Nature of the Work

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, childbirths, 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 closely with police and fire department personnel. 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 policies and protocols, they give appropriate emergency care and when necessary, transport the patient. EMTs and paramedics also treat patients with minor injuries on the scene of an accident or at their home without transporting them to a medical facility. Some Paramedics work as part of helicopter flight crews that transport critically ill or injured. All treatments are carried out under the supervision of medical doctors.

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 condition and gives additional care as needed. At the medical facility, EMTs and paramedics transfer patients to the emergency department staff, report their observations and actions, and may provide additional emergency treatment. After each run, EMTs and paramedics replace used supplies, check equipment, decontaminate the equipment and the interior of the ambulance, and write a patient care report.

Beyond these general duties, the specific responsibilities of EMTs and paramedics depend on their level of qualification and training. To determine this, and the Texas Department of Health certifies or licenses emergency medical service (EMS) providers and the National Registry of Emergency Medical Technicians (NREMT) registers providers at four levels: First Responder, also called Emergency Care Attendant (ECAs), EMT-Basic, EMT-Intermediate, and EMT-Paramedic. The lowest level, First Responders (ECAs), 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-B, represents the first component of the emergency medical technician system. An EMT-B is trained to care for ill or injured patients on scenes and during transport by ambulance to the hospital. The EMT-B has the skills to assess a patient’s condition and manage respiratory, cardiac, other medical and trauma emergencies. The EMT-Intermediate (EMT-I) has more advanced training that allows administration of intravenous fluids, use of advanced airway techniques and equipment to assist patients experiencing emergencies. Paramedics (EMT-P) provide the most extensive pre-hospital care. In addition to the procedures already described, paramedics may administer drugs, interpret electrocardiograms (EKGs), use manual defibrillators to restart the heart, perform surgical airways, and use other complex equipment.

Working Conditions

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 noisy accident scenes and back injuries from lifting patients. In addition, EMTs and paramedics may be exposed to diseases such as Hepatitis and HIV, as well as violence from drug overdose victims or mentally unstable patients. The work may not only be 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 should be emotionally stable, have good dexterity, agility, and physical coordination, and be able to lift and carry heavy loads.

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 duty for extended periods. Many EMTs and paramedics work 24/48 hours shifts in which they work for 24 hours and are off the next 48 hours. Because emergency services function 24 hours a day, EMTs and paramedics have irregular working hours that add to job stress.

Employment

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, or emergency medical services (EMS). EMTs and paramedics may respond to only a few calls for service per month, or may answer 20 calls for service per shift.

Full- and part-time paid EMTs and paramedics were employed in a number of settings. 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 Emergency Medical Services. 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.

Training, Other Qualifications, and Advancement

Formal training and certification is needed to become an EMT or paramedic. In Texas, an applicant must complete a Department of Health approved course, pass a credentialing exam and skill exam. All initial applicants will be required to take the National Registry of EMTs examination to obtain a Texas certification or licensure. To maintain certification, EMTs and paramedics must reregister, every 2 years for the National Registry, and/or every four years for the Texas Department of Health. Graduates of approved EMT basic training programs that pass a written and practical examination administered by the State certifying agency or the NREMT earn the title of Registered EMT-Basic. In order to re-register or recertify, an individual must meet the continuing education requirements set by the issuing entity.

Training is offered at progressive levels: EMT-Basic, EMT-Intermediate, and EMT-paramedic. The EMT-Basic represents the first level of skills required to work in the emergency medical system. Formal classroom experiences are enhanced with combined time in an emergency room and on an ambulance. Coursework typically emphasizes emergency skills such as managing respiratory, trauma, and cardiac emergencies and patient assessment. 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. The course is a prerequisite for further training as an EMT-Intermediate or EMT-Paramedic.

EMT-Intermediate training requirements vary from State to State. In Texas, EMT-Intermediates receive additional training in assessment, trauma, physiology, airway management, and medical emergencies. Training commonly includes 250 hours of additional instruction beyond EMT-Basic coursework. Prerequisites for taking the EMT-Intermediate examination include certification or registration as an EMT-Basic, required classroom work, and a specified amount of clinical experience. EMT-Intermediate is not a prerequisite for EMT-Paramedic training.

The most advanced level of training for this occupation is EMT-Paramedic. At this level, the caregiver receives additional training in physiology, pharmacology, patient assessment, cardiology, trauma, airway management and extensive training in other body systems. The Paramedic Professions program lasts eighteen to twenty-four months and can result in an associate degree in applied science. Such education prepares the graduate to take the NREMT and the State Credentialing Examination and become certified as an EMT-Paramedic. Extensive classroom, clinical and field training 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.

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, or dispatchers, 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, nurse practitioners, physician assistants, physicians, or other health care workers.

Job Outlook

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.

Earnings

Earnings of EMTs and paramedics 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 annual salaries in the South Central U.S. were $35,259 for an EMT-Paramedic, $28,527 for an EMT-Intermediate, and $28,064 for an EMT-Basic. Several agencies in the Central Texas Area offer starting salaries of at least $40,000 annually. The Journal of Emergency Medical Services also reported an increase in salaries over the previous years. EMT’s and paramedics 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, 2000

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.

Related Occupations

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.

Sources of Additional Information

General information about emergency medical technicians and paramedics is available from:

National Association of Emergency Medical Technicians, 408 Monroe St., Clinton, MS 39056

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

National Highway Transportation Safety Administration, EMS Division, 400 7th St. SW., NTS-14, Washington, DC.

TC Home	EMSP Home
Last updated:8/27/2006 at 10:41 AM