Anybody who has been involved in a car accident or fire, been injured in a natural disaster, or suddenly fallen gravely ill at home knows that the emergency medical technician (EMT), who responds to their emergency call for help, can be the one who literally saves their life. The EMT is one of the first responders and provides medical care to the sick or injured directly at the location of the accident or illness, stabilizing them physically and preparing them for transport to a medical facility. All EMTs take specialized training courses and receive additional qualifying on-the-job experience. Obtaining an EMT certification is the first step for anyone interested in becoming an EMT. Those in the emergency medical technician profession find their career very rewarding.
There are three different levels of EMT certification, each with its own training requirements. EMT is the lowest level of certification. EMT’s are responsible for assessing the individual’s situation and stabilizing him or her until more advanced help arrives on the scene, and they are authorized to perform a few basic medical procedures. The next level is Advanced EMT, which requires more experience and training, and qualifies the holder to perform more procedures. Finally, the third level is Paramedic, the most advanced level of EMT certification, requiring many hours of classroom training and hands-on experience.
Emergency medical technicians are allowed to provide basic medical services, such as giving a patient oxygen or glucose, applying a splint, assisting a patient with the use of a hand-held asthma inhaler or with the administration of his or her prescribed nitroglycerin, or helping with the use of epinephrine auto-injectors.
In contrast, the duties of a Paramedic can range from administering life-saving heart shock treatment to supporting new life by delivering babies. Paramedics have the highest level of EMT certification and training; they are trained to provide a wider range of more advanced care that supports and maintains patients after they have first been resuscitated. Paramedics can give injections and use devices that provide for better airway management, which can result in a patient’s increased ability to breathe. Depending on the state, a paramedic is usually trained in the use of between 30-40 medications.
An EMT certification prepares an individual to respond to emergency medical events. An emergency dispatcher, also known as a 911 operator, dispatches both EMTs and paramedics to the scene of a medical emergency. Emergency police and/or fire department personnel are typically also dispatched. The EMT will need to quickly assess what has happened and immediately perform basic emergency treatment. EMTs will often be part of an ambulance crew; EMT certification allows the EMT to attend to patients in the back of the ambulance on the way to a hospital or other treatment facility, or in the event a patient is being transferred from one medical facility to another.
Emergency medical technicians must be certified or registered by the National Registry of Emergency Medical Technicians (NREMT) in every state. Some states offer their own certification examination while also providing an option for the individual to take the NREMT examination. In light of constant advances and changes in medicine and medical equipment, EMTs and paramedics must stay current on their training and certifications; they are required to re-register every two years in order to maintain their certification.
Qualities of an Emergency Medical Technician
Emergency medical technicians (EMTs) must react and respond quickly in emergency situations. They have scant minutes to arrive and assess the condition of an ill or injured person and provide stabilizing treatment prior to transporting the patient to a medical facility. Whether the EMT’s level is that of First Responder, Basic, Intermediate, or Paramedic, because of this critical role they play in activating and administering emergency healthcare to injured or ill patients during potentially life- threatening circumstances in addition to possessing an EMT certification, EMTs must also possess a variety of other skills, qualities, and abilities to be effective in their jobs.
Emergency medical technicians are professionals; they should present themselves and act as such. Their uniform and grooming should be neat and clean at all times. EMTs are governed by high standards and moral principles; they always adhere to the EMT oath, the National Association of Emergency Medical Technicians Code of Ethics, and the Declaration of Geneva oath. These standards require EMTs to accept and fulfill their obligations to society and other medical professionals. EMTs must maintain complete confidentiality about the condition of their patients, releasing information only to other medical personnel as needed for continued patient care.
EMTs all desire to provide patients with the best care possible. To do that, EMTs must be committed to obtaining full knowledge and practicing the skills that enable them to provide that level of excellent care. EMTs should also be sufficiently motivated to continually expand their knowledge, skills and abilities in order to remain current on their understanding of trauma and critical illness, use of the latest medical equipment, and the best means of providing medical care.
Strong medical knowledge is required for EMTs to properly perform their job. They must be quick thinking and highly observant, first assessing the larger emergency scenario and a patient’s condition, and then based upon their observations, providing the appropriate and necessary treatment. EMTs may need to perform a procedure to open a patient’s airway in order to achieve acceptable levels of breathing; they may need to perform cardiopulmonary resuscitation or defibrillation; they may need to intervene to control or stop external bleeding, immobilize a body to prevent spinal damage, or splint a broken bone. Oftentimes EMTs need to work to prevent patients from going into shock.
