I was a paramedic before med school and I would suggest becoming an EMT and working on an ambulance or being an ER tech. The pluses of becoming an EMT include the exposure to the prehospital aspect of Emergency Medicine, that many EM Residents/Physicians don't get the opportunity to witness. EM Residency Programs might require a month of EMS, where the residents go on ride alongs and teach Paramedics and stuff, but its still not that long. Also, by being an EMT you can start taking care of patients by yourself and start develop patient communications skills and physical exam techniques. These are two good reasons for becoming an EMT, and although I am loyal to the EMS community, there are also pluses for becoming an ER tech. If you can get a job in an ER as a tech you will be witness to different medical procedures and sometimes different types of patients. Another thing that is useful, is seeing what it is like to work in an ER. It will give you a glimpse into what it is like to be an ER doc if that is something you think you might be interested in. Some medical schools don't allow EM rotations until your 4th year or late in your 3rd year, so you really don't get many opportunities for EM exposure before its about time to apply to residencies. Just my thoughts, but I would think about these two options....Good Luck.