Training, Certifications, Skills, Advancement: Emergency Medical Technicians and Paramedics

Formal training and certification is needed to become an EMT or paramedic. 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. Due to 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.

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 EMTs and paramedics become instructors, dispatchers, or physician assistants, while others move into sales or marketing of emergency medical equipment. A number of people become EMTs and paramedics to assess their interest in healthcare, and then decide to return to school and become registered nurses, physicians, or other health workers.