National Registry Paramedic Exam: Career Opportunities in EMS

After graduating as a paramedic, the next step is to decide where and for whom you want to work. Because of the dynamic nature of individual state regulations, providing intricate information on how to be certified or licensed in each state is next to impossible. Appendix A lists contact information for each state, along with its website. It will guide you in the process as outlined by each entity when it comes to reciprocity, certification, and licensure.

CERTIFICATION VERSUS LICENSURE
Summarized from the National Association of Emergency Medical Technicians:
Although some EMS agencies continue to use the terms certification and licensure interchangeably, there are important functional distinctions between the two. The federal government has defined “certification” as the process by which a nongovernmental organization grants recognition to an individual who has met predetermined qualifications specified by that organization. Similarly, the National Commission for Certifying Agencies has recently defined certification as “a process, often voluntary, by which individuals who have demonstrated the level of knowledge and skill required in the profession, occupation, role, or skill are identified to the public and other stakeholders.”

There are three hallmarks of certification; certification is

1. a voluntary process.

2. by a private organization.

3. for the purpose of providing the public information on those individuals who have successfully completed the certification process (usually entailing successful completion of educational and testing requirements) and demonstrated their ability to perform their profession competently.

Nearly every medical profession certifies its members in some way. Private certifying boards certify physician specialists. Although certification may assist a physician in obtaining hospital privileges or participating as a preferred provider within a health insurer’s network, it does not affect his or her legal authority to practice medicine. Licensure, on the other hand, is the state’s grant of legal authority, pursuant to the state’s police powers, to practice a profession within a designated scope of practice.

Under the licensure system, states define, by statute, the tasks and function or scope of practice of a profession and provide that these tasks may be legally performed only by those who are licensed. As such, licensure prohibits anyone who is not licensed from practicing the profession, regardless of whether the individual has been certified by a private organization.

For example, a surgeon can practice medicine in any state in which he or she is licensed regardless of certification by the American Board of Surgery. Confusion between the terms “certification” and “licensure” arises because many states call their licensure processes “certification,” particularly when they incorporate the standards and requirements of private certifying bodies in their licensing statutes and require that an individual be certified in order to have state authorization to practice. For example, the use of “certification” by the National Registry of Emergency Medical Technicians by some states as a basis for granting individuals the right to practice as EMTs and calling the authorization granted “certification” is an example of this practice.

Regardless of what descriptive title is used by a state agency, if an occupation has a defined statutory or regulatory scope of practice and only individuals authorized by the state can perform those functions and activities, the authorized individuals are licensed. It does not matter if the authorization is called something other than a license; the authorization has the legal effect of a license. The various state offices of EMS or like agencies serve as the state licensing agencies.

Career path for EMS
When you started EMS, you might have thought this would be a good way to give back to the community or make some extra money; however, over the last year, you have been seriously considering a career in EMS. I mean, what the heck, you just finished paramedic school. As you look through your training history, it becomes apparent that in order to make a career out of EMS, you need to take some very important steps. What courses do you take first? What direction would you like your career to take? What path is the most appropriate for you?
The good news is that at any time during your EMS career, you can change the focus of your studies without having to take steps backward. For example, if you start out being a career paramedic and want to get into EMS management, a few classes can help you achieve that goal. The reverse is also true.

The following five tips may help you choose or switch your current career path:

