There are many jobs in the medical field which interface with the paramedic and EMS. Some are positions like First Responder and EMT-Basic, while others are medical providers in the Emergency Department where the paramedic transports their patients.
Some of these jobs include:
- First Responder
- EMT-Basic (and sometimes also the EMT-Intermediate or Advanced EMT)
- Respiratory Technician
- Registered Nurse/Licensed Practical Nurse
- Physician and licensed practitioners
A First Responder is a basic level of first aid and medical training, and is a certification level sometimes found in rural departments, though in some regions first responder-level certification is the medical certification for firefighter responders.
An EMT-Basic is a certified medical technician, as is the EMT-Intermediate (sometimes called Advanced EMT). We will revisit them in a moment.
A Respiratory Technician is another certified medial technician, specializing in the treatment of respiratory problems. They are frequently encountered in the emergency department as part of the team treating patients, since they are specialists in this area. Usually, they are responsible for setting up and administering respiratory treatments such as nebulizers, ventilators, and Continuous Positive Airway Pressure (CPAP) treatments.
A Registered Nurse is the RN or Nurse that most people are familiar with. They are licensed by their state to work as nurses, and are the most commonly encountered medical professional by EMS; many patients are picked up by EMS from nursing homes or physician’s offices, and the RN is usually the person transferring the patient to the paramedic, and the RN in the emergency department is the person to whom most paramedics transfer their patients. Licensed Practical Nurses (LPN) are other nurses that are frequently encountered by EMS.
The Physician, Nurse Practitioner (NP), and Physician’s Assistant (PA) are all licensed medical practitioners (people who are licensed to practice medicine). Paramedics sometimes encounter these professionals in clinic settings, and occasionally in the Emergency Department.
All of the various health care professionals are part of a team, a team oriented on treating sick and injured patients. Often, in an emergency department any particular patient will be treated by a physician, at least one RN, at least one patient care technician of some kind (possibly a hospital-based paramedic or EMT), and sometimes also an RT or other specialized technician.
As for the EMT-Basic (often just referred to as an “EMT”) and EMT-Intermediate (sometimes called the “I”, also sometimes known as an Advanced EMT), they are often found staffing ambulances, and in some places most of the ambulances are staffed with two EMTs.
EMT training is approximately 200 hours of classroom and lab time, and is often offered by local community or junior colleges as a one-semester course. EMTs are usually certified first by the NREMT, just like paramedics, and in turn use their NREMT certification to apply for state certification along with a background check.
The EMT skill set includes controlling bleeding, splinting fractures and dislocations, performing CPR, assisting patients with certain medications, and a variety of other medical skills. They are trained to perform patient assessments and gather patient histories, though the training provided for EMTs is not as advanced as that for a paramedic.
The Intermediate or Advanced EMT is often trained to perform certain medical procedures above the level of the Basic, such as intravenous (IV) lines, and often has a small box of medications such as aspirin and nitroglycerin. In some jurisdictions, there are no EMT-I or Advanced EMTs at all, and the only two certification levels are Basic and Paramedic, but others rely on the I to perform in place of paramedics, especially in more rural regions where the nearest paramedic ambulance may be dozens of minutes away.
As noted, some places use two EMTs in an ambulance as their EMS response vehicle, and if the EMTs find a patient who may need more advanced care, they then ask for a paramedic to be dispatched to meet them and take over the care of their patient.
Some places use ambulances that are staffed by one EMT and one paramedic, and other areas use ambulances that are staffed with two paramedics. The exact system in use varies by location, and is sometimes different within the same region or county. When you call 9-1-1, you may get any of the above, depending greatly on where you live.
Fire-based EMS services hire EMT-Basic and Paramedics who are also certified Firefighters, and require them to work on fire apparatus in a fire department. Many jurisdictions around the US operate EMS in this way, with firefighters operating as EMS responders as well as firefighters. Sometimes, these agencies do not staff ambulances which transport patients, instead calling for Private or Third-Service EMS ambulances to transport patients, but sometimes the fire agency is also the EMS ambulance transport agency. Fire-based Paramedics are firefighters, and are expected to operate as part of a fire response, including possibly operating on an engine or ladder apparatus, making entry into active fire scenes, or operating as rapid intervention or rehab for other firefighters. Fire department paramedics usually work 24 hour shifts, in a variety of shift schedules.
The Third-Service EMS is an EMS agency which is municipal in nature, staffed by EMT-Basics and Paramedics who are employed by the state, county, or city where the agency operates, but are not part of the Fire department nor the Police department (thus, EMS would be the Third municipal service, with Police and Fire being the first two). An example of third-service EMS is Austin-Travis County (Texas).
In areas that operate Third-service EMS agencies, Police respond to police/law enforcement matters, such as break-ins, the Fire department responds to fire calls, such as fire alarms sounding, water flow alarms being tripped, or smoke/flames spotted, and the EMS agency responds to medical calls.
Sometimes, the Fire and Police departments are dispatched with EMS. Technical rescue and motor vehicle collisions often result in all three agencies being dispatched: Police for crowd and traffic control as well as accident or criminal scene investigation; Fire for rescue equipment or technical rescue; EMS for patient care and transport. Third service EMS paramedics often work the same shifts and schedules as their Fire or Private EMS counterparts; often 24 hours in shifts.
Private EMS refers to non-government agencies, sometimes for-profit companies and sometimes non-profit agencies, who operate ambulance services in the local EMS system. Some nationally-recognized private for-profit EMS agencies include American Medical Response (AMR), Rural/Metro Ambulance, and Air Methods. These agencies are often businesses, and are operated as such.
Some areas operate with private ambulance companies as both EMS and interfacility transport ambulance agencies, and some with private ambulance companies only in one role or the other, and some with multiple private ambulance companies performing several roles.
Private ambulance company paramedics are trained to, and required to maintain their certifications at the same level as other paramedics in their region. Many hospital ambulance services are included in this category (since many hospitals are private enterprises). Many private EMS agencies offer a wide variety of shifts, from 8-hour five-day-per-week shifts to 24-hour shifts. Most commonly, 12- and 24-hour shifts are seen. Private EMS agencies that operate 9-1-1 ambulances are usually staffing ambulances on shifts that match the fire departments with which they are teamed.
Not all paramedics work on ambulances or in fire trucks. Some hospitals use paramedics as technicians in their Emergency departments, and sometimes in other floors in the hospital.
Paramedics who work in these settings are often directly supervised by their physician, although not always with the physician immediately in the room with them. Paramedics who work in the hospitals generally have the same scope-of-practice as their ambulance-based counterparts, though this varies. Hospital shifts for paramedics tend to be the same as for the physician and nursing staff, typically lasting 12 or 12.5 hours per shift, three or four shifts per week.
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