Emergency Medical Technician Training

What You Need to Know

EMTs pulling a patient out of an ambulance
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In the United States, ambulances are staffed with either paramedics, emergency medical technicians (EMTs), or a combination of both. Not all ambulances respond to 911 emergency calls and in many cases, the non-emergency ambulances are staffed with two EMTs and no paramedics.

EMTs and paramedics are really two distinct parts of the same healthcare provider. EMTs learn a foundation of tools and skills that paramedic training will later build upon.

But don't let that progression fool you. EMT skills are just as important as those of a paramedic. Indeed, a successful paramedic is one that doesn't ever forget to do the basics.

Basic Life Support

Emergency medical technicians are trained to provide basic life support. It's an unfortunate term because basic doesn't really give credit to the life-saving skills that EMTs must master. Often, in emergency medical care, the most basic training is the most important for saving lives. CPR, as an example, is the most basic medical course anyone can take, but is arguably the most important skill for any healthcare provider.

Basic life support is the primary level for all ambulances in the U.S. If an ambulance is transporting a patient, there is an attendant in the back of the ambulance with the patient providing either basic or advanced life support. The only exception to this rule is the rare case of critical care transport (CCT) or specialty care transport (SCT) teams.

Less than one percent of all ambulances on the road use special teams to care for patients moving from one healthcare facility to another. These teams may consist of nurses, physicians, respiratory therapists, or combinations of all of these together with EMTs or paramedics.

The difference between basic and advanced life support (ALS) is constantly changing, so it's very hard to adequately define BLS.

One rule of thumb is that if the procedure involves needles or if the tube goes past the throat, it's not basic life support. There are some advanced assessment tools that are also out of the BLS scope of practice, such as electrocardiograms (ECGs).

What EMTs Learn

To better understand what basic life support (BLS) is, let's take a look at the overview of the skills that an EMT learns:

  • Patient Assessment: The EMT must learn to assess patients and to recognize signs and symptoms of life-threatening medical conditions. EMTs learn to obtain a history and perform a physical examination. This becomes the basis of both the EMT assessment as well as the paramedic assessment for those EMTs who go on to become paramedics.
  • Airway Management: One of the most important systems to sustain life is the respiratory system. EMTs learn to maintain a patient's airway using airway adjuncts (tools that help keep the tongue out of the way of the glottal opening, where air enters the trachea) as well as suction to remove secretions and foreign objects from the throat. They also learn to treat shortness of breath using oxygen and sometimes aerosolized medications. The use of medications like albuterol depends on the state or municipality where the EMT operates.
  • Splinting: Certification for EMT was created years before paramedics were developed. The impetus for creating EMTs came from the trend of serious vehicle collisions during the halcyon days of muscle cars in the 1960s. Trauma from car crashes helped develop the training for what were then simply ambulance drivers. Immobilizing fractures was a major part of the curriculum.
  • Bandaging: Along with splinting fractures comes bandaging open wounds. The same mechanisms of injury that break bones also tear open skin and muscle. EMTs need to know how to handle both well.
  • Delivering Babies: Borne out of the simple fact that ambulances get called to women in labor, it was important that they knew what to do when they got there. When it comes to paramedic skills around childbirth, there is very little more that they learn beyond the basics of EMT training.

    These are the basic skills and haven't really changed since EMTs were created. In 1996, a curriculum for training emergency medical technicians (at the time called emergency medical technician-basic) was published by the National Highway Traffic Safety Administration (NHTSA), which makes a little bit of sense when you remember the relationship between EMTs and car accidents.

    There have been a few things added over the years (a new series of emergency medical services training standards was published between 2005-2009), including medications like albuterol, epinephrine, naloxone, and nitroglycerin. A big exception to the "no needles" rule of thumb above is the use of epinephrine and naloxone. Both of these medications are given through injection. In most cases, EMTs use auto-injectors designed for layperson use to administer these medications. The use of medications other than oxygen and orally administered glucose (a very simple sugar given to patients with hypoglycemia) is by no means universal. Wide regional differences exist in both the EMT and the paramedic worlds.