1. Continue your education—I can’t say enough about furthering your education. The more credentials, classes, and continuing medical education credits you earn, the more marketable you will be. When going to national or state conferences, choose tracks that best fit with your overall career goals. If you are currently an EMT and think you might be interested in becoming a paramedic, take a few of the courses listed in the Advanced Life Support (ALS) track. Likewise, most EMS conferences now feature management courses; expand your knowledge by attending one of these. In addition to conferences, seek out EMS courses that offer college credit, certificates, or degrees.
2. Plan your career—Take time to plan your career. Goal-setting is a skill that takes time to develop. Whether you choose the operations route, management, or even being an EMS educator, you need to set goals for yourself. Start with small, attainable goals like completing a paramedic course or completing an associate’s degree in business management. Your small goals should add up and feed into your big-picture goal. Preplanning will help steer the direction of your education and provide milestones and checkpoints for your professional achievements.
3. Be flexible—Keep an open mind to changes in your goal-setting process. Know when to push through and when to reevaluate your situation. There really are no hard and fast rules about when to evaluate how well your process is going; however, as discussed in the last section, you will reach milestones throughout your path. At those times, it is a good idea to take a step back and look at how well your plan is working. Don’t be afraid to change direction. There are many opportunities from operations (EMT/paramedic/line supervisor) to management (training/middle management/human resources/billing) that you may have not considered.
4. Try different organizations—Within the scope of paramedicine, individual organizations perform general EMS functions differently. Agencies have different policies and procedures that differentiate them. Try commercial EMS agencies and volunteer or mixed organizations to gain as much knowledge in operations as possible. This will become particularly important if your career path steers you toward management.
5. Find a mentor—Mentors are an important part of career success. We don’t put enough emphasis on finding people to guide us through our careers. A seasoned paramedic can provide a world of guidance to a new EMT. Similarly, an experienced EMS manager can assist newer supervisors in gaining necessary skills. How do you know what you are getting into? Trying to navigate EMS systems can be intimidating, even for personnel who have been around for a while. Imagine what it’s like to be starting out in a new system. Mentors will not only teach you how to take a blood pressure correctly, they will show you why you are taking a specific action. When you hit a crossroad between management and operations career paths, a mentor can help you ask the right questions to make a wise decision.

Your career will take many turns over time, and there will be plenty of opportunities if you position yourself along the way. Two important things to remember about planning your career: It is never too late to change, and always keep an open mind. EMS is a growing profession and things continue to change. Stay in tune through education, and find a mentor to help guide you. If you really want a career in EMS, go after it. This is an exciting time to be part of a changing environment.

SPECIFIC CAREER CHOICES IN EMS AS A PARAMEDIC
The field is shifting away from volunteer services toward paid professionals as the population grows and becomes more urbanized; job growth through 2012 is projected to be faster than normal. As the baby boomers age, they will require more medical services, spurring more demand for EMTs and paramedics. Additional job openings will come through attrition and stressful conditions. Volunteer and part-time jobs will be available among more rural populations.

A list of common EMS job sites is listed at the end.

FLIGHT PARAMEDIC
Working as a flight paramedic can be very rewarding. Even though you might have the chance to work as a flight paramedic right out of school, it usually takes hard work, experience, and education to land a job as a flight paramedic. Some facts about a career as a flight paramedic: There are approximately 1200 flight paramedics in the United States. To illustrate how competitive the field is, for every opening for flight paramedic, there are approximately 250 applicants. There are approximately 227 air ambulance programs in the United States. Most programs are hospital based, flying out of urban areas, and staff their helicopters with a nurse and a flight paramedic, although some use a physician and a nurse, reserving their paramedic for ground transport duties when the helicopter is grounded for weather, preventive maintenance, or other reasons.

Typical Duties of Flight Paramedics
One of the most important duties of a flight paramedic is to keep up with education. Usually, the person chosen for a flight paramedic position will already be highly trained. Most air ambulance services look for someone who came from a busy ambulance service. On top of that, they look for people who have a high degree of training. National Registry Paramedic is usually a required certification. Flight programs give great weight to those that hold instructor certifications in Advanced Cardiac Life Support (ACLS), Basic Trauma Life Support (BTLS), Pre-Hospital Trauma Life Support (PHTLS), and Pediatric Trauma Life Support (PTLS). Once on the job as a flight paramedic, your organization may require you, besides your usual requirements for continuing education, to further your education.

Another requirement of the job, not only during the interview process, but after being hired as well, is the upkeep of a professional appearance. Remember, you will be the face of the organization that you represent. You will be interacting with patients, families, other emergency professionals, doctors, and nurses. You will also be expected to assist with patient care. This can be as simple as obtaining vital signs to administering medications. This is why organizations that hire flight paramedics place such an emphasis on education, both before employment and after employment. Not only are well-educated paramedics more likely to be hired as flight paramedics, but after being hired, they are less likely to make a mistake that could jeopardize a patient. You will be expected to be an important part of the patient care team.

