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Emergency Medical Services
An excerpt from the Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2006-07 Edition, Emergency Medical Technicians and
Paramedics, on the Internet at http://www.bls.gov/oco/ocos101.htm
People’s lives often depend on the quick reaction and competent care of emergency medical technicians (EMTs) and paramedics—EMTs with additional advanced training
to perform more difficult prehospital medical procedures. Incidents as varied as automobile accidents, heart attacks, drownings, childbirth, and gunshot wounds all
require immediate medical attention. EMTs and paramedics provide this vital attention as they care for and transport the sick or injured to a medical facility.
In an emergency, EMTs and paramedics typically are dispatched to the scene by a 911 operator, and often work with police and fire department personnel.
Once they arrive, they determine the nature and extent of the patient’s condition while trying to ascertain whether the patient has preexisting medical problems.
Following strict rules and guidelines, they give appropriate emergency care and, when necessary, transport the patient. Some paramedics are trained to treat patients
with minor injuries on the scene of an accident or at their home without transporting them to a medical facility. Emergency treatment for more complicated problems is
carried out under the direction of medical doctors by radio preceding or during transport.
 EMTs and paramedics may 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. Usually, one EMT or paramedic drives while the other
monitors the patient’s vital signs and gives additional care as needed. Some EMTs work as part of the flight crew of helicopters that 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 room staff, and
may provide additional emergency treatment. After each run, EMTs and paramedics replace used supplies and check equipment. If a transported patient had a contagious
disease, EMTs and paramedics decontaminate the interior of the ambulance and report cases to the proper authorities.
Beyond these general duties, the specific responsibilities of EMTs and paramedics depend on their level of qualification and training. To determine this, the National
Registry of Emergency Medical Technicians (NREMT) registers emergency medical service (EMS) providers at four levels: First Responder, EMT-Basic, EMT-Intermediate, and
EMT-Paramedic. Some States, however, do their own certification and use numeric ratings from 1 to 4 to distinguish levels of proficiency.
The lowest-level workers—First Responders—are trained to provide basic emergency medical care because they tend to be the first persons to arrive at the scene of an
incident. Many firefighters, police officers, and other emergency workers have this level of training. The EMT-Basic, also known as EMT-1, represents the first component
of the emergency medical technician system. An EMT-1 is trained to care for patients at the scene of an accident and while transporting patients by ambulance to the
hospital under medical direction. The EMT-1 has the emergency skills to assess a patient’s condition and manage respiratory, cardiac, and trauma emergencies.
The EMT-Intermediate (EMT-2 and EMT-3) has more advanced training that allows the administration of intravenous fluids, the use of manual defibrillators to give
lifesaving shocks to a stopped heart, and the application of advanced airway techniques and equipment to assist patients experiencing respiratory emergencies.
EMT-Paramedics (EMT-4) provide the most extensive prehospital care. In addition to carrying out the procedures already described, paramedics may administer drugs orally
and intravenously, interpret electrocardiograms (EKGs), perform endotracheal intubations, and use monitors and other complex equipment.
Working Conditions
EMTs and paramedics work both indoors and outdoors, in all types of weather. They are required to do considerable kneeling, bending, and heavy lifting. These workers risk
noise-induced hearing loss from sirens and back injuries from lifting patients. In addition, EMTs and paramedics may be exposed to diseases such as hepatitis-B and AIDS,
as well as violence from drug overdose victims or mentally unstable 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.
EMTs and paramedics employed by fire departments work about 50 hours a week. Those employed by hospitals frequently work between 45 and 60 hours a week, and those in private
ambulance services, between 45 and 50 hours. Some of these workers, especially those in police and fire departments, are on call for extended periods. Because emergency services
function 24 hours a day, EMTs and paramedics have irregular working hours.
Training, Other Qualifications, and Advancement
Formal training and certification is needed to become an EMT or paramedic. A high school diploma is typically required to
enter a formal training program. Some programs offer an associate degree along with the formal EMT training.
All 50 States have a certification procedure. In most States and the District of Columbia, registration with the NREMT is required at some or all levels of certification. Other
States administer their own certification examination or provide the option of taking the NREMT examination. To maintain certification, EMTs and paramedics must reregister, usually
every 2 years. In order to reregister, an individual must be working as an EMT or paramedic and meet a continuing education requirement.
Training is offered at progressive levels: EMT-Basic, also known as EMT-1; EMT-Intermediate, or EMT-2 and EMT-3; and EMT-Paramedic, or EMT-4. EMT-Basic coursework typically emphasizes
emergency skills, such as managing respiratory, trauma, and cardiac emergencies, and patient assessment. Formal courses are often combined with time in an emergency room or ambulance.
The program also 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 who pass a
written and practical examination administered by the State certifying agency or the NREMT earn the title “Registered EMT-Basic.” The course also is a prerequisite for EMT-Intermediate
and EMT-Paramedic training.
EMT-Intermediate training requirements vary from State to State. Applicants can opt to receive training in EMT-Shock Trauma, wherein the caregiver learns to start intravenous fluids and
give certain medications, or in EMT-Cardiac, which includes learning heart rhythms and administering advanced medications. Training commonly includes 35 to 55 hours of additional instruction
beyond EMT-Basic coursework, and covers patient assessment as well as the use of advanced airway devices and intravenous fluids. Prerequisites for taking the EMT-Intermediate examination
include registration as an EMT-Basic, required classroom work, and a specified amount of clinical experience.
The most advanced level of training for this occupation is EMT-Paramedic. At this level, the caregiver receives additional training in body function and learns more advanced skills. The
Technology program usually lasts up to 2 years and results in an associate degree in applied science. Such education prepares the graduate to take the NREMT examination and become certified
as an EMT-Paramedic. Extensive related coursework and clinical and field experience is required. Because of the longer training requirement, almost all EMT-Paramedics are in paid positions,
rather than being volunteers. Refresher courses and continuing education are available for EMTs and paramedics at all levels.
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.
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