Emergency Medical Technicians
An emergency medical technician-paramedic is a licensed and/or certified out-of-hospital health-care provider. EMTs represent the uppermost level of prehospital health care providers and serve as managers of pre-hospital treatment teams. They work under the direction of a physician—often by two-way radio—to evaluate and manage acutely ill or injured patients in ambulance services or other life-support units.
The emergency medical system is a complex emergency response structure that has strict guidelines for its certification levels of health professionals. Emergency medical technicians are classified under four levels of prehospital certification: First Responder; Emergency Medical Technician-Basic (EMT-B); Emergency Medical Technician-Intermediate (EMT-I), and Emergency Medical Technician-Paramedic (EMT-P). Education and training varies across the four levels, with the emergency medical technician-paramedic having the highest level of training. An emergency medical technician has developed independent reasoning and training to make rapid assessments and interventions that can save people's lives. The EMT-P is considered an extension of the emergency room physician to the patient in the field and has the greatest amount of responsibility.
Provision of initial treatment
The responsibilities of an emergency medical technician are numerous, demanding, and extremely stressful. The EMT's most common responsibilities are related to provision of initial treatment:
- Organization and preparation for emergency calls: Besides having all of the equipment stocked, ambulance maintained and cleaned, and communication devices checked, the emergency medical technician must be psychologically and emotionally prepared to care for distressed patients and family members.
- Immediate and safe response to the emergency scene by knowing the proper location and road systems while maneuvering a heavy and bulky ambulance through traffic.
- Assessment of the safety hazards at the emergency scene, including the safety of the crew, the victims, and the bystanders—as well as understanding the nature of the injuries or illnesses that may be encountered.
- Rapid and efficient evaluation of victims of trauma or illness, using advanced patient assessment skills while recognizing and assigning priority to the most critical injury or illness.
- Delivery of high-quality patient care while utilizing protocols for procedures and interventions established by the emergency medical technician agency, as well as recognizing the need for back-up by an emergency physician.
- Transportation of patients to appropriate institutions if the patients are unstable or needing specialty care (i.e. neurological trauma, cardiovascular intervention). The emergency medical technician makes the decision regarding the best facility for managing the patient's injury or illness.
- Keeping records of all assessment findings and interventions completed on the patient from the field to the receiving facility.
Over the years, the scope of the EMTs responsibilities has widened to include educating the public about health issues and participating in injury and disease prevention programs. EMTs are also playing an increasingly important role in medical and public health research programs.
Emergency medical technicians can work in a variety of settings. Many EMTs work for ambulance agencies. On the other hand, emergency centers, sports facilities, long-term care facilities, and large industries are also employing emergency medical technicians to deliver health care.
Educational requirements for emergency medical technicians differ slightly from state to state. Some EMT programs are designed to accommodate part-time students; others are structured as full-time college-level courses of study. The average length of training for EMTs is 1000 hours, but upgraded standards will probably add a small increase to the number of training hours over the next few years.
Persons considering an EMT-P program must be high school graduates and demonstrate their ability to meet the physical and psychological demands of emergency work. The physical demands are considerable, since EMTs must frequently lift and move patients away
from danger zones or into emergency vehicles, without time to call for assistance. Likewise, the sheer number of potential on-the-job hazards, ranging from toxic chemical spills or fire to collapsing buildings or human violence adds to the emotional stress of EMT work. In addition to demonstrating their physical stamina and emotional stability, persons entering an EMT-P program must be certified at the EMT-ambulance level. Some programs, however, offer a combination of EMT-ambulance and EMT-P training. Students who have acquired basic EMT training in the armed forces within the past 12 months and have had their work approved by a state agency may be permitted to enroll in an EMT-P program.
In some states, students enrolled in EMT-P programs are eligible to earn an associate's degree. On the national level, the United States Department of Transportation (U.S. DOT) determines the minimum requirements that must be met for the education of emergency medical technicians. Accredited EMT-P programs include didactic instruction, in-hospital clinical experience, and a supervised field internship in an advanced life-support unit. The course work should also acquaint students with an understanding of their legal and ethical responsibilities as emergency medical personnel.
The education of a emergency medical technician focuses on three dimensions of human experience and activity:
- The affective domain: assignment of various feelings, morals, and thoughts to information, situations, and scenarios.
- The cognitive domain: recall of information and comprehension of facts, figures, and statistics.
- The psychomotor domain: skill attainment through practice in clinical and controlled laboratory settings.
Advanced skills and knowledge of medical management of patients in the field is a central component of EMT training. Common areas of training are:
- advanced airway management techniques, including endotracheal intubation
- intravenous fluid management, including the initiation of intravenous lines and administration of proper fluid replacement
- administration of emergency medications
- cardiac monitoring, interpretation, and intervention
- advanced patient assessment and evaluation
- management of trauma patients
- administration of established advanced cardiac life support, including defibrillation (delivering an electrical shock) for abnormal heart rhythms
- administration of advanced first aid
- complex immobilization techniques used in acute fractures, dislocations, and strains
- proper physical restraining of violent patients, with training focused on safety and de-escalation techniques
Continuing education and specialized training
The education of EMTs does not end with course completion and certification or licensure. The importance of keeping one's skills current is equally important. Every two years, emergency medical technicians must acquire a specific number of continuing education credits in order to maintain certification or licensure in their respective states. Most employers will provide classes for the emergency medical technicians to obtain the necessary continuing education credits.
Specialized certifications are important for the emergency medical technician to complete and update every two years. These certifications include: Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), Basic Trauma Life Support (BTLS), and Prehospital Trauma Life Support (PHTLS).
The role of emergency medical technicians is expanding because of their ability to independently manage various types of patients. The emergency medical technician has become instrumental in transport of critical care patients from one facility to another via ground transport, helicopter, or larger aircraft. In order for a emergency medical technician to function on an acute care transport vehicle, additional training in critical care medications, ventilators, various advanced monitoring systems, and fluid management must be completed.
Defibrillation—A procedure to stop the fibrillation (irregular contraction) of heart muscle by using electric shock.
Emergency medical technician—A licensed and/or certified out-of-hospital health care provider who serves as the manager of the pre-hospital treatment team.
Intubation—Inserting a tube in a patient's mouth or nose to assist delivery of oxygen or air.
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National Association of Emergency Medical Technicians. 408 Monroe Street, Clinton, MS 39056. (601) 924-7744. firstname.lastname@example.org.
Lori Beck, RN, MSN, FNP-C