Typical Requirements for a Flight Paramedic
According to the International Association of Flight Paramedics, the typical requirements for a flight paramedic are as follows:

National Registry as a paramedic
Instructor certification in ACLS, BTLS, PHTLS, Pediatric Advanced Life Support (PALS)
Experience in a high-volume 911 system
Experience in interfacility transport of critical care patients
Emergency department or hospital intensive care unit experience
Being well-read and up-to-date on current research and treatments
To find out more information, go to the International Association of Flight Paramedics website at http://flightparamedic.org/ or http://bcctpc.org/.

CRITICAL CARE PARAMEDIC
The critical care paramedic (CCP) is expected to perform thorough assessments that include the interpretation of patient laboratory and radiological data. This advanced care usually involves transporting critically ill or injured patients from one hospital to another. CCPs’ high level of decision-making and differential skills relating to patient care results in their implementing treatment measures both autonomously and after consultation with physicians.

Typical Duties of the Critical Care Paramedic
Typical duties identified in the CCP competency profile include the use of invasive hemodynamic monitoring devices and advanced techniques to manage life-threatening problems affecting patient airway, breathing, and circulation. Included is the use of ventilatory support equipment, intra-aortic balloon pumps, left ventricular assist devices, and in neonatal care, Isolette’s. CCPs typically implement treatment measures that are invasive or pharmacological in nature.

TACTICAL PARAMEDIC
Specially trained tactical medicine teams often support high-risk law-enforcement operations by providing scene commanders with medical threat assessments, delivering immediate emergency medical care, and promoting the safety and health of law-enforcement personnel. Tactically trained EMS personnel achieve their objectives through mission preplanning, implementation of medically effective practices developed for law-enforcement scenarios, and provision of a critical interface between law enforcement personnel, EMS, and the emergency healthcare system.

Typical Duties of the Tactical Paramedic
The goals of tactical medicine are, broadly, to facilitate the success and the safety of law-enforcement missions during all phases of a tactical or SWAT operation through the delivery of preventive, urgent, and emergency medical care. The principles that are held by tactical medicine providers were initially developed by the military for small unit operations and continued to gain widespread acceptance in the civilian law-enforcement community. Their primary function during a mission is to provide broad medical oversight to operations including injury prevention, resource allocation, and rapid access to emergency medical care within the operation. During law-enforcement operations, medical activities and casualty movements are a coordinated effort between the command post, operational team leaders, and the medical support element.

A fundamental principle in tactical medicine is that the medical mission may be subordinate to the overall law-enforcement mission. In contrast to conventional EMS and hospital practices, in which the sole priority is usually the health and welfare of the patient, the essential priority in a tactical mission is the success of the law-enforcement objective. When a casualty occurs during a tactical operation, medical providers may be directed to delay or modify medical care until the tactical commander determines that rendering care will not jeopardize the overall mission.

The three goals of tactical combat casualty care are as follows:

1. Treat casualties

2. Prevent additional casualties

3. Complete the mission

The role of the tactical medic is to support the law-enforcement mission. Usually when a SWAT team takes a hit from the bad guys, more than one team member is wounded. Tactical medics care for the downed team members, the police, citizen victim, and the bad guys, too. In applying combat medicine triaging—the sorting of victims according to a system of priorities—the police are treated first because they are not a threat. Officers also have a higher survival rate because they wear body armor.

In addition to training with SWAT and going out on call-outs as members of the tactical team, tactical medics may go through weeks of basic SWAT school, a time filled with bumps, bruises, painful muscles and joints, and wagonloads of challenging stress.
Police Tactical School is not blood-in-the-mud medic training. (“Blood in the mud” refers to military combat medicine, the basis for fire and rescue tactical medicine.) Rather, tactical school is about police tactics, athletics, conquering phobias, defense and control tactics, and learning the ways of the tactical hunters, and it may include the mechanics of superior marksmanship using shotguns, handguns, automatic weapons, and less lethal launchers. Some of the tactical skills taught date back to the ancient Roman legions, whereas others are new-era tactics that use technology and unconventional ground-combat strategies.

