Introduction To The Emergency Medical Service (EMS)

In every city and town across the United States, emergency medical personnel are standing by to deliver life-saving care in the event of a medical emergency or accident. Emergency medical service (EMS) professionals, including EMT-Basics, are dedicated to not only preserving life, but also to improving the quality of life for their patients. The life of an EMS professional is extremely rewarding, but it can also be very challenging and stressful.

EMS professionals must have the ability to remain calm in dangerous situations and think quickly to resolve problems. These abilities are critical to your success as an EMS professional. In addition, every EMS professional must be dedicated to a life of learning. The world of emergency medicine is always changing, requiring EMS professionals to learn new skills and hone the skills they already possess to provide patients with the best care.

Before you ever set foot in the field, you must take and pass a state-approved EMT-Basic course modeled after the National Standard Curriculum developed by the National Highway Traffic Safety Administration (NHTSA). In most states, you’re required to complete between 110 and 150 hours of training in the classroom. After completing the course, you’ll be eligible to take the EMT-Basic exam, and upon successful completion you will receive your certification.

Levels of EMS Certification

The EMT-Basic is just one of several levels of EMS certification.

The basic levels of certification, which may vary from state to state, include the following:

- Certified first responder. Some cities and states provide training programs for first responders. As the name suggests, first responders are often the first emergency personnel to arrive on the scene of an accident or medical emergency. These individuals are trained in basic lifesaving procedures, such as oxygen administration and basic airway maneuvers. Some first responders are also trained in the use of an automated external defibrillator (AED), which is often used in cardiac emergencies.

- Emergency Medical Technician-Basic. EMT-Basics must complete a state-approved course modeled after the national guidelines developed by the NHTSA. During this training, candidates learn how to respond to medical and trauma emergencies. EMT-Basic candidates are trained in airway management, respiratory and cardiac emergencies, and patient assessment. In addition, they learn the basics of scene assessment and technical operations. Most EMT-Basics are trained in assisted medication administration, which requires a basic understanding of pharmacology, anatomy, and physiology. Additional training is sometimes required depending on state guidelines.

- Emergency Medical Technician-Intermediate. The training that EMT-Intermediates receive is similar to the training that EMT-Basics receive, with a few additional courses of study. In addition to the core curriculum, EMT-Intermediates receive training in advanced airway maneuvers, intravenous fluid administration, and medication administration.

- Emergency Medical Technician-Paramedic.

Paramedics are the most highly trained EMS professionals. Like EMT-Basics and EMT-Intermediates, paramedics must take an NHTSA-approved course. However, paramedics must complete about 1,400 hours of clinical training and a field internship before they can receive certification. Their training includes comprehensive knowledge of advanced airway techniques, medication administration, and trauma emergencies.

Many paramedics complete additional training in specialized fields, such as critical-care transport or pediatrics.

EMS Agencies

There are many types of EMS agencies that you can contact for information about employment once you receive your certification.

The different types of EMS agencies that may be available in your region include the following:

- Volunteer agencies. Volunteer agencies are generally made up of concerned citizens who devote their time and skills to serving their communities. In most cases, volunteers do not get paid for their services. However, these agencies will sometimes sponsor people in their EMS training. Many EMTs start their careers at a volunteer agency because it’s a great place to receive hands-on training and gain experience.

- Municipal agencies. Municipal agencies are often organized and supported by a state, city, or town. Often, you’ll need to take a written exam in order to gain employment with one of these agencies. Unlike volunteer agencies, these organizations have the ability to provide EMTs with salaries and certain benefits. There is also the opportunity for career advancement at these agencies.

- Hospital-based agencies. In some cities and towns, hospitals have their own ambulance services that cover specific areas. These agencies are very similar to municipal agencies in terms of the level of care they are able to provide to patients and the various benefits they can offer to employees.

- Proprietary agencies. Proprietary agencies are private EMS agencies that are assigned to a specific hospital or area. These agencies are often contracted by hospitals or municipalities that do not have their own EMS transport systems. Proprietary agencies may also provide specialized services, such as air medical transport.

- Other agencies. Other EMS agencies include first-responder units, air medical transports, and specialty EMS agencies.

First-responder units provide first-responder services to emergency calls in various regions. Air medical transport is often called on during trauma emergencies that require rapid transport to a hospital or specialized facility. Specialty EMS agencies sometimes work on movie and TV sets or provide services for special occasions, such as sporting events.

Before you can start your career in emergency medicine, you must pass the EMT-Basic exam.

Most of the state exams are based on the national exam developed by the National Registry of Emergency Medical Technicians (NREMT). This standardized test is designed to measure your competence in a number of important subject areas. It costs around $70 to take the EMT-Basic exam. This nonrefundable fee is charged every time you attempt to take the test. Candidates have six opportunities to pass the EMT-Basic exam. After failing the first three attempts, the candidate must complete 24 hours of remedial training before taking the test again. The candidate will then have three additional attempts to pass the exam. If the candidate fails to pass the exam during these final three attempts, he or she will be required to take the entire EMT-Basic training course again. The test has between 70 and 120 questions. You will have two hours to complete the exam.

The following chart provides a breakdown of the types of questions that you will most likely see on the EMT-Basic exam:

It is important to remember that your state exam may contain questions that are not included on the NREMT cognitive exam. You should also review the notes from your class and the objectives of the National Standard Curriculum to ensure that you’re prepared for any question that may come up on the exam.

In January 2007 the NREMT changed the format of their test to a computer-based test (CBT). Candidates now take the exam at a computer within a testing facility. The NREMT uses a computer adaptive testing (CAT) method that tailors the exam to each individual.

The system delivers one multiple-choice question at a time. The first few questions help the computer measure the candidate’s abilities. When the candidate answers a question correctly, the computer will select a slightly more difficult follow-up question. When the candidate answers a question incorrectly, the computer will choose a slightly easier question. As the candidate continues to answer questions, the computer determines whether the candidate’s ability meets the passing standard.

Your state may not adhere to the NREMT’s testing guidelines, so it is important to contact your local testing facility for more information. To find out more about certification testing in your area, do a Google search to find the contact information for your state EMS agency.

Your exam results are usually available within a week or two. Candidates taking the NREMT exam can often access their results within 24 to 48 hours of taking the exam on the NREMT Web site. An overall score of 70 is often considered passing. If you don’t meet the passing standard, you can retake the exam. Your local testing facility will provide more information on when you’ll be eligible to retake the test.

Certain state licensing agencies may utilize a scoring system that differs from the one employed by the NREMT. Contact your state’s division of emergency medical services to learn more about the scoring guidelines for certification in your area. Again, you can locate the contact information for your state EMS agency by turning to the appendix.

Preparing for the EMT exam:

Some questions on the EMT-Basic exam assess your knowledge of what do to before you administer patient care. These questions are called preparatory questions, and they assess your knowledge of what to do when you arrive at a scene. They also assess your knowledge of legal and ethical issues as well as your understanding of the different stress-management techniques EMT-Basics employ to stay healthy.
Remember, the test you take may differ from the NREMT exam. This means that you may see questions on state or municipal EMT-Basic exams that include additional questions regarding preparatory topics and other subjects not covered on the NREMT exam.