Emergency Medical Technicians

• Nature of the Work

  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 then 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. EMT's then give appropriate emergency care following strict guidelines for which procedures they may perform. 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 treat patients with anti-shock trousers (which prevent a person's blood pressure from falling too low).

  EMT-Intermediates, or EMT-I's, have more advanced training that allows them to administer intravenous fluids; use defibrillators to give lifesaving shocks to a stopped heart, as well as other intensive care procedures.

  EMT-Paramedics, EMT-P's, 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-P's 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.

• Working Conditions

  EMT's work both indoors and outdoors, in all kinds 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. 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 employed by fire departments often have about a 50-hour workweek. Those employed by hospitals frequently work between 45 and 58 hours a week and those in private ambulance services between 48 and 51 hours. Some EMT's, especially those in police and fire departments, are on call for extended periods. Because most emergency services function 24 hours a day, EMT's have irregular working hours that add to job stress.

• Employment

  EMT's held about 138,000 jobs in 1994. Two-fifths were in private ambulance services, about 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 no paid EMT jobs.

• Training, Other Qualifications, and Advancement

  Formal training is needed to become an EMT. EMT-Basic training is 100 to 120 hours of classroom work plus 10 hours of internship in a hospital emergency room. 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 a nondegree course in colleges and universities.

  The EMT-Basic 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.

  EMT-Intermediate training varies from State to State, but includes 35-55 hours of additional instruction in patient assessment as well as the use of esophageal airways, intravenous fluids, and antishock garments. Training programs for EMT-Paramedics, of which there were about 85 in 1993, generally last between 750 and 2,000 hours. Refresher courses and continuing education are available for EMT's at all levels.

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

  In addition to EMT training, EMT's in fire and police departments must be qualified as firefighters or police officers.

  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. 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. 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 of 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 have some kind of certification procedure. In 31 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.

  EMT's should be emotionally stable, have good dexterity, agility, an physical coordination, and be able to lift and carry heavy loads. EMT's 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 EMT's become EMT instructors, firefighters, dispatchers, or police officers, or 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.

• Job Outlook

  Competition for jobs will be keen in fire, police, and rescue squad departments because of attractive pay and benefits and good 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 average for all occupations through the year 2005. Driving the growth will be an expanding population. Also, the number of older people, who are more likely to need emergency services, is increasing rapidly. 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.

  Most 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.

• Earnings

  Earnings of EMT's depend on the employment setting and geographic location as well as the individual's training and experience. According to a survey conducted by the Journal of Emergency Medical Services, average starting salaries in 1995 were $19,919 for EMT-Ambulance or Basic, $21,818 for EMT-Intermediate, and $23,861 for EMT-Paramedic. EMT's working in fire departments command the highest salaries, as the accompanying table shows. Table 1: Average annual salaries of emergency medical technicians, by type of employer, 1995

  Employer                    Paramedic    EMT-I     EMT-Basic
  
  All employers                $31,137    $26,102    $26,333
  Private ambulance services    28,619     23,330     22,238
  Hospitals                     29,264     28,000     22,500
  Fire Departments              37,690     28,667     33,962
  

  Source: Journal of Emergency Medical Services Those in emergency medical services which are part of fire or police departments receive the same benefits as firefighters or police officers.

• Related Occupations

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

• Sources of Additional Information

  Information concerning training courses, registration, and job opportunities for EMT's can be obtained by writing to the State Emergency Medical Service Director.

  General information about EMT's is available from:
  National Association of Emergency Medical Technicians 102 W. Leake St., Clinton, MS 39056.

  National Registry of Emergency Medical Technicians P.O. Box 29233, Columbus, OH 43229.

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