Emergency medical technician ( EMT ) is a term used in various countries to denote a healthcare provider trained to provide pre-hospital emergency medical services.
The precise meaning of the term varies by jurisdiction, but in many countries EMTs respond to emergency calls, perform certain medical procedures and transport patients to hospital in accordance with protocols and guidelines established by physician medical directors. They may work in an ambulance service (paid or voluntary), as a member of technical rescue teams, or as part of an allied service such as a fire or police department. EMTs are trained to assess a patient's condition, and to perform such emergency medical procedures as are needed to maintain a patent airway with adequate breathing and cardiovascular circulation until the patient can be transferred to an appropriate destination for advanced medical care. Interventions include cardiopulmonary resuscitation, defibrillation, controlling severe external bleeding, preventing shock, body immobilization to prevent spinal damage, and splinting of bone fractures.
Paramedics in Canada
In Canada the scope of practice of Paramedics is described by the National Occupational Competency Profile (NOCP) for Paramedics document developed by the Paramedic Association of Canada . Most providers that work in ambulances will be identified as 'Paramedics'. However, in many cases, the most prevalent level of emergency prehospital care is that which is provided by the Emergency Medical Responder (EMR). This is a level of practice recognized under the National Occupational Competency Profile, although unlike the next 3 successive levels of practice, the EMR is not specifically considered a Paramedic, per se . The high number of EMRs across Canada cannot be ignored as contributing a critical role in the chain of survival, although it is a level of practice that is least comprehensive (clinically speaking), and is also generally not consistent with any medical acts beyond advanced first-aid, with the exception of automated external defibrillation (which is still considered a regulated medical act in most provinices in Canada).
Of considerable relevance to understanding the nature of Canadian Paramedic practice, the reader must appreciate the considerable degree of inter-provincial variation. Although a national consensus (by way of the National Occupational Competency Profile) identifies certain knowledge, skills, and abilities as being most synonymous with a given level of Paramedic practice, each province retains ultimate authority in legislating the actual administration and delivery of emergency medical services within its own borders. For this reason, any discussion of Paramedic Practice in Canada is necessarily broad, and general. Specific regulatory frameworks and questions related to Paramedic practice can only definitively be answered by consulting relevant provincial legislation, although provincial Paramedic Associations may often offer a simpler overview of this topic when it is restricted to a province-by-province basis.
Regulatory frameworks vary from province to province, and include direct government regulation (such as Ontario's method of credentialing its practitioners with the title of A-EMCA, or Advanced Emergency Medical Care Assistant) to professional self-regulating bodies, such as the Alberta College of Paramedics. Though the title of Paramedic is a generic description of a category of practitioners, provincial variability in regulatory methods accounts for ongoing differences in actual titles that are ascribed to different levels of practitioners. For example, the province of Alberta uses the title "Emergency Medical Technician", or 'EMT' for the Primary Care Paramedic and 'Paramedic' only for those qualified as Advanced Care Paramedics Advanced Life Support (ALS) providers - but almost all provinces are gradually moving to adopting the new titles, or have at least recognized the NOCP document as a benchmarking document to permit inter-provincial labour mobility of practitioners, regardless of how titles are specifically regulated within their own provincial systems. In this manner, the confusing myriad of titles and occupational descriptions can at least be discussed using a common language for comparison sake.
Primary care paramedics
Primary care paramedics (PCP) are the entry-level of paramedic practice in Canadian provinces. The scope of practice includes performing semi-automated external defibrillation, interpretation of 4-lead or 12 lead ECG's depending on the area, administration of Symptom Relief Medications for a variety of emergency medical conditions (these include oxygen, epinephrine, glucagon, salbutamol, ASA and nitroglycerine, performing trauma immobilization (including cervical immobilization), and other fundamental basic medical care. Primary Care Paramedics may also receive additional training in order to perform certain skills that are normally in the scope of practice of Advanced Care Paramedics. This is regulated both provincially (by statute) and locally (by the medical director), and ordinarily entails an aspect of medical oversight by a specific body or group of physicians. This is often referred to as Medical Control, or a role played by a base hospital. For example, in the province of Ontario many paramedic services allow Primary Care Paramedics to perform 12-lead ECG interpretation, or initiate intravenous therapy to deliver a few additional medications, such as 50% Dextrose.
Training
Paramedic training in Canada is intense, as paramedics are seen as health professionals, equal in importance to nurses, respiratory therapists, cardiac perfusionists and others. Nevertheless, the nature of training and how it is regulated, like actual paramedic practice, varies from province to province. Training varies regionally, for example, the Primary Care Paramedic training may be three months (British Columbia) to three years (Quebec) in length.
In the United Kingdom
The UK has no legal definition of an emergency medical technician, more frequently called an ambulance technician . There is no legal requirement to have any particular qualification, or indeed, any qualification at all. This is in contrast to the higher paramedic level, which is protected in law, and the inappropriate usage of which title can be prosecuted.
The most widely recognised qualification for a technician is the Institute of Healthcare Development (IHCD, a division of the Edexcel examination board) ambulance technician qualification, which has been used by every NHS ambulance service. It has also been offered by a number of universities as part of a pre-hospital care course.
This qualification generally takes around three months to complete, including three weeks of driver training. It is split into five modules, of which two are driving-related and three focus on clinical care. The higher paramedic qualification involves three additional modules.
There is a move away from the IHCD award, as ambulance services move to employing only university-qualified paramedics and the lower qualified Emergency Care Assistants (based on first aid at work along with emergency driving and basic ambulance skills) or Emergency Care Support Workers who will have the same skills as ECAs but with some additional skills. IHCD will cease to exist late in 2008, and NHS ambulance trusts are considering how to maintain appropriate skills levels.
There are many private companies also offering courses titled as emergency medical technician or ambulance technician, with lengths ranging from a five days to several weeks or other courses such as the Royal College of Surgeons of Edinburgh accredited Pre-Hospital Care Course run by BASICS awarding the Pre-Hospital Emergency Care Certificate . These courses are not recognised by the statutory ambulance services, and any person moving from a private company to the NHS would be required to take an IHCD qualification.
These private service technicians are most likely to work on patient transport work, or as medical cover for public or private events. They may provide contracted work to the statutory ambulance service, usually as second-line support units, although they may in some circumstances, respond to 999 emergency calls.
EMTs in the United States of America
Certification
In the United States, EMTs are certified according to their level of training. Individual states set their own standards of certification (or licensure, in some cases) and all EMT training must meet the minimum requirements as set by the National Highway Traffic Safety Administration's (NHTSA) standards for curriculum. The National Registry of Emergency Medical Technicians (NREMT) is a private organization which offers certification exams based on NHTSA education guidelines. Currently, NREMT exams are used by 46 states as the sole basis for certification at one or more EMT certification levels.
Levels of EMTs
See also: Emergency medical responder levels by U.S. stateThe NHTSA recognizes four levels of EMTs:
- EMT-B (Basic)
- EMT-I/85 (Intermediate)
- EMT-I/99 (Intermediate)
- EMT-P (Paramedic)
Some states also recognize the Advanced Practice or Cr
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