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Brief History

  • Before the implementation of emergency care, a transportation-only service provided by the local funeral home was responsible for delivering patients to hospitals.
  • The Highway Safety Act (1966) established a program that included emergency services. The Department of Transportation led the development of the EMS through its National Highway Traffic Safety Administration (NHTSA).
  • The National Registry of Emergency Medical Technicians (NREMT) was founded (1970)
  • The EMS (Emergency Medical Services) System Act (1973) funded the administration, training, and hiring for the EMS system.
  • The NREMT published the National Emergency Medical Services Education and Practice Blueprint (1993) which guided the development of a uniform national curriculum.
  • The National EMS Scope of Practice Model defined four levels of EMS licensure: EMR (Emergency Medical Responder), EMT (Emergency Medical Technician), AEMT (Advanced EMT) and Paramedic.

Levels of Licensure

  • EMR (Emergency Medical Responder): First Responders in an emergency. Trained to manage immediate care of an emergency. Skills include airway management, bleeding control, CPR and AED (automated external defibrillation), and scene control. Many civilians, who are likely to be first to arrive in an emergency, such as police officers, firefighters, volunteers, are often trained as a first responder.
  • EMT (Emergency Medical Technician): Used to be called EMT-Basic. In addition to the skills of a first responder, the EMT provides transportation and more advanced medical care using the facilities in an ambulance. The role of the EMT is to stabilize the patient's conditions until arrival at the hospital, where treatment will be provided.
  • AEMT (Advanced EMT): Used to be called EMT-Intermediate. In addition to the skills of an EMT, the AEMT can administer much more medications. These include both oral and intravenous medications.
  • Paramedic: The paramedic provides the highest level of pre-hospital care. These include advanced interventions, administering a wide variety of medications, and advanced life support.

EMT Responsibilities

  • BSI (Body Substance Isolation) Scene Safe: Before entering any scene, always make sure that you are not placing yourself or your crew in danger. BSI (Body Substance Isolation) Scene Safe is a good pneumonic to verbalize before any practical test. It show you are properly shielded from infectious material by wearing gloves and that you have checked to make sure the scene is safe. Safety is a critical criterion for the passing of any practical exam.
  • Patient Assessment and Emergency Care: Assess and evaluate the patient, recognize the problem at hand, and provide interventions to stabilize the condition. Patient assessment is a large section of the EMT curriculum and will be discussed more in the appropriate section.
  • Safe Lifting and Moving: Transportation of the patient from the scene of accident to the ambulance.
  • Transport and Transfer of Care: Involves ongoing assessment and intervention while driving the ambulance to the nearest hospital, where care will be transferred.
  • Documentation: Complete the PCR (pre-hospital care report) carefully for incident. This will ensure that you have the proper documentation for legal issues. A copy of the PCR will be included in both the patient's medical record and the EMS system's permanent record.
  • Patient Advocacy: Be supportive of the patient at all times and protect the patient's confidentiality. Patient confidentiality is an important legal issue that will be discussed in a later section.
  • QI (Quality Improvement): Also called CQI (Continuous QI) is a system of reviews that audits the EMS that maintains the quality of care. To ensure a high quality of service, the EMT is to document carefully, participate in review and feedback programs, maintain the functionality of equipments, and participate in education programs.
  • Medical oversight: Lastly, keep in mind that EMTs are the extended arms of a doctor called the medical director, who is in charge of and legally responsible for clinical aspects of the EMS system under his or her authority. Everything an EMT does follow medical direction. This includes off-line medical direction (standing orders) that the EMT can use without contact the doctor and on-line medical direction where the EMT communicates with the doctor. As long as an EMT follows medical direction, he or she is not legally held responsible for medical consequences.

Access to the System

  • 9-1-1: The universal number used to access emergency services, including police, fire, and EMS.
  • E-9-1-1: Enhanced 9-1-1. An advanced emergency call tracking system that displays the caller's number and location automatically. Provides automatic number identification (ANI) and automatic location identification (ALI) used to track incoming emergency calls.