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EMS: Courage and Compassion in ActionBy Shawn Godfrey - July 23, 2007
 | | Shawn Godfrey is a certified paramedic and the operations manager for the Village Ambulance Service Inc. in Williamstown |
Honey, the “Ambulance Drivers” are here!
When you call 9-1-1 to report an emergency, assistance is immediately dispatched. If you are reporting a crime, a police car comes to protect and serve. If your house is on fire, a fire truck comes to extinguish the blaze. If you are ill or injured, an ambulance comes to render medical aid.
But who are the people inside these emergency vehicles? We know they're the men and women of our local emergency services squad, and they're highly trained and qualified to take very good care of us, but what are their official titles?
While working in the field, I have been called everything from "Doctor" to "Ambulance Driver." Rarely have I been called by my official title: Emergency Medical Technician-Paramedic.
It certainly doesn’t help that television programs or the media are often confused by the different certification tiers of the Emergency Medical Technician (EMT). Unfortunately, with so many people getting their information from either Grey’s Anatomy or CNN, the confusion has crossed over into our everyday vocabulary and perception of what an EMS provider actually is. Although the days of referring to the EMT as an “ambulance driver” are mostly in the past, I personally wouldn’t mind being mislabeled as “doctor,” so long as the paycheck accompanied the title.
Unlike other emergency services, our equipment (mainly the ambulance) precedes our training and certifications by several decades. Now that the education and training has become much more invasive, ambulance crews, no matter what the level, are able to do more than just offer their patients a ride to the hospital.
Who Are We?
First and foremost, everyone certified to work on an ambulance in this country is classified as an Emergency Medical Technician (EMT). The only variation is the supplementary level, and this depends at what tier the technician is currently trained.
There are two tiers of certification that are relevant to almost every state: EMT-Basic and EMT-Paramedic. Some states use different names for the basic level EMT – California, for example, uses EMT-1 for its Basic level.
Some states, like Massachusetts, recognize an intermediate level of certification (often called EMT-Intermediate) that falls between EMT-Basic and EMT-Paramedic. Due to a host of reasons, including limited training availability and the popularity of the EMT-Paramedic, the EMT-Intermediate is gradually falling out of favor in most areas.
Within the industry, it is very common to refer to the EMT-Basic as simply EMT, and to refer to the EMT-Paramedic as Paramedic. For some paramedics, however, referring to them as simply an EMT could prove devastating to their already inflated ego. You know who you are.
What's the Difference?
The biggest difference between the EMT-Basic and the EMT-Paramedic is their training, interventions, and overall scope of practice (what they are allowed to perform in the field).
The EMT-Basic usually receives 110-150 hours of training and are trained to provide emergency care while at the scene and in transit. EMT-Basics are trained in emergency first aid and CPR, as well as patient assessment skills and management of trauma, respiratory and cardiac emergencies. The EMT-Basic is also trained in the use of semi-automatic cardiac defibrillation (device used to convert fatal heart rhythms), and specialized skills, like hazardous materials training and psychiatric intervention.
The EMT-Intermediate, in addition to the initial EMT-Basic training, receives 40-80 hours of training in the skill of intravenous (IV) initiation and maintenance, and the use of advanced airway and breathing modalities, like those seen on the hit show ER. You know, when Dr. Green puts the long, clear tube down the patient’s throat.
The EMT-Paramedic, in addition to EMT-Basic and EMT-Intermediate training hours, receives anywhere from 1,500 hours to 2,000 hours of training, most of which is spent learning “hands-on” skills in the field (in the ambulance) and the clinical (in the hospital) setting. Many EMT-Paramedic programs often award two-year degrees and, in some cases, a four-year degree in EMS management may be earned.
The scope of practice differences between the EMT-Basic and the EMT- Paramedic can be remembered by using the “break the skin” axiom.
Most states do not allow the EMT-Basic to administer needle injections or initiate intravenous (IV) lines. The EMT-Paramedic, on the other hand, can administer injections, establish IVs, as well as employ advanced airway management devices to support breathing. The EMT-Basic is usually restricted to using oxygen, asthma inhalers, and epinephrine auto-injectors (a common exception to the “break the skin” rule), whereas the EMT-Paramedic is trained in the use of 30-40 medications and 12-lead EKG interpretation and treatment, depending on where he or she practices.
Different Titles; Same Objective
The EMT-Basic, EMT-Intermediate, and EMT-Paramedic all respond to emergency medical incidents. All ambulance crewmembers are required to at least have EMT-Basic certification in order to treat patients in the back of an ambulance. In my opinion, EMT-Basic level training provides the most important elements of emergency medical training, while the more advanced EMT-Intermediate and Paramedic level training addresses supportive care and maintaining patients after initial resuscitation.
All 50 states require EMS workers to be certified. In 38 states and the District of Columbia, registration with the National Registry of Emergency Medical Technicians is required. All other states, like Massachusetts, have their own certification examinations and requirements. Certification is maintained by reregistering, usually every two years, meeting continuing education requirements, and paying a recertification fee.
During emergency transport via ambulance, the EMT-Basic, Intermediate, or Paramedic is in constant radio contact with the receiving Emergency Department’s (ED) doctors and nurses. This ensures that the ED staff is aware of the patient’s condition on a continuous basis. It also allows the ED physician to order medication and/or additional procedures for the patient that can be administered by the EMS crew.
Courage and Heart
No matter what level, the EMT requires a great deal of education, devotion, strength, courage and heart. You can be sure that if you're ever in a situation that requires Emergency Medical Services, you're in the hands of qualified, competent, and skilled caregivers.
To say the least, EMS is a complicated industry. There are different rules in each state and, often times, in each city or county. For more information, contact your state's EMS office.
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| Great article. Thanks for writing it. I hope you are doing well. See you at fyp. | | from: Colleen :) | on: 07-28-2007 |
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| Thanks for the information. As an EMT, I'm always called a paramedic too! I would like the pay, let alone a doc's pay! | | from: Jorge | on: 07-25-2007 |
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| Your articles are always so informative, Mr. paramedic. I enjoy the humor you sprinkle on your writing, too. I think my next accident will be in the vicinity of Village Ambulance so I can get great emergency care AND a chuckle at the same time... When are you working next???!! | | from: Aurora | on: 07-23-2007 |
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| Great article Shawn, as a Paramedic I have been called a great variety of things much like you, and I have had to explain to countless number of people the difference between EMT and Paramedic (we dont have EMT-I here). It's great that you took the time to explain it. I think that the media needs to understand our profession more and portray us properly unlike they usually do. again great article, keep up the good work and stay safe out there. | | from: Jenna | on: 07-23-2007 |
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| Great article Shawn. As the wife of a paramedic I find myself explaining the difference between the three levels. I think I will refer future questions to your article. There is no doubt what ever level the EMT is, they all do an excellent and efficient job. Keep up the great work! | | from: Donna | on: 07-23-2007 |
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| Whatever you wnat to call them, EMT, Paramedic, Driver, ... these dedicated professionals, like Shaun, continue to provide a critical service to our community. Thank you Shaun, for ALL that you in uniform and out. Whatever you want to be called is fine by me. | | from: EMS STALKER | on: 07-23-2007 |
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