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Pre-Hospital Forum Frequently Asked Questions (FAQ)

Source: National Association of Emergency Medical Technicians

What is EMS?
EMS stands for Emergency Medical Services. EMS provides medical care outside of the hospital or medical office setting. Most often, people call EMS when they have had an accident or are experiencing a medical emergency. Emergencies might include heart attack, difficulty breathing, falls, accidents, drowning, cardiac arrest, stroke, drug overdose and acute illnesses. EMS services may provide both basic and advanced medical care at the scene of an emergency and en route to a hospital.

What is an EMS system?
EMS is much more than an ambulance service. The delivery of emergency medical care is made up of many parts, together which are called the EMS system. The EMS system includes the call center that receives the call for and dispatches help, those who respond first (such as police officers and firefighters), an ambulance transportation team of EMTs and/or paramedics, physicians and nurses who provide advice via radio or phone, air medical services (helicopters and small airplanes), hospital receiving facilities, governmental and medical oversight.

Who provides EMS?
When a person becomes ill or injured and dials 911 or another emergency phone number, the call is answered by an EMS dispatcher, who is trained to obtain important information from the call-taker about the location and type of emergency. The dispatcher also may give the caller patient care instructions while sending emergency responders to the scene of the emergency. These responders may be trained to different levels:

* First Responders (who have about 40 hours of training);
* EMT-Basics (who have about 110 hours of training);
* EMT-Intermediates (who have about 200-400 hours of training); and
* Paramedics (who have 1,000 or more hours of training).

The training level of responders is a local decision and based upon local resources and the priorities of those who fund the EMS system. Each of these levels of EMS responders is trained to perform different kinds of skills to assist the patient.

EMS responders work under protocols approved by a physician medical director. Many of these medical directors are members of the National Association of EMS Physicians. The medical director oversees the care of patients in the EMS system, and he or she is knowledgeable about patient care interventions and how EMS systems deliver care. Typically, EMS medical directors work in conjunction with local EMS leaders to assure quality patient care.

EMS care may be provided by a private ambulance company, fire departments, police departments, a public EMS agency, a private ambulance company, a hospital or by a combination of the above. EMS responders may be paid or volunteers in the community.

What is a tiered EMS system?
Often EMS systems are “tiered.” This means that different levels of providers may respond to a scene. In many EMS systems, it is common to have basic level EMS professionals (First Responders and EMTs) respond to a scene first. They are then followed by Advanced Life Support responders (paramedics). The structure of EMS response varies greatly around the United States based on location, resources, local leadership and history.

How can I get a job in EMS?
In most locations in the United States, the first step you must take to work in EMS is to take courses to become a Basic-level Emergency Medical Technician (EMT-B). This is the minimum level of education that most EMS professionals have before entering the workforce. Individuals who work as firefighters or police officers may perform some emergency medical work when trained as First Responders. Some paramedic programs provide an all inclusive program that includes both EMT and paramedic training in one program. All levels of EMS training are set by the federal government through the National Highway Traffic Safety Administration.

Where can I obtain EMT training?
EMT training is offered at many community colleges, technical schools, hospitals, universities and EMS, fire and police academies. If you are interested in EMT training, you should contact your state EMS office. If you are interested in paramedic training, you should contact the Committee on Accreditation for EMS Professionals. Both of these agencies will help you find local training in your area.

How long is EMS training?
EMT training varies from two to six months, depending on the training site and hours of class scheduled per week. Some training programs have class every day for a couple of months for those interested in getting done quickly, while other, longer programs accommodate those students who have family, a full-time job or other responsibilities that limit their time available for education. Approximate training requirements are:

* First Responders – 40 hours of training
* EMT-Basics – 110 hours of training
* EMT-Intermediates – 200 to 400 hours of training
* Paramedics – 1,000 or more hours of training

What does an EMT learn?
An EMT must be proficient in CPR, and training is centered on recognizing and treating life-threatening emergencies outside the hospital environment. An EMT learns the basics in how to handle cardiac and respiratory arrest, heart attacks, seizures, diabetic emergencies, respiratory problems and other medical emergencies. He or she also learns how to manage traumatic injuries such as falls, fractures, lacerations and burns. An EMT is also introduced into patient assessment, history taking and vital signs.

What skills does a basic EMT perform?
An EMT can perform CPR, artificial ventilations, oxygen administration, basic airway management, defibrillation using an AED, spinal immobilization, vital signs and bandaging/splinting. An EMT may administer nitroglycerin, glucose, epinephrine and albuterol in special circumstances.

What skills does a paramedic perform?
A paramedic performs all of the skills performed by an EMT-Basic. In addition, he or she performs advanced airway management such as endotracheal intubation. A paramedic obtains electrocardiographs (ECGs), introduces intravenous lines and administers numerous emergency medications. A paramedic assesses ECG tracings and defibrillates. He or she has extensive training in patient assessment and is exposed to a variety of clinical experiences during training.

