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Emergency Medical Technicians and Paramedics - What They Do


People's lives often depend on the quick reaction and competent care of emergency medical technicians (EMTs) and paramedics. Incidents as varied as automobile accidents, heart attacks, slips and falls, childbirth, and gunshot wounds require immediate medical attention. EMTs and paramedics provide this vital service as they care for and transport the sick or injured to a medical facility.

In an emergency, EMTs and paramedics are typically dispatched by a 911 operator to the scene, where they often work with police and fire fighters. Once they arrive, EMTs and paramedics assess the nature of the patient's condition, while trying to determine whether the patient has any pre-existing medical conditions. Following protocols and guidelines, they provide emergency care and transport the patient to a medical facility. EMTs and paramedics operate in emergency medical services systems where a physician provides medical direction and oversight.

EMTs and paramedics use special equipment, such as backboards, to immobilize patients before placing them on stretchers and securing them in the ambulance for transport to a medical facility. These workers generally work in teams. During the transport of a patient, one EMT or paramedic drives, while the other monitors the patient's vital signs and gives additional care, as needed. Some paramedics work as part of a helicopter's flight crew to quickly transport critically ill or injured patients to hospital trauma centers.

At the medical facility, EMTs and paramedics help transfer patients to the emergency department, report their observations and actions to emergency department staff, and may provide additional emergency treatment. After each run, EMTs and paramedics document the trip, replace used supplies and check equipment. If a transported patient has a contagious disease, EMTs and paramedics decontaminate the interior of the ambulance and report cases to the proper authorities.

EMTs and paramedics also provide transportation for patients from one medical facility to another, particularly if they work for private ambulance services. Patients often need to be transferred to a hospital that specializes in treating their injury or illness or to facility that provides long-term care, like nursing homes.

Beyond these general duties, the specific responsibilities of EMTs and paramedics depend on their level of qualification and training. The National Registry of Emergency Medical Technicians (NREMT) certifies emergency medical service providers at five levels: First Responder; EMT-Basic; EMT-Intermediate (which has two levels called 1985 and 1999) and Paramedic. Some States, however, have their own certification programs and use distinct names and titles.

The EMT-Basic represents the first response of the emergency medical system. An EMT trained at this level is prepared to care for patients at the scene of an accident and while transporting patients by ambulance to the hospital under the direction of more highly trained medical personnel. The EMT-Basic has the emergency skills to assess a patient's condition and manage respiratory, cardiac, and trauma emergencies.

The EMT-Intermediate has more advanced training. However, the specific tasks that those certified at this level are allowed to perform varies greatly from State to State.

Paramedics provide more extensive pre-hospital care than do EMTs. In addition to carrying out the procedures of the other levels, paramedics administer medications orally and intravenously, interpret electrocardiograms (EKGs), perform endotracheal intubations, and use monitors and other complex equipment. However, like the EMT-Intermediate level, what paramedics are permitted to do varies by State.

Work Environment
EMTs and paramedics work both indoors and out, in all types of weather. They are required to do considerable kneeling, bending, and heavy lifting. These workers are at a higher risk for contracting illnesses or experiencing injuries on the job than workers in other occupations. They risk noise-induced hearing loss from sirens and back injuries from lifting patients. In addition, EMTs and paramedics may be exposed to communicable diseases, such as hepatitis-B and AIDS, as well as to violence from mentally unstable or combative patients. The work is not only physically strenuous but can be stressful, sometimes involving life-or-death situations and suffering patients. Nonetheless, many people find the work exciting and challenging and enjoy the opportunity to help others. These workers experienced a larger than average number of work-related injuries or illnesses

Many EMTs and paramedics are required to work more than 40 hours a week. Because emergency services function 24 hours a day, EMTs and paramedics may have irregular working hours.

Education & Training Required
A high school diploma is usually required to enter a formal emergency medical technician training program. Training is offered at progressive levels: EMT-Basic, EMT-Intermediate, and Paramedic.

At the EMT-Basic level, coursework emphasizes emergency skills, such as managing respiratory, trauma, and cardiac emergencies, and patient assessment. Formal courses are often combined with time in an emergency department or ambulance. The program provides instruction and practice in dealing with bleeding, fractures, airway obstruction, cardiac arrest, and emergency childbirth. Students learn how to use and maintain common emergency equipment, such as backboards, suction devices, splints, oxygen delivery systems, and stretchers. Graduates of approved EMT-Basic training programs must pass a written and practical examination administered by the State licensing agency or the NREMT.

At the EMT-Intermediate level, training requirements vary by State. The nationally defined levels, EMT-Intermediate 1985 and EMT-Intermediate 1999, typically require 30 to 350 hours of training based on scope of practice. Students learn advanced skills such the use of advanced airway devices, intravenous fluids, and some medications.

The most advanced level of training for this occupation is Paramedic. At this level, the caregiver receives training in anatomy and physiology as well as advanced medical skills. Most commonly, the training is conducted in community colleges and technical schools and may result in an associate's degree. These programs may take up to one to two years. Such education prepares the graduate to take the NREMT examination to become certified as a Paramedic. Extensive related coursework and clinical and field experience is required. Refresher courses and continuing education are available for EMTs and paramedics at all levels.

Certifications Needed (Licensure)
All 50 States require EMTs and Paramedics to be licensed, but the levels and titles vary from State to State. In most States and the District of Columbia certification by the NREMT is required at some or all levels. Some States administer their own certification examination or provide the option of taking either the NREMT or State examination. In most States, licensure renewal is required every two to three years and generally, EMTs and Paramedics must take refresher training courses or complete continuing education requirements. Many States restrict licensure based on an individualís criminal history.

Other Skills Required (Other qualifications)
EMTs and paramedics should be emotionally stable, have good dexterity, agility, and physical coordination, and be able to lift and carry heavy loads. They also need good eyesight (corrective lenses may be used) with accurate color vision. Many employers require a criminal background check.

Emergency Medical Technicians and Paramedics - What They Do - Page 2

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