Paramedics are transformed by the tactical school experience. Although these specialty team medics normally aren’t armed with weapons, they must be proficient in their use to save their own lives or those of others. U.S. Army and Navy medics are taught to use various firearms because enemies have engaged medics and the wounded in calculated patterns of combat, targeting them with extreme acts that ignore the generally accepted codes of conventional warfare. Civilian tactical medic skills mirror those of the military. Teams do not go into situations planning that their medics will be potential shooters, but in real combat, the patterns of evolving situations are subject to change. SWAT teams are law enforcement’s bedrock infantry and special operations’ response to many bad situations. SWAT teams can and do save lives, prevent further violence, and bring the majority of such incidents to a peaceful conclusion.

A tactical rescue technician course prepares medics for typical scenarios. Simply transferring civilian medical care methods to the “battlefield” won’t work. Tactical situations call for different medical protocols than those expected by a conventional paramedic. For example, controlling direct pressure and IV fluid applications may not be as relevant while under fire. Popular thinking also maintains that if a tourniquet is used, the patient will lose the limb. However, in reality, the most common cause of preventable combat or battlefield death has been the failure to use a tourniquet to control severe extremity bleeding. The loss of 2.5 liters of blood is likely to be associated with death from hemorrhagic shock. Indicators of shock during tactical care are the patient’s state of consciousness and quality of radial pulse. Also, in combat casualty situations with open wounds, the sooner antibiotics are on board, the better. If you think you have what it takes, become a tactical paramedic.

OFFSHORE PARAMEDIC
An offshore paramedic provides emergency medical services on an offshore rig. The primary duty of an offshore paramedic is to provide first aid services to rig workers who sustain injuries, are involved in an accident, or become sick. Thus, a person must have adequate medical qualifications to become an offshore paramedic.
 

Typical Requirements
An offshore paramedic is required to hold numerous medical qualifications. The minimum requirement is usually a degree in paramedical science. This is a certificate normally issued by a state or national governing body or licensing board. Training as a military paramedic also may be acceptable. Generally, the maritime authority responsible for hiring makes the determination on a case-by-case basis regarding whether you have sufficient experience.
The “rig” medic is an essential part of an offshore rig and provides emergency medical care for all personnel, along with other various occupational health tasks. They are responsible for the provision of the rig’s primary first aid response. The rig medic reports directly to the Offshore Installation Manager (OIM)/captain and chief officer.

The rig medic provides the following services and has the following responsibilities:
Provide trauma and medical care to injured and sick personnel on the rig
Operate and maintain the rig hospital, medical supplies, and medical equipment
Ensure that all hospital and emergency medical equipment is serviceable and rectify any deficiencies
Ensure the hospital and related areas are clean
Communicate with local and/or international shore-based medical facilities as required
Communicate with OIM/captain and safety officer with respect to injury and sickness reporting
Advise departmental supervisors of injuries or sicknesses that involve their respective departments
Advise OIM/master when a medical emergency evacuation of injured or sick crew member is required

DIVE PARAMEDIC TECHNICIAN
Commercial, professional, and scientific divers often find themselves at work in medical and geographic isolation. Medical evacuation of injured divers can be complicated by long distances and large bodies of water. This process may be further complicated by access difficulties, such as no runway and limited helicopter landing capabilities. Further, decompression accidents require immediate recompression. Delays in definitive treatment can result in fatal outcome, permanent neurological injury, or other career-ending complications.

Therefore, it is common to find hyperbaric recompression chambers located at the working diver’s site of operation. Chambers can be aboard offshore drilling rigs, on oil and gas production platform support vessels, on research vessels, and at shore-based island marine science facilities. Treatment guidance will be directed medically by a contracted physician trained in diving medicine. However, it is uncommon for this physician to be in close proximity to the chamber and ready to evaluate the diver and accompany him or her during treatment. Rather, the contracted physician may be many hundred to several thousand miles away. To be therapeutically effective, therefore, an on-scene specialized medical presence is essential. A certified Dive Medic Technician (DMT), essentially a “diving” paramedic, represents the best option. Specialized training is necessary in order for these medics to function effectively as the eyes, hands, and ears of the diving medicine physician. Training is extended to invasive skills in order to administer physician-ordered adjunctive interventions and manage complications related to decompression insults and barotrauma.

USEFUL WEBSITES FOR FINDING AVAILABLE CAREERS IN EMS
https://www.nremt.org/
www.jems.com
http://www.emsworld.com/
http://www.firerescue1.com/
http://emsjobs.com/
www.ems1.com