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Emergency Medical Technicians and Paramedics
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| Significant
Points |
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- Job
stress is common due to irregular hours and treating patients
in life-or-death situations.
- Formal
training and certification are required but State requirements
vary.
- Employment
is projected to grow faster than average as paid emergency
medical technician positions replace unpaid volunteers.
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| Nature
of the Work |
[About this section] |
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People's lives often depend on the quick reaction and competent
care of emergency medical technicians (EMTs) and paramedics,
EMTs with additional advanced training to perform more difficult
pre-hospital medical procedures. 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. (Police
and detectives and firefighting occupations appear elsewhere
in the Handbook.) 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 rules and guidelines, they give
appropriate emergency care and, when necessary, transport
the patient. 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. Emergency
treatments for more complicated problems are carried out
under the direction of medical doctors by radio preceding
or during transport.
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 EMTs work as part of the flight crew
of helicopters that transport critically ill or injured
patients to hospital trauma centers.
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. After each run, EMTs and paramedics replace used
supplies and check equipment. If a transported patient had
a contagious disease, EMTs and paramedics 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.
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| Working
Conditions |
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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 mentally unstable 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.
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| Employment |
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EMTs and paramedics held about 172,000 jobs in 2000. Most
career EMTs and paramedics work in metropolitan areas. There
are many more volunteer EMTs and paramedics, especially in
smaller cities, towns, and rural areas. They volunteer for
fire departments, emergency medical services (EMS), or hospitals
and may respond to only a few calls for service per month,
or may answer the majority of calls, especially in smaller
communities. EMTs and paramedics work closely with firefighters,
who often are certified as EMTs as well and act as first responders.
Full-
and part-time paid EMTs and paramedics were employed in
a number of industries. About 4 out of 10 worked in local
and suburban transportation, as employees of private ambulance
services. About 3 out of 10 worked in local government for
fire departments, public ambulance services and EMS. Another
2 out 10 were found in hospitals, where they worked full
time within the medical facility or responded to calls in
ambulances or helicopters to transport critically ill or
injured patients. The remainder worked in various industries
providing emergency services.
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| Training,
Other Qualifications, and Advancement |
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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 of Emergency Medical Technicians (NREMT)
is required at some or all levels of certification. Other
States administer their own certification examination or provide
the option of taking the NRMET examination. To maintain certification,
EMTs and paramedics must reregister, usually every 2 years.
In order to re-register, 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. 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 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 of 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, 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 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 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 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. 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.
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| Job
Outlook |
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Employment of emergency medical technicians and paramedics
is expected to grow faster than the average for all occupations
through 2010. Population growth and urbanization will increase
the demand for full-time paid EMTs and paramedics rather than
for volunteers. In addition, a large segment of the population—the
aging baby boomers—will further spur demand for EMT services,
as they become more likely to have medical emergencies. There
will still be demand for part-time, volunteer EMTs and paramedics
in rural areas and smaller metropolitan areas. 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 independent third service rescue squad
departments, where salaries and benefits tend to be slightly
better. Opportunities will be best for those who have advanced
certifications, such as EMT-Intermediate and EMT-Paramedic,
as clients and patients demand higher levels of care before
arriving at the hospital.
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| Earnings |
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Earnings of EMTs and paramedics depend on the employment setting
and geographic location as well as the individual's training
and experience. Median annual earnings of EMTs and paramedics
were $22,460 in 2000. The middle 50 percent earned between
$17,930 and $29,270. The lowest 10 percent earned less than
$14,660, and the highest 10 percent earned more than $37,760.
Median annual earnings in the industries employing the largest
numbers of EMTs and paramedics in 2000 were:
| Local
government |
$24,800 |
| Hospitals |
23,590 |
| Local
and suburban transportation |
20,950 |
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.
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| Related
Occupations |
[About this section] |
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Other workers in occupations that require quick and level-headed
reactions to life-or-death situations are Air Traffic Controllers,
Firefighting Occupations, Physician Assistants, Police and
Detectives, and Registered Nurses.
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| Sources
of Additional Information |
[About this section] |
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Disclaimer: Links to non-BLS Internet sites are provided
for your convenience and do not constitute an endorsement. |
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General information about emergency medical technicians and
paramedics is available from:
National
Association of Emergency Medical Technicians, 408 Monroe
St., Clinton, MS 39056. Internet: http://www.naemt.org/
National
Registry of Emergency Medical Technicians, P.O. Box 29233,
Columbus, OH 43229. Internet: http://www.nremt.org/
National
Highway Transportation Safety Administration, EMS Division,
400 7th St. SW., NTS-14, Washington, DC. Internet: http://www.nhtsa.dot.gov/people/injury/ems
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