Automobile accident injuries, heart attacks, near drownings, unscheduled childbirths, poisonings and gunshot wounds all demand urgent medical attention. Emergency medical technicians (EMT's) give immediate care and often transport the sick or injured to medical facilities.

Following instructions from a dispatcher, EMT's—who usually work in teams of two—drive specially equipped vehicles to the scene of emergencies. If necessary, they request additional help from police or fire department personnel. They determine the nature and extent of the patient's injuries or illness while also trying to determine whether the patient has epilepsy, diabetes or other preexisting medical conditions. Following strict guidelines, EMT's employ procedures they are certified to use to give appropriate emergency care.

All EMT's, including those with basic skills—the EMT-Basic—may open airways, restore breathing, control bleeding, treat for shock, administer oxygen, immobilize fractures, bandage wounds, assist in childbirth, manage emotionally disturbed patients, treat and assist heart attack victims, give initial care to poison and burn victims, and use automated external defibrillators to assist in the care of patients experiencing cardiac arrest.

EMT-Intermediates have more advanced training that allows them to administer intravenous fluids; use manual defibrillators to give lifesaving shocks to a stopped heart, use advanced airway techniques and equipment to assist patient's experiencing respiratory emergencies, as well as use other intensive care procedures.

EMT-Paramedics provide the most extensive pre-hospital care. In addition to the procedures already described, paramedics may administer drugs orally and intravenously, interpret eletrocardiograms (EKG's), perform endotracheal intubations, and use monitors and other complex equipment.

When victims are trapped, as in the case of an automobile accident, cave-in or building collapse, EMT's free them or provide emergency care while others free them. Some conditions are simple enough to be handled following general rules and guidelines. More complicated problems can only be carried out under the step-by-step direction of medical personnel by radio contact.

When transporting patients to a medical facility, EMT's may use special equipment such as backboards, to immobilize them before placing them on stretchers and securing them in the ambulance. While one EMT drives, the other monitors the patient's vital signs and gives additional care as needed. Some EMT's work for hospital trauma centers or jurisdictions which use helicopters to transport critically ill or injured patients.

At a medical facility, EMT's transfer patients to the emergency department, report to the staff their observations and the care they provided and help provide emergency treatment.

In rural areas, some EMT-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.

After each run, EMT's replace used supplies and check equipment. If patients have had a contagious disease, EMT's decontaminate the interior of the ambulance and report cases to the proper authorities.

 

EMT's work both indoors and outdoors, in all types of weather. Much of their time is spent standing, kneeling, bending and lifting. They may risk noise-induced hearing loss from ambulance sirens and back injuries from lifting patients. EMT's may be exposed to diseases such as Hepatitis-B and AIDS, as well as violence from drug overdose victims or psychological emergencies.

EMT's employed by fire departments often have about a 50-hour workweek. 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 EMT's, especially those in police and fire departments, are on call for extended periods. Because emergency services function 24 hours a day, EMT's have irregular working hours that add to job stress.

 

EMT's should be emotionally stable, have good dexterity, agility and physical coordination, and be able to lift and carry heavy loads. Good health and stamina are essential. The work is not only physically strenuous, but stressful—not surprising in a job that involves life-or-death situations. Nonetheless, many people find the work exciting and challenging.

EMT's need good eyesight (corrective lenses may be used) with accurate color vision. They require a calm temperament and the ability to make quick and level-headed decisions, and be able to follow precise procedures and instructions. Meticulous personal hygiene and a fanatical regard for cleanliness and safety are a must for all healthcare workers.

 

Applicants to an EMT training course generally must be at least 18 years old and have a valid driver's license. Recommended high school subjects for prospective EMT's are driver education, health, and science. First aid training in the Armed Forces is also good preparation.

