January 15, 2014
What Is An EMT?
Imagine that you have fallen out of a tree. You managed to not hit many branches on the way down. You were even able to slow your decent by grabbing a few. Unfortunately, when you land you hear a snap and feel excruciating pain in your right thigh. You looked down to confirm what you already suspected: your femur is broken. Luckily, someone sees you, and they call 911. The crew arrives and places you on a backboard and splints your leg. The pain is horrible. The femur is the largest bone in your body, and every time you move brilliant light rushes through your leg. You look up at the medic and ask, “Can I have something for the pain?” only to have him respond, “I’m sorry. We can’t give you anything until we get to the hospital.”
You don’t understand as you think back to another incident where you fractured a bone. That time the crew was able to give you pain medication and the warm waves of opiates masked what was otherwise a very painful injury. What is the difference this time? Well, many people do not know that all medics are not created equal, at least not trained equally. There are different types of EMT’s that are recognized by the National Registry of Emergency Medical Technicians (NREMT). The Highway Traffic and Safety Administration develops the curriculum for all emergency care providers and the NREMT is in charge of the certification and competency testing. The level of care you receive depends on the level of EMT that shows up to your emergency.
Although state licensure can vary from state to state, here is the run down on the different levels of EMT recognized by the National Registry.
Emergency Medical Responder (EMR)
This was previously known as the First Responder. This is the lowest level of Emergency Medical Professional in terms of level of care. They receive extensive training in the recognition and treatment of basic emergency situations. They do not perform invasive procedures (such as IV’s or giving medications) and they do not transport. This level of provider is designed for first responders (volunteer firefighters, police officers, security guards, etc.). They provide basic life support and first aid (CPR, AED, wound management, spinal immobilization, etc.) until an ambulance arrives to deliver a higher level of care and transport.
Emergency Medical Technician (EMT)
This was previously known as the EMT-Basic. The EMT is trained at a higher level than the EMR, although they are still usually limited to basic life support. They can splint bone fractures, immobilize the spine and, of course perform CPR and operate an AED. In most states, they are not able to start IV’s or give medications outside of oxygen and assisting the patient with their own medication (i.e. aerosol bronchodilator or prescribed nitroglycerin). Their main objective in the care of emergencies is recognition and transport to the appropriate medical facility for definitive care.
Advanced Emergency Medical Technician (AEMT)
This was previously known as EMT-Intermediate. As an EMT-I, they were trained in gaining IV access and fluid therapy. They were also trained in placing an endotracheal tube in patients who were either not breathing or could not maintain their own airway. They had limited medications they could administer intravenously. These were primarily of two types: intravenous dextrose (D-50), which is administered in a patient with hypoglycemia, and sodium bicarbonate, which is a base that is administered in certain cases where significant metabolic acidosis is suspected. Now that the new curriculum is active, the AEMT can also give certain other medications such as epinephrine, naloxone, and a few other medications. They are still unable to administer narcotics to patients and are not typically trained in extensive cardiac monitoring.
This was previously known as an EMT-Paramedic. Paramedics are trained at the highest level of care in pre-hospital emergency medicine. Most paramedic programs are typically at least two years in length and teach extensive courses in anatomy, physiology, pharmacology, cardiology, pulmonology, endocrinology, and obstetrics. Paramedics are trained in both invasive and noninvasive treatments including chest decompression (needle thoracostomy) for the treatment of tension pneumothorax, cricothyrotomy (a surgical airway placed in the cricothyroid membrane), and many other lifesaving procedures. These are the guys and gals that carry opiate based narcotics which can help in the event of a painful injury. Outside of narcotics, they typically have access to a plethora of other medications that can treat many life threatening medical emergencies.
It is important to remember that while these levels of pre-hospital emergency responders carry the minimum certification standards required by the NREMT, each state has freedom to license at their discretion, and each level may train above the minimum requirements accordingly. Contact your local ambulance service to inquire about the scope of practice you can expect in the event of an emergency.
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