Emergency medical technician
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EMTs loading an injured skier into an ambulance |
An
emergency medical technician (
EMT) is an emergency responder trained to provide
emergency medical services to the critically ill and injured.
Once thought of as an "
ambulance driver or attendant," the modern EMT performs many more duties than in the past, and responds to many types of emergency calls, including
medical emergencies, hazardous materials exposure,
childbirth,
child abuse, fires, rescues, injuries,
trauma and
psychiatric crises. As NFPA regulations state that Rescuers be medically certified, many EMT's are also part of Technical Rescue teams, such as Extrication, Rope Rescue, Water Rescue, etc. They may be part of an EMS, Fire, or independent rescue team.
EMTs are trained in basic medical knowledge and skills. Patient treatment guidelines are described in protocols following both national guidelines and local medical policies. The goal of EMT intervention is to rapidly evaluate a patient's condition and to maintain a patient's
airway,
breathing and
circulation by
CPR and
defibrillation. In addition, EMT intervention aims to control external
bleeding, prevent
shock, and prevent further injury or disability by immobilizing potential spinal or other bone fractures, while expediting the safe and timely transport of the patient to a hospital emergency department for definitive medical care.
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). All EMT training must meet the minimum requirements as set forth in the
U.S. Department of Transportation's standards for the EMT-B (Emergency Medical Technician - Basic) curriculum.
The
National Registry of Emergency Medical Technicians (NREMT), a voluntary standards and testing body, recognizes four levels of EMT: EMT-B (Basic), EMT-I/85 (Intermediate), EMT-I/99 (Intermediate) and EMT-P (
Paramedic). Some states such as
California use an EMT-I or "EMT-One" Roman numeral designation which is equivalent to the National EMT-Basic; this should not be confused with the EMT-Intermediate (hereafter EMT-I).
New York State has an
AEMT-CC (Advanced EMT - Critical Care) certification, which is unique to New York, but almost identical in curriculum to the national standard EMT-Intermediate/99. Part of the reason why New York possesses this level is that it also has an AEMT-I (Advanced EMT- Intermediate) certification which is at the same level as the national standard for EMT-I/85.
Oklahoma recognized a similar level, called EMT-Cardiac, until recently; however, that level has been phased out, and EMTs certified in Oklahoma at that level have since been trained and certifed to the
paramedic level or downgraded to EMT-I.
The primary ALS provider in the State of Rhode Island is the EMT-Cardiac, which is unique to Rhode Island. The EMT-C is a certification between the EMT-I and EMT-P, allowing the use of more cardiac drugs than the EMT-I, but fewer than the EMT-P. The time and cost of an EMT-C program is generally less than 1/3 that of an EMT-P program, and is much more popular. EMT-C or higher licencure is generally required by fire departments in the state as well, who provide Emergency Medical Services in the majority of the state.
An ambulance with only EMT-Bs is considered a BLS or
Basic Life Support unit whereas an ambulance with EMT-Ps, EMT-Is (I/99 Standard), or AEMT-CC(New York Only) is dubbed an ALS or
Advanced Life Support unit. Additionally, an ambulance whose highest provider is an EMT-I (I/85 standard) or New York State AEMT-I, is considered an ILS or Intermediate Life Support Unit.
Many BLS companies also provide "rescue" services, such as Motor vechicle extrication, all aspects of technical rescue and water rescue. It is part of an EMT duty in most states to be able "extricate a person" from whatever situation the EMT is presented with, whether the person fell down a flight of stairs and is in a cellar, or is stuck in a motor vehicle.
EMT-B skills include
CPR,
first aid,
airway management,
oxygen administration,
spinal immobilization,
bleeding control and traction splinting. EMT-I skills add
IV therapy,
endotracheal intubation and initial cardiac drug therapy. Both EMT-I (Intermediate) and EMT-P require something similar to a
residency to attain; an EMT-B is the highest level of training one can receive without actively functioning as an EMT and being sponsored by one's EMS (Emergency Medical System/Service) organization or a hospital.
Some states, namely Tennessee, utilize a slightly modified NREMT-B curriculum. This includes the standard NREMT-B Skills, although adds several more advanced skills, termed Extended Life Support. These skills include the use of anti-shock trousers, IV fluids and establishing IVs in medical and trauma situations, pharmacology to administer 1:1000 epinepherine and/or use an EpiPen in anaphylaxis, nitroglycerine in chest pain, activated charcoal in poisonings, metered-dose inhalers, and nebulized albuterol and other nebulizer medications, and finally glucose testing and administration of oral and intravenous dextrose to increase blood sugar. Tennessee EMT-Bs are also trained in use of the pharyngeo-tracheal lumen ("PTL") and CombiTube advanced airway adjuncts, and the activation of aeromedical assets. Tennessee EMT-IVs are licensed after passing the NREMT-B test and an in-house skill testing at the training location.
Like the responsibilities of an EMT, training programs for certification vary greatly. On one end of the spectrum, there are fast track programs that can be very intense often demanding a schedule of 8 to 12 hour days for at least two weeks. The level of motivation and time constraints of the students should be taken into consideration before enrolling into this type of program. On the other side of the spectrum are 3 to 4 month training programs whose popular venue is a local community college. Training consists of a few hours a day, couple days a week. For those seeking EMT as a pre-requisite to become a paramedic or firefighter, longer programs may not be ideal because a 4 month program will add even more time to the typical 2 year paramedic or firefighter program.
