The world of public safety has no shortage of acronyms. EMS and EMT are prime examples of two common terms used by both the general public and those in the service provider professions. It would be more accurate to refer to these two sets of letters as initialisms rather than acronyms as they are not pronounced as words. Regardless, the first two letters of each represent the words, emergency medical. It is the conclusion of the terms which set them apart and identify one as an individual and the other as an organizational structure.
What is an EMT?
Once referred to as ambulance attendants, the position of emergency medical technician (EMT) has evolved from a job to an occupation to a profession. However, the journey to earning respect as a specialist in emergency medical care did not happen quickly. Before the title and certification of EMT, those in the role of transporting the injured to the hospital had little to do with the patient’s treatment. While the human quality of compassion was common among early 911 dispatch calls and ambulance attendants, medical training was rarely provided.
Eventually, first-aid training and equipment became standard in large cities. Later, states began to require more advanced knowledge of emergency medical care in the field and certifications developed. Today, all jurisdictions in the United States mandate a training curriculum for EMTs to become certified, a necessity to work in the profession.
EMT certifications vary by state, but most share some universal criteria. For instance, there is almost always a classroom portion of the course, usually 300-500 contact hours within a standard academic semester. Additionally, EMT students are often required to complete a form of on the job training, sometimes referred to as a clinical, in hospital emergency rooms, and riding with ambulance or fire/rescue personnel.
After classroom and clinical training, students must complete a state-specific exam to become certified and employed as an EMT. There is also an optional national certification exam available once someone has completed their state’s licensing requirements. Additionally, EMTs must be periodically recertified to maintain their license. While recertification will vary by state, it is usually required every three to five years and achieved through a continuing education and training process.
Employment as an EMT
Once someone has earned their certification, they can begin working as a licensed EMT. Two of the most common employers of EMTs are ambulance services and fire departments. It is often within these organizations where EMTs receive additional training on emergency vehicle operations and agency-specific policies and procedures.
Both ambulance and rescue crews from the fire service often utilize two-person units for emergency responses. Upon arrival at a scene, both EMTs will quickly assess the area for safety concerns and determine proper vehicle placement. They will then turn their focus to patient care and administer anything from basic first aid to CPR to delivering a child. For patients being transported to the hospital, one EMT will drive while the other rides in the back of the ambulance and continues to provide medical treatment.
There are also several specialty assignments available for EMTs, usually requiring several years of experience on an ambulance or fire/rescue truck. One of the most coveted positions is that of an EMT on a helicopter. Essentially an air-ambulance, these medically equipped helicopters respond to incidents where patients have experienced severe trauma and other life-threatening medical emergencies. Helicopter crews work in conjunction with EMTs, firefighters, and law enforcement officers on the ground to coordinate a rapid response and transport those in dire need of emergency medical treatment.
It is not unusual to find EMT certification requirements for those employed in the specialty occupation of the ski patrol. Tasked with rescuing injured, lost, or stranded skiers, EMTs assigned to the ski patrol trade a traditional ambulance and work boots for a snowmobile and skis. On what might be considered the other extreme in emergency rescue, ocean lifeguards are often certified as EMTs and bring their skills to saving lives in and around the water. EMTs may also find employment opportunities in places such as hospitals, medical clinics, theme parks, and airports.
What is EMS?
Born from a combination of the previously mentioned ambulance attendants and fire departments, emergency medical services (EMS) has evolved into a vital multidisciplinary partnership of organizations. Unlike a particular agency, EMS can be a combination of public entities, private business or medical practices, non-profit groups, or volunteer organizations. Further, EMS is rarely restricted by geopolitical boundaries in that the combination of involved institutions frequently represent city, county, state, private, and other non-governmental organizations.
The most common initiator of EMS is the 911 call. Emergency dispatchers represent the starting point for the rest of the complex but efficient system of providing emergency medical care. Some 911 call takers are trained in emergency medical dispatching (EMD), allowing them to give instructions to callers on how to care for patients. Sometimes referred to pre-arrival instructions, dispatchers using EMD can direct callers on everything from clearing an obstructed airway to stopping a hemorrhage to treating for shock.
The next phase of patient care within EMS is usually the EMTs arriving on an ambulance or fire truck. As mentioned, treatment begins on the scene of the medical emergency and continues during transportation to the hospital. Depending on the jurisdiction, fire rescue personnel may be from a different agency than EMTs on an ambulance. Additionally, it is not uncommon for medical helicopter crews to represent a completely different organization, often from another city or county.
Once a patient arrives at the hospital, the next segment of the EMS team takes over. Doctors, nurses, and other caregivers are briefed by arriving EMTs. The ambulance crew provides the nature of the injury or medical emergency, the treatment given so far, any known medications or medical history, and other pertinent information. As doctors in some emergency departments are employed in either private practice or by a third party, separate from the hospital itself, this represents another example of the varying partnerships in EMS.
The emergency medical system serves as a model of how multiple organizations can accomplish a shared goal. In other areas of society, bringing a multifaceted approach to problem-solving can be met with resistance. Each entity has its own rules, policies, boundaries, certifications, and other processes to dictate its function. Yet, somehow, EMS has largely overcome individual organizational obstacles and continues to effectively and efficiently go about the crucial mission of saving lives.