Do EMTs and paramedics need a license?
Every state in the Unites States has a lead EMS agency or state office of EMS that determines requirements of EMS professionals in their state. Some state EMS offices issue licenses to EMS providers; others do not. All EMTs have to complete continuing education classes.

What is the National Registry of EMTs?
Currently, 43 states require EMTs and paramedics meet the requirements (certification) of the National Registry of EMTs in order to gain a license as an EMS provider in their state. Some states require EMTs and paramedics to maintain certification with the NREMT as part of the continued license and others have their own system.

Who represents EMS workers?
EMS workers are represented by a variety of organizations depending on where they work. The National Association of EMTs is a national, professional association of EMTs and paramedics from all types of services, (public, private, fire, industrial, military, volunteer, rural, urban). Other organizations may represent EMTs and paramedics in certain areas such as the International Association of Fire Fighters the International Rescue and Emergency Care Association and the National Volunteer Fire Council . Many EMTs and paramedics who work in paid (not volunteer) fire departments are represented by the International Association of Fire Fighters (IAFF). Some non-firefighter EMTs and paramedics are unionized by a variety of labor unions and many work without unions.

How much do EMTs and paramedics earn?
Salaries of paid EMTs and paramedics are generally below $30,000. Management salaries are generally below $50,000. Because paid firefighters are unionized, their salaries tend to be higher and their jobs coveted in some areas. Volunteers in general are not paid but some receive nominal monies for their services and some are able to earn pensions. Most EMS workers across the United States are volunteers.

How many EMTs are there in the United States?
Estimates about the US market suggest that it has:

* 17,000 transporting ambulance services (includes fire departments)
* 26,000 fire departments (most of which provide some sort of EMS and about half of which offer ambulance transport)
* 52,000 ambulances
* 600,000 EMTs
* 142,000 paramedics
* 1,009,000 firefighters (many of whom are cross-trained in EMS)

It is not known how many individuals are involved in providing EMS worldwide.

Are emergency response vehicles allowed to ignore traffic laws, such as stop lights?
Ambulance operations are governed by local and state laws, so there is not one answer that applies to all communities. That said, contrary to popular belief, emergency vehicles in most communities are not granted unrestricted right of way. In most cases, emergency vehicles must obey all signs and signals. For example, they must stop at a red light or stop sign before proceeding through an intersection. Sometimes, emergency vehicles operate contrary to traffic control devices when responding to an emergency, and sometimes, they exceed posted speed limits. However, even during these times, emergency vehicle operators must drive with due regard for the safety of the public.
 
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When you're using the Pre-Hospital Forum, here's what you need to know:

For SDN's complete policy, please see SDN Forums Terms of Service (TOS) FAQ.

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10. Be sure to have fun! The educational process can be frustrating sometimes. We're all in it together and we're here to help each other.

Enjoy the Pre-Hospital Forum! :)
 
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Will EMS Help My Medical School Application?

Yes, it will.

But…

It is widely agreed upon by those of us on this board who have gone from EMS to medical school that wanting to be a doctor is not a good reason to become an EMT (any level). There are several reasons for this:

EMS and medicine are not the same thing. Some elements overlap but they are totally separate skill sets and work environments. You could get into EMS and love it and then be bitterly disappointed by medicine. You could be needlessly turned off from a career in medicine because you decide you dislike EMS.

EMS is viewed by most medical school admission committees as some kind of medical related extracurricular activity like research or volunteering. Yes it shows some dedication to the field. Yes they’ll like it. But the real key to getting into medical school is your grades and MCAT scores. People love to hear that there are other ways to get in despite a mediocre GPA and poor test taking skills but that’s the exception to the rule. If you are looking at EMS just because it will look good on your application your time will be better spent studying and prepping for the MCAT.

EMS training without any real EMS experience is not particularly valuable. To really get anything useful out of it you need to become an EMT (usually a ~120 hour course followed by written and practical tests) and then work as an EMT. Work as an EMT is usually pretty mundane. You would be doing lots of interfacility transports which means trucking nursing home patients to doctor’s appointments. To get the experience you really want you would need to become a paramedic. That usually requires you to work as an EMT for a year then go to paramedic school (1000 to 1400 hours followed by clinical rotations, field internship and more testing). By that time you will have spent more time getting into EMS than you would have in undergraduate school. So again, your best bet is to study more bio and Ochem and take an MCAT prep course.

So does this mean people should avoid EMS. No! If you want to get into EMS because you want to work in EMS then by all means go for it. It’s a great field and can be very rewarding. If you are already in EMS and want to change to medicine for some reason then again, go for it and use your experiences to your benefit. Just don’t start down the EMS pathway hoping it will lead to medicine. It might, but it’s not the best way to get where you really want to go.

Note: This FAQ has generated a lot of controversy and discussion. If you're interested go here.
 
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