EMTs should have good communication skills; they are required to communicate both with patients and with other emergency response and medical personnel. Communication with patients should be in a calming and reassuring manner so as to minimize the patient’s anxiety, thereby making assessment and treatment easier for all involved and potentially increasing the patient’s chances of survival. EMTs must know how to operate the radio and communicate properly with other emergency personnel via the radio.
The ability to work as a team with other emergency personnel is essential for all EMTs. When responding to an emergency, an EMT and paramedic typically share ambulance duties, with one driving the ambulance while the other cares for the patient in the back. An EMT may also need to be part of a helicopter crew that transports a critically ill or injured patient to a specialized facility or hospital when more immediate medical attention is needed. And, as part of a larger emergency medical response team, the EMT must perform at his/her level, allowing paramedics or other advanced EMTs to provide additional services as needed. EMTs must clearly communicate all care they provided so the next step or level of caretaker can make appropriate decisions as to subsequent treatments.
Physical and emotional stress is an inherent part of an EMT’s job. EMTs respond quickly and provide emergency medical treatment in the midst of such critical, dangerous, and life-threatening situations as automobile accidents, fires, natural disasters, and violent crimes. The EMT must be able to work effectively in any number of stressful scenarios. Further, some situations are potentially threatening to them as well. An EMT could be exposed to communicable or infectious disease, contaminants, or dangerous air. To address these stressors, basic EMTs must be trained in proper handling of blood-borne pathogens and also in how to take the necessary respiratory, blood, bodily fluid, and secretion precautions.
Leaders in any position make assessments and decisions based upon the resources available to them at a given time. This is also true of those in the emergency medical technician field. EMTs must demonstrate leadership by making their assessments quickly, based upon the medical personnel and equipment available at that instant; further, they must be confident in their decision-making ability. Similarly, EMTs must also accept the need to follow directions from others in a leadership position, such as the police.
Effective EMTs possess all of the above referenced skills and abilities and demonstrate many more in the course of performing their jobs.
Advantages of an EMT Certification
There are many advantages to working as an emergency medical technician (EMT). EMTs are both challenged and rewarded in the course of performing their various duties and responsibilities. In addition to giving back to their community, EMTs derive great satisfaction out of knowing they have helped other people and possibly saved lives, especially when the people they have helped recognize and thank them for their services. Likewise, EMTs are continually challenged to provide their services under oftentimes adverse circumstances. In addition to job satisfaction there are many other advantages to having an EMT certification.
Individuals who wish to get a quick start on their EMT careers without having to obtain a lengthy post- secondary education can obtain an EMT certification and enter the workforce in a relatively short period of time. In some locales, the emergency services facility will pay for individuals to obtain their EMT certification as long as they commit to working for the emergency service facility for a period of time after obtaining their certification.
Being EMT-certified also allows the EMT to begin work on a volunteer basis in order to obtain valuable on-the-job experience that is needed to obtain higher levels of EMT certification. Some universities offer volunteers free emergency medical service, reimbursement for campus parking, and even vouchers for food. Volunteer EMTs, working at social or sporting events, will often have free admission to these events. Of course the volunteer EMT may need to respond to some medical emergency that has happened during the event, but for the most part, the volunteer EMT is simply standing by in case of an actual emergency.
Because of the different levels of EMT, ranging from EMT to Paramedic, an individual currently working as an EMT can go on to obtain additional EMT certifications in order to advance to levels of greater job responsibility, more advanced patient care, and higher wages. Having an EMT certification is also beneficial for anyone who is considering pursuing a medical career, as the individual will have gained valuable training and hands-on experience that will look very good on a college or medical school application.
There are clear advantages to obtaining an EMT certification. From a long-term career perspective, EMTs can use their certification to springboard into other medical careers. From a personal perspective, EMTs are rewarded by knowing they have helped others and supported their community.
Professional EMT Associations and Organizations
Joining a professional emergency medical technician (EMT) association is an intelligent career move for EMTs and paramedics who take their jobs and their profession seriously. Professional associations offer members benefits that might not otherwise be available; they can be invaluable also at helping members develop their careers. Professionals looking to advance their EMT careers should join at least one such association.