Formal training is needed to become an EMT. Training is offered at three progressive levels— EMT-Basic, EMT-Intermediate, and EMT-paramedic—and fully qualified technicians complete all three programs. In some cases, First Responder training programs that provide emergency medical basics for firefighters, police officers and others, whose jobs make them likely to be the first persons to arrive at an incident scene, may qualify individuals for entry-level jobs. However, continued employment requires completion of EMT training. EMT training is available in all 50 States and the District of Columbia, and is offered by police, fire and health departments; in hospitals; and as nondegree courses in colleges and universities. In addition to EMT training, EMT's in fire and police departments must be qualified as firefighters or police officers.

The EMT-Basic is the minimum training needed to qualify for an emergency medical technician job. EMT-Basic training is 110 to 120 hours of classroom work plus 10 hours of internship in a hospital emergency room. The program provides instruction and practice in dealing with bleeding, fractures, airway obstruction, cardiac arrest and emergency childbirth. Students learn to use and care for 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 National Registry of Emergency Medical Technicians earn the title of Registered EMT-Basic.

EMT-Intermediate training requirements vary from State to State, but typically include 35-55 hours of additional instruction beyond EMT-Basic and cover 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 and field internship.

Most graduates of EMT-Intermediate programs continue their education and receive the EMT-Paramedic certification. EMT-Paramedic training programs generally last between 750 and 2,000 hours. Due to this strenuous training requirement, most EMT-Paramedics are in paid positions. Refresher courses and continuing education are available for EMT's at all levels.

In most State's, registration for EMT-Paramedics by the National Registry of Emergency Medical Technicians or a State emergency medical services agency requires current registration or State certification as an EMT-Basic, completion of an EMT-Paramedic training program and required clinical and field internships, as well as passing a written and practical examination. Although not a general requirement for employment, registration acknowledges an EMT's qualifications and makes higher paying jobs easier to obtain.

All 50 States possess a certification procedure. In 38 States and the District of Columbia, registration with the National Registry is required at some or all levels of certification. Other States require their own certification examination or provide the option of taking the National Registry examination.

To maintain their certification, all EMT's must reregister, usually every 2 years. In order to reregister, an individual must be working as an EMT and meet a continuing education requirement.

 

Advancement beyond the EMT-Paramedic level usually means leaving fieldwork. An EMT-Paramedic can become a supervisor, operations manager, administrative director or executive director of emergency services. Some EMT's become EMT instructors, firefighters, dispatchers or physicians assistants, while others move into sales or marketing of emergency medical equipment. Finally, some become EMT's to assess their interest in health care and then decide to return to school and become registered nurses, physicians or other health workers.

 

Earnings of EMT's depend on the employment setting and geographic location as well as the individual's training and experience. Those in emergency medical services who are part of fire or police departments receive the same benefits as firefighters or police officers. According the 1996 Journal of Emergency Medical Services salary survey, average annual salaries of emergency medical technicians, by type of employer in 1996 were:

 

EMT's held about 150,000 jobs in 1996. About two-fifths were in private ambulance services; a third were in municipal fire, police or rescue squad departments; and a quarter were in hospitals. In addition, there are many volunteer EMT's. Most paid EMT's work in metropolitan areas. In many smaller cities, towns and rural areas, there are more volunteer positions than paid EMT jobs.

Competition for jobs will be keen in fire, police, and rescue squad departments because of attractive pay, good benefits and job security. Opportunities for EMT's are expected to be excellent in hospitals and private ambulance services, where pay and benefits usually are low.

Employment of EMT's is expected to grow much faster than the national average for all occupations through the year 2006. Much of this growth will occur as positions change from volunteer to paid positions. Also driving the growth will be an expanding population, particularly in older age groups that are the greatest users of emergency medical services. Additional job openings will occur as more States begin to allow EMT-Paramedics to perform primary care on the scene without transporting the patient to a medical facility.

Many job openings will occur because of this occupation's substantial replacement needs. Turnover is quite high, reflecting this occupation's stressful working conditions, limited advancement potential, and the modest pay and benefits in the private sector.