Emergency Medical Technicians and Paramedics

Significant Points

  • Irregular hours and treating patients in life-or-death situations lead to job stress in this occupation.
  • State requirements vary, but formal training and certification are required.
  • Employment is projected to grow rapidly as paid emergency medical technician positions replace unpaid volunteers.

Nature of the Work [About this section]  Index

People’s lives often depend on the quick reaction and competent care of emergency medical technicians (EMTs) and paramedics. Incidents as varied as automobile accidents, heart attacks, drownings, childbirth, and gunshot wounds all require immediate medical attention. EMTs and paramedics provide this vital attention as they care for and transport the sick or injured to a medical facility.

Depending on the nature of the emergency, EMTs and paramedics typically are dispatched to the scene by a 911 operator and often work with police and fire department personnel. Once they arrive, they determine the nature and extent of the patient’s condition while trying to ascertain whether the patient has preexisting medical problems. Following strict procedures, they give appropriate emergency care and transport the patient. Some conditions can be handled following general rules and guidelines, while more complicated problems are carried out under the direction of medical doctors by radio.

EMTs and paramedics may use special equipment such as backboards to immobilize patients before placing them on stretchers and securing them in the ambulance for transport to a medical facility. Usually, one EMT or paramedic drives while the other monitors the patient’s vital signs and gives additional care as needed. Some who work for hospital trauma centers, which use helicopters to transport critically ill or injured patients, are part of the flight crew.

At the medical facility, EMTs and paramedics help transfer patients to the emergency department, report their observations and actions to staff, and may provide additional emergency treatment. Some 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, EMTs replace used supplies and check equipment. If a transported patient had a contagious disease, EMTs decontaminate the interior of the ambulance and report cases to the proper authorities.

Beyond these general duties, the specific responsibilities of EMTs and paramedics depend on their level of qualification and training. To determine this, the National Registry of Emergency Medical Technicians (NREMT) registers emergency medical service (EMS) providers at four levels: First Responder, EMT-Basic, EMT-Intermediate, and EMT-Paramedic. Some States, however, do their own certification and use numeric ratings from 1 to 4 to distinguish levels of proficiency.

The lowest level—First Responders—are trained to provide basic emergency medical care because they tend to be the first persons to arrive at the scene of an incident. Many firefighters, police officers, and other emergency workers have this level of training. The EMT-Basic, also known as EMT-1, represents the first component of the emergency medical technician system. An EMT-1 is trained to care for patients on accident scenes and on transport by ambulance to the hospital under medical direction. The EMT-1 has the emergency skills to assess a patient’s condition and manage respiratory, cardiac, and trauma emergencies.

The EMT-Intermediate (EMT-2 and EMT-3) has more advanced training that allows administration of intravenous fluids, use of manual defibrillators to give lifesaving shocks to a stopped heart, and use of advanced airway techniques and equipment to assist patients experiencing respiratory emergencies. EMT-Paramedics (EMT-4) provide the most extensive pre-hospital care. In addition to the procedures already described, paramedics may administer drugs orally and intravenously, interpret electrocardiograms (EKGs), perform endotracheal intubations, and use monitors and other complex equipment.

Working Conditions [About this section]  Index

EMTs and paramedics work both indoors and outdoors, in all types of weather. They are required to do considerable kneeling, bending, and heavy lifting. These workers risk noise-induced hearing loss from sirens and back injuries from lifting patients. In addition, EMTs and paramedics may be exposed to diseases such as Hepatitis-B and AIDS, as well as violence from drug overdose victims or psychologically disturbed patients. The work is not only physically strenuous, but also stressful, involving life-or-death situations and suffering patients. Nonetheless, many people find the work exciting and challenging and enjoy the opportunity to help others.

EMTs and paramedics employed by fire departments work about 50 hours a week. 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 of these workers, especially those in police and fire departments, are on call for extended periods. Because emergency services function 24 hours a day, EMTs and paramedics have irregular working hours that add to job stress.

Employment [About this section]  Index

EMTs and paramedics held about 150,000 jobs in 1998. In addition, there are many more volunteer EMTs, especially in smaller cities, towns, and rural areas, who work for departments where they may respond to only a few calls for service per month. Most career EMTs and paramedics work in metropolitan areas.

EMTs and paramedics are employed in a number of industries. Nearly half work in local and suburban transportation for private ambulance firms that transport and treat individuals on an emergency or non-emergency basis. About a third of EMTs and paramedics work in local government for fire departments and third service providers, in which emergency medical services are provided by an independent agency. Another fifth are found in hospitals, where they may work full-time within the medical facility or respond to calls in ambulances or helicopters to transport critically ill or injured patients.

Training, Other Qualifications, & Advancement [About this section]  Index

Formal training and certification is needed to become an EMT or paramedic. 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 administer their own certification examination or provide the option of taking the National Registry examination. To maintain certification, EMTs and paramedics must re-register, usually every 2 years. In order to re-register, an individual must be working as an EMT 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. The EMT-Basic represents the first level of skills required to work in the emergency medical system. 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 to use and maintain 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. The course is also 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, where 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 35-55 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 more advanced skills. The Paramedic 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 National Registry of Emergency Medical Technicians 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. 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 health care and then decide to return to school and become registered nurses, physicians, or other health workers.

Job Outlook [About this section]  Index

Employment of EMTs is expected to grow faster than average for all occupations through 2008. Much of this growth will occur as positions change from volunteer to paid and as the population grows, particularly older age groups that are the greatest users of emergency medical services. In addition to job growth, openings will occur because of replacement needs; some workers leave because of stressful working conditions, limited advancement potential, and the modest pay and benefits in the private sector.

Most opportunities for EMTs and paramedics are expected to arise in hospitals and private ambulance services. Competition will be greater for jobs in local government, including fire, police, and third service rescue squad departments, where job growth for these workers is expected to be slower.

Earnings [About this section]  Index

Earnings of EMTs depend on the employment setting and geographic location as well as the individual’s training and experience. Median annual earnings of EMTs were $20,290 in 1998. The middle 50 percent earned between $15,660 and $26,240. The lowest 10 percent earned less than $12,700 and the highest 10 percent earned more than $34,480. In local and suburban transportation, where private ambulance firms are located, the median salary was $18,300 in 1997. In local government, except education and hospitals, the median salary was $21,900. In hospitals, the median salary was $19,900.

Those in emergency medical services who are part of fire or police departments receive the same benefits as firefighters or police officers. For example, many are covered by pension plans that provide retirement at half pay after 20 or 25 years of service or if disabled in the line of duty.

Related Occupations [About this section]  Index

Other workers in occupations that require quick and level-headed reactions to life-or-death situations are police officers, firefighters, air traffic controllers, and workers in other health occupations.

Sources of Additional Information [About this section]  Index

Disclaimer: Links to other Internet sites are provided for your convenience and do not constitute an endorsement.

General information about EMTs and paramedics is available from:

O*NET Codes: 32508 About the O*NET codes

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