There are numerous professional EMT and emergency medical services (EMS) associations and organizations. The four largest and most important ones include the National Registry of Emergency Medical Technicians (NREMT), the International Association of Emergency Medical Services Chiefs (IAEMSC), the National EMS Advisory Council (NEMSAC), and the National Association of Emergency Medical Technicians (NAEMT).
Information at the NREMT website states that the NREMT’s most important objective is to ensure the public that the EMS personnel who provide patient care and treatment when they need it most are trained and qualified to do so. On the NREMT website, individuals can learn how to obtain the EMT certification they need toward obtaining their state’s EMT license and being authorized to work as an EMT. The NREMT is also the source EMTs go to when it is time for their EMT recertification. They will find numerous helpful resources, including job search support.
The Mission Statement posted on the IAEMSC website indicates that the IAEMSC supports, promotes, and advances EMS leadership, and also serves as an advocate for the EMS profession in the community. This organization supports the needs of both patients and EMS chief officers by addressing issues they face. Paid annual memberships include regular, associate, affiliate, and corporate level sponsorships.
As its name states, NEMSAC is an advisory council comprised of EMS representatives and consumers. Its purpose is to provide advice to the National Highway Traffic Safety Administration about emergency medical services. While NEMSAC does not administer any programs or make final decisions regarding EMS, through professional knowledge and consideration it offers recommendations on how to advance emergency medical systems across the country.
The NAEMT’s mission is to represent and serve EMS personnel by advocating on their behalf and providing educational programs and up-to-date information on the latest research. EMS professionals pay an annual (or lifetime) membership fee and receive numerous benefits including opportunities for networking and leadership development, the ability to connect with other EMS practitioners to gain new and different perspectives, and receipt of regular news updates about the EMS profession and events taking place across the nation.
Many states, cities, and municipalities have their own EMS/EMT associations. Some websites consolidate information regarding the numerous associations and resources available to EMS personnel. One example is www.FirstResponder.gov, which provides links to many other sites including those listed above. The National Association of State EMS Officials is a national network of state, regional, and local emergency medical care systems. This organization works to improve and coordinate state, regional, and local emergency care systems. Membership benefits to this organization include advocacy on EMS issues, a newsletter, opportunities to attend an annual meeting, workshops, and more.
Take time to read the newsletters and updates that cover key industry issues and hot topics so as to stay current and informed. Connect with other professionals you may be able to use as references when searching for a new job. And, get to know those who could potentially be your competition for future jobs by finding out what training and/or education they have. Be as proactive as possible in making your membership in an EMS professional association work for you. History of the EMT Profession
The history of emergency medical technicians (EMTs) dates back to 1500 B.C. when the Good Samaritan treated travelers’ wounds. Ancient Greeks and Romans transported wounded soldiers off the battlefield in chariots. In 1797, Napoleon Bonaparte appointed his army’s chief physician, Dominique-Jean Larrey, to develop a plan to care for wounded soldiers. Larrey developed the first triage and “ambulance volante” transport system. Larrey also developed protocols for treating the wounded. Trained personnel must: 1) reach injured soldiers quickly, 2) treat and stabilize them in the field, 3) provide rapid transport to a medical facility, and 4) provide them with medical treatment en route. Larrey’s protocols remain applicable today.
In the 1860s flying ambulances were used as organized care for casualties during the Civil War. Civilian ambulance services began in Cincinnati in 1865. Horse-drawn carriages transported sick and injured people to hospitals, with interns accompanying them on the ride. The first motorized ambulance was built for a Chicago hospital in 1899, providing rapid transport for patients.
Well-known authors, such as Ernest Hemingway and Somerset Maugham, became ambulance drivers in World War I. Physical conditions prevented them from joining the army, so they joined an ambulance corps out of patriotism or a sense of adventure. They risked their own lives, witnessing much pain and suffering.
Air transport of wounded soldiers began in Albania in 1915, with the use of a French fighter aircraft. During that same time, Sir Hugh Owen-Thomas, Britain’s father of orthopaedic surgery, developed a splint that reduced from 80% to 20% the mortality rate from femur fractures. In later wars, helicopters were (and still are) used for rapid evacuation and transport of casualties from the field to treatment facilities. Today’s mortality rate of wounded soldiers is approximately 10%, due to ever-improving technology and triage practice.
