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Emergency Medical Technician: Training and Education

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Certification and formal training is necessary to become an emergency medical technician or paramedic. All fifty states have specific certification requirements. In most jurisdictions, registration with the National Registry of Emergency Medical Technicians (NREMT) is required at some or all levels of EMT certification. Alternatively, some states administer their own certification exam or offer the NREMT exam as an option. EMTs and paramedics must re-register, usually every two years. To qualify for re-registration, an EMS personnel must be working as an EMT or paramedic and complete a minimum number of hours of continuing education.

Training is offered at three progressive levels:

  • EMT-Basic (EMT-B)
  • EMT-Intermediate (EMT-I)
  • EMT-Paramedic (EMT-P)

EMT-Basic courses emphasize emergency skills, such as managing trauma, respiratory, and cardiac problems, controlling bleeding, and performing detailed patient assessments. Formal courses are combined with time in an emergency department or ambulance "ride-along." The curriculum also provides training and hands-on practice in dealing with severe bleeding, orthopedic fractures, choking, respiratory arrest, emergency childbirth, and spinal cord injuries. Students learn how to use emergency devices like automated external defibrillators (AEDs), backboards, suction machines, splints, oxygen, and specialized folding stretchers. Graduates of EMT-Basic training who pass a written and practical exam given by the NREMT earn the title "Registered EMT-Basic." The EMT-B course is a prerequisite for more advanced
EMT-Intermediate and EMT-Paramedic training.

EMT-Intermediate (EMT-I) education requirements vary from location to location. In addition to the nationally recognized EMT-Intermediate curriculum, there are several state-specific "intermediate" levels including "EMT-Shock Trauma," where the provider learns to start intravenous fluids and give certain medications, or "EMT-Cardiac" or "EMT-Critical Care" which includes learning heart rhythms and administering advanced medications. Training often includes 35 to 55 hours or more of additional education beyond EMT-Basic, and teaches in-depth patient assessment and the use of advanced airway devices and administration intravenous (IV) fluids. Providers often must have a certain amount of clinical experience to be eligible for EMT-I licensure.

The most advanced level is EMT-Paramedic (EMT-P or paramedic). Paramedics receive additional training in anatomy and physiology and learns many advanced skills which are normally only performed by emergency physicians. Paramedic programs usually last one or two years and can result in an associates degree. This education prepares the graduate to take the NREMT examination and become certified as a nationally-registered EMT-Paramedic. Paramedic training requires extensive coursework.  Hospital clinical and field experience is almost always required. Because of the longer training requirement, virtually all paramedics are in paid positions. 

Paramedics and EMTs should be stable emotionally and have good agility, dexterity, and coordination. They must be able to lift and carry heavy loads. They also need good vision (with corrective lenses, if necessary) and have accurate color vision.

For those wishing to advance beyond the paramedic level, it is usually necessary to leave fieldwork. Paramedics (and EMTs) can become supervisors, operations managers, executive directors, or administrative directors, of private ambulance companies. Some paramedics become dispatchers, instructors, or certified physician assistants (PA-C). Others move into sales or marketing of emergency medical equipment, emergency vehicles, or ambulances. Some people become EMTs to explore their interest in healthcare, and often decide to return to college to become registered nurses (RNs), respiratory therapists, physicians, or other healthcare workers.

Statistics: Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2004-05 Edition, Emergency Medical Technicians and Paramedics.

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