    Becoming EMT Certified

    Every state has its own rules and regulations governing the training and certification of emergency medical technicians. Most follow the National Emergency Medical Services Education Standards published by NHTSA. The standards estimate that training for EMT will take between 150-190 hours. Many states have minimum hours defined in statute. California, for instance, requires a minimum course length of 120 hours for EMT certification, well below the national standard estimate. Programs can take longer than the minimum, of course.

    Once the training course has been successfully completed, the EMT applicant has to pass a certification exam. In all but four states (New York, Wyoming, Illinois, and North Carolina), an applicant will take an exam developed and administered by the National Registry of Emergency Medical Technicians (NREMT). In those states, the exam will be administered by the state and the rules will be different than described here.

    Once the exam is passed, the applicant will be certified by the NREMT. What happens next depends on the state, but typically the newly-minted, NREMT-certified EMT will submit his NREMT certification to the state EMS office for a state license (we won't go into the debate over license versus certification here). The state license and the NREMT certification are good for two years. Renewal is state-specific, and will typically require continuing education hours. Most states don't make an EMT keep his NREMT certification after the initial license is issued.

    EMTs Moving From State to State

    If you have a current NREMT certification, you have the most important part of moving your license from one state to another. Often, however, that's not enough. Plenty of states have additional requirements to complete before you can become licensed, even if you are already nationally certified.

    It's complicated and there's no way to cover all the bases. The best advice is to call the EMS office for the state where you're headed. Get the list of things you need to do and make sure you tick all the boxes.

    What EMTs Don't Learn in School (Usually)

    Emergency medical technicians are taught to handle patients in what amounts to the worst day (possibly the last) of the patient's life. But that's not what most EMTs are going to do when they finally get through the process and climb into an ambulance for the first time. Most EMTs are not going to race through the mean streets with the sirens wailing and the lights flashing, only to snatch a vulnerable patient from the gaping jaws of death just in the nick of time.

    Most EMTs are going to drive that same patient two days later from the hospital where he was transported during the emergency to the hospital where he will finish his recovery. That's the reality of ambulance transportation: most ambulances are not used for emergencies.

    EMT training programs spend little time. if any, teaching EMT candidates the real skills that will make them the most successful during the early years of their careers: compassion, tenderness, and interpersonal communication, just to name a few.

    The emergency skills are absolutely necessary, regardless of whether an EMT is rushing to 911 calls or handling interfacility transfers. Indeed, the sickest patients a new EMT will have under his care are those that he's transporting from hospital to hospital. If something happens during transport, the EMT will be expected to notice and react.

    The skills of reassessment during what is often perceived as "routine" work are not reinforced in typical training programs. EMTs are taught to arrive, assess, treat, transport, rinse, and repeat. They don't usually get any guidance on how to handle patients that need constant monitoring, sometimes for hours during transport.

    To fully prepare EMTs for the real world, it's imperative that we give them the tools for the job they'll really be doing. Like a pilot on a passenger jet, they have to be ready for the unforeseen, but they also have to know how to handle the mundane without being caught off guard.

    Sources:

    Davis CS, Southwell JK, Niehaus VR, Walley AY, Dailey MW. Emergency medical services naloxone access: a national systematic legal review. Acad Emerg Med. 2014 Oct;21(10):1173-7. doi: 10.1111/acem.12485.

    U.S. Department of Transportation/National Highway Traffic Safety Administration. (2009). National Emergency Medical Services Education Standards. Washington, DC.

    U.S. Department of Transportation/National Highway Traffic Safety Administration. (2009). National Emergency Medical Services Education Standards: Emergency Medical Technician Instructional Guidelines. Washington, DC.

    U.S. Department of Transportation/National Highway Traffic Safety Administration. (2005). National EMS Core Content. Washington, DC.

    U.S. Department of Transportation/National Highway Traffic Safety Administration. (2007). The National EMS Scope of Practice Model. Washington, DC.

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