The first-known volunteer rescue squads were organized in the 1920s in Virginia and New Jersey. Virginia’s Julian Wise witnessed the drowning of a boy and, as an adult, developed a water rescue and recovery unit. Manpower shortages post-World War II made it difficult for hospitals to maintain their own ambulance programs, so city police or fire departments assumed that responsibility. Ambulance services were not regulated; in many cases, local undertakers, with the only vehicle in which an individual could lie down, provided ambulance services. Basic first aid was often the only training required.
During the 1960s, it was observed that rapid response by a trained person improved a cardiac patient’s outcome. Ventilators and cardiopulmonary resuscitation (CPR) became the emergency treatment standard. In 1966, 11 recommendations were presented for improving the care and ultimate outcome of patients outside of hospital settings. They included proper training for rescue squad and ambulance personnel, development of standards for ambulances, local government adoption of ambulance services, and the development of a single, nationwide telephone number for summoning an ambulance. The first statewide emergency medical services (EMS) system was developed, and helicopters began to be used for civilian emergency use.
The National Registry of Emergency Medical Technicians (NREMT) was created in 1970 as a national certification agency that would establish uniform standards for the training of emergency ambulance personnel. The Emergency Medical Services Systems Act of 1973 provided guidelines for developing regional EMS systems that included training, transportation, patient transfer, disaster plan, and communications. Emergency medical care in pre-hospital scenarios has evolved and improved to the point that emergency medical technicians today are recognized as valuable members of the larger healthcare team. Training and EMT certification programs have been developed to ensure EMTs receive the most up- to-date information and also focus on continuing their education in this ever-changing work environment.
EMT’s Duty to Act
Practicing emergency medical technicians (EMTs) are guided by the EMT oath and their Code of Ethics. In essence, the oath states that an EMT will honor laws to the benefit of patients, adding that the EMT will serve “unselfishly and continuously in order to help make a better world for all mankind.” The Code of Ethics states that an EMT will accept and fulfill obligations to society and that an EMT’s most basic responsibility is to “conserve life, to alleviate suffering … and to encourage the quality and equal availability of emergency medical care.” An EMT’s duties and obligations seem clear. Or do they?
Imagine you, an EMT, are on your way home one evening after work and you come upon the scene of an automobile accident. What do you do? Do you stop and begin providing emergency medical treatment to the driver of the car? Or do you just wait until emergency responders arrive to provide your witness report? In some states, you could be legally obligated to help the driver, while in others you may have no obligation to assist.
There has been much discussion over an EMT’s duty to act. While on duty, an EMT has a duty to act, to respond appropriately and in accordance with his or her level of training when called out to assist with a medical emergency. Volunteer EMTs generally do not have a duty to act because they receive no pay for their volunteer service. While a volunteer EMT does not have a legal obligation to act, he or she may still voluntarily and willingly choose to do so. Similarly, an off-duty EMT legally does not have a duty to act because the EMT is not getting paid for his or her service.
If the off-duty EMT decides to aid the injured car driver, he or she may be protected by a Good Samaritan law, which simply put, legally protects one citizen who has unselfishly come to the aid of another. The “good Samaritan” is exempt from legal liability when aiding an injured person; he or she does not have to fear being sued for some unintentional injury to the injured or ill person. As a professional with EMT certification, you should understand your state’s Good Samaritan law. In some cases the law applies only to trained rescuers such as EMTs and doctors while in other states the law covers untrained citizens.
It is also important to understand that the Good Samaritan law does not provide EMTs with blanket protection. If you are off-duty and providing emergency medical aid, you cannot act in gross negligence, with willful disregard, abandonment, or outside your scope of training and practice, just as you would never act that way while on-duty and providing medical assistance.
The Laws of Consent apply too. If the patient is an adult and is conscious and able to make a fully rational, informed decision, the patient will need to give their expressed consent to receive treatment. Implied consent applies if the patient is unresponsive or otherwise unable to make a rational decision. Implied consent also applies to minors if the parents or guardians are unavailable to provide consent.
Many believe emergency medical services (EMS) professionals have a duty to act, whether they are on or off the job; because of their training, they owe a greater duty to the community than does a non-trained individual. The truth is most states do not require an off-duty EMT to provide treatment. Should the EMT decide to treat someone who has fallen ill or been injured, they are obligated to continue providing treatment that falls within their level of training until emergency medical personnel arrive.