Regardless of their level of training, 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 rules is guided by a
physician, often with the advice of a medical advisory committee. A physician acting in direct supervision of an EMT program is referred to as a Medical Director and the supervision provided is referred to as Medical Direction.
In California, for example, each county 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, where a regional medical-advisory council ("REMAC") determines protocols for one or more counties in a geographical section of the state. In other areas of the US, a list of permitted actions ("
Acts Allowed" list) may be issued by a state or local authority.
Some skills may be performed "by protocol" given that certain conditions exist, or "off-line medical direction." Other skills require the prior approval of a physician by radio or telephone, or "on-line medical direction." Some areas maintain an "Austere Care Protocol" which modifies the level of care provided during communications failures or disasters.
Paramedics (EMT-Ps) receive more advanced education and training, including instruction on pharmacology and the administration of lifesaving drugs; the technique of inserting a breathing tube into a person's lungs as in
intubation; and even surgical techniques such as sticking a hollow needle directly into the trachea (
cricothyrotomy) or the chest when necessary to save a life.
For example, if air in the chest (outside of the lungs) called a
pneumothorax is preventing the lungs from expanding, the chest must be decompressed to allow the lungs to expand normally and allow inspired air to reach the
alveoli so that
oxygen can enter the bloodstream.
The use of these invasive skills is governed by complex protocols intended to maximize the life-saving value of bringing these skills to the patient in the field while minimizing the risk of errors or additional injury to patients.
There are also many other different certifications a good EMT would want to get like PreHospital Trauma Life Support(PHTLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support(PALS).
EMTs may be employed by a commercial, hospital or municipal EMS (Emergency Medical Service) agency or fire department. Some EMTs may be employed by commercial ambulance services (usually) providing non-emergency patient transportation, or providing emergency medical services to "
9-1-1" emergency calls under contract with municipalities or county governments. Some EMTs may work in clinical settings, such as a hospital's emergency department, while others may be employed in an industrial setting, or for 'home health care' providers.
EMTs may be employed by private ambulance services,((though as an EMT-B the pay is usually low)) which provide non-emergency
transportation of in-
hospital patients. Many ambulance services provide transport for patients not experiencing an emergency, but nonetheless requiring medically supervised
transportation. Such patients may include those being transferred between hospitals, bedridden patients being discharged to nursing homes or patients who are to undergo specialized treatment, therapy or diagnostic procedures. Private ambulances are also capable of responding to "9-1-1" emergency calls.
In many locales,
firefighters and some police officers (particularly in the
Highway Patrol) are now also cross-trained as EMTs; the majority of these are EMT-Bs, although a growing number of prospective firefighters earn EMT-P certification in order to increase their chances of being hired. Some large companies, especially industrial facilities, even maintain their own in-house EMTs as part of the plant's firefighting or
security guard force. Some colleges and universities train EMTs and host
student run EMS in their areas to respond to student medical emergencies.
EMTs may also serve as an unpaid volunteer for a volunteer ambulance service, volunteer rescue squad or volunteer fire department, especially in rural or suburban areas. Rural communities often find it difficult to finance emergency medical services, and recruiting, training and retaining volunteer EMTs is a continuing challenge. This is especially true in small communities since the EMTs who volunteer often know personally the patients they're dealing with. Some of the beneifts to having volunteers are that they usually provide medical services for free, whereas a paid company can charge up to $2,000 per trip to the hospital. Further, many private paid ambulance companies only specialize in transport, whereas many volunteer squads still perform rescue operations as well as EMS. This seems to be a worthwhile idea as many suburban and rural fire companies who are taking over rescue are not medically trained. Further, it has been reported that in a time of crisis, there would not be enough paid EMS workers to properly staff a major incident. Also, many of the immediate EMS personnel that responded to 9/11/01 after the towers collapsed were actually volunteers and NOT paid.
In response to
nursing shortages, EMT-Ps are being increasingly used in the
emergency rooms and
Intensive Care Units of hospitals, where they can serve as ER technicians, with varying scopes of practice.
Currently, in the
United States of America, the busiest EMS service per ambulance is
New Orleans' Health Department EMS, which responds to approximately 4,000 "911" calls per month, utilizing six ambulances for the entire city of about 500,000 people, due to the
Hurricane Katrina catastrophe.
EMTs and paramedics of the
New York City Fire Department's Emergency Medical Service Command, along with hospital employed EMTs and paramedics under its jurisdiction, responds to over 3,000 requests for 911 assistance daily; over 1.3 million calls annually (2003).
*
First aid,
Wilderness first aid,
Wilderness emergency medical technician,
Oxygen first aid*
Medical emergency,
Emergency medical services*
Triage*
Paramedic,
Medic,
Combat medic,
91W*
Certified first responder,
Combat lifesaver*Meisel, Zachary (Nov. 8, 2005).
"Ding-a-Ling-a-Ling".
Slate.
*
National Registry of Emergency Medical Technicians*
National Association of Emergency Medical Technicians*
National Highway Traffic Safety Agency, Office of Emergency Medical Services
