position where you learn basic life-saving skills and health care knowledge required to provide pre-hospital care. People at this level are typically paired with a higher-level provider (EMT-I or paramedic) in ambulances, on fire trucks, or in the emergency department. Certification requires at least 154 hours of classroom and practical education. Many colleges will offer one-month, three-month, or semester-long courses that allow you to become trained and certified.
2. Intermediate/Enhanced EMT (also called EMT-I). This is an intermediate position that does not exist in all states, but it expands the scope of practice for the EMT-B with more skills, medications, and knowledge. It requires basic EMT training and some experience in the field.
3. Paramedic (also called EMT-P). This is the most advanced pre-hospital provider. EMT-Ps have a broad health care knowledge and an advanced life-saving skill set. This training often requires at least 700 hours of classroom training, as well as a significant amount of experience in the field, but medics can work in any setting, including airborne (helicopter) and wilderness EMS.
Christina: It usually costs approximately $500–$1,000 to become a Basic EMT, plus the cost of testing and certification. However, many employers and/or universities will cover all costs if you have arranged to work or volunteer for them after you complete your training.
Is this a paid or volunteer position?
Kyle: There are paid positions available for EMTs, but these are often full-time jobs with private ambulance services or fire departments that require dual training in firefighting. Particularly for EMT-Bs, the best positions for those interested in medical school are volunteer based, in my opinion, such as those with a local volunteer fire department or with your college EMS organization.
What is the time commitment?
Christina: Most pre-med students volunteer or work as part-time EMTs, which requires a minimum of two to four 12-hour shifts per month. Full-time employees work closer to fifteen 12-hour shifts per month. When considering volunteer versus paid work, note that volunteering is always a positive for medical school applications.
Many universities have their own student-run EMS service, which affords you the opportunity to coordinate your class and EMS schedule so that you can adequately balance both commitments. Some of the larger collegiate EMS groups are staffed 24/7 and operate multiple ambulances daily, which requires a more significant time commitment. When I volunteered with Tulane EMS, students volunteered for anywhere from 3 to 20 shifts per month, depending on their rank within the organization.
Kyle: The characteristics of each EMT position are highly variable, but at Bates College, our EMS unit had 24-hour shifts where you carried a radio and responder pack. During that period, you responded to all calls (even if they happened during class!) and provided care as needed to students, faculty, staff, and visitors on campus. Depending on how many EMTs we had available, we typically completed between 12 and 20 shifts per semester, or about 2 to 3 per month; the commitment was significant, but certainly not prohibitive, and did not interfere with my other time commitments.
Many private ambulance services also have 12- or 24-hourshifts, but these positions are better suited for full-time (40+ hours/week) or part-time employment over the summer, as they require a significant time commitment.
How did your experience help prepare you for applying to and starting medical school?
Christina: Volunteering as an EMT for Tulane and New Orleans EMS was the most influential experience that I had prior to medical school. As an EMT, I had the opportunity to perfect the basics of collecting a patient history and performing a physical exam, a necessity for any type of physician. Working as an EMT taught me how to excel in high-pressure situations, making medical school tasks ranging from taking exams to scrubbing into various surgeries much easier.
Kyle: More and more medical schools are requiring EMT training, often provided to students in the summer prior to matriculation, because it is an excellent way to introduce students to the basics of health care.
Would you suggest aspiring medical students become EMTs before applying or matriculating to medical school?
Christina: EMS will give you the medical skills you need to excel during your clinical rotations and provide an outstanding foundation of knowledge for your pre-clinical years. Additionally, it fosters a great sense of leadership and teamwork and cultivates a passion for serving the community through medicine.
Kyle: Becoming an EMT is a great way to test out whether you are suited for health care. The mix of high-stress, highacuity work with routine, low-stress work is very common in health care, and EMT training allows you to experience both extremes (and the middle ground, of course) before committing to eight or more years of medical training. It also indoctrinates you to many of the basic tenets of health
care: the language of medicine, rapid assessment and planning, physical examination techniques, note writing, patient confidentiality, maintaining composure under pressure, and so on. For those reasons, I highly recommend EMT training for any students who think they might be interested in medicine, because it is an excellent distillation of the knowledge, skills, and mindset required to become a doctor.
What advice do you have for someone interested in becoming an EMT?
Christina: If you want to work or volunteer as an EMT during college, start your training as early as possible. Additionally, if you are interested in volunteering for a university-run EMS group, make sure you are applying to a good program with high call volume, multiple ambulances, and the ability to train you well. Finally, try to volunteer for larger city or county EMS groups as well; they typically have very interesting patients as well as experienced paramedics who can teach you a great deal.
Kyle: I would suggest seeking out the EMS organization in your state as well as any student organizations at your college or contacting your local volunteer fire department. Nothing quite beats the feeling of riding in the back of an ambulance with its sirens blazing heading toward the worst day of someone’s life, knowing that you have the knowledge, skills, and dedicated team members to help that person.