EMS is a challenging field. It ranks among the most stressful jobs a person can undertake. You will be with people on the worst day of their lives. An EMT will see a person die, or find someone recently passed. They will see people at their worst. They will have to deal with people in pain, and people just looking for a drug fix or people that have had too much of a fix. EMS is also one of the more dangerous career choices as well. It would be a disservice to sugarcoat the job. However, EMS is a vital job and without it, many people, sick and injured, would not make it to the hospital. Let’s explore what EMS is and why you should consider joining this career field.
A Brief History of EMS
The concept of rapid prehospital transport actually gets its start during the Napoleonic wars. Napoleon Bonaparte’s chief surgeon Jean Larrey began a rapid transport service to transport wounded soldiers from a battlefield. Before Larry, wounded soldiers would not be picked up till after hostilities between forces ceased. Most of the time these soldiers would already be dead or were near death by the time they were found. In 1796 the first ambulances were humble little horse-drawn carriages that picked up the wounded while the fighting was still raging. This invention lowered to the mortality rate of wounded soldiers who would have otherwise died on the battlefield.
Civilian Ambulances were first used in 1832. London had an epidemic of cholera, due to polluted water. They used horse-drawn carriages to transport the sick to hospitals so they could receive proper care. The difference here is that the physician would begin to render care before the patient reached the hospital. Prehospital care started in the cholera-ridden streets of London. Before these carriages, most of the medical cure would be handled by the family.
The doctor would visit the house and leave them there after instructing the family on how to care for the sick. Many people in London did not have transport to get to a hospital. After 1832, with the advent of these civilian ambulances, patients not only could be transported to a facility more suited to their care but also could begin treatment while the patient was being transported.
The first modern hospital-based services began in Ohio. These were crewed carriages that responded to a variety of medical issues. These carriages would carry the equipment of contemporary medicine of the time. As society changed and the automobile was introduced so did the level and efficiency of care. 1960 marked the year that EMS services began to fully resemble what people think of today in regards to ambulances and EMS.
During this year the modern EMT began to surface. Before the 60’s EMS providers would splint, bandage, and mostly take care of a traumatic injury or rapidly transport patients to a hospital. EMT’s gained access to CPR and defibrillators as well as medical interventions that they could use before they transported the patient. It was the time where we can safely say that prehospital care became a standard of care.
The White Paper in 1971 set the groundwork for the modern ambulance systems and the EMS standard of care. The federal EMS protocols and requirements are a direct result of the White Paper. Before this standardization there was unregulated. Any vehicle with four wheels could be an ambulance. The standard created, not only detailed how emergency medical personnel should be instructed, but also laid the foundation that detailed how ambulances should be constructed and how they should be stocked. Eventually leading up the mobile emergency rooms they are today.
Different Levels of EMS
EMS is structured into tiers. Each level of pre-hospital care has different requirements, roles, responsibilities, and liability. We will go over Medical Liability and Neglect in a different post. The levels of EMS are the Medical First Responder, The EMT-B, The AEMT, and the Paramedic or EMT-P. There special certifications that a Paramedic can gain after they reach this level to further enhance their scopes of practice such as CCT or Critical Care Transport. The rules and regulations for training vary State by State, as does what level of EMS Provider are accepted in that state. Be sure to check your state’s requirements.
The Medical First Responder
The Medical First Responder or MFR is the lowest level of licensure in the EMS system. These providers know the very basics of Prehospital care such as: CPR, Automatic External Defibrillator (AED) use, and bandaging and splinting. However, that is the extent of their medical knowledge and the most common MFR’s are police, firefighters, lifeguards, etc.
The Emergency Medical Technician Basic or EMT-B
The EMT-B makes up the vast majority of Emergency Medical Technicians. These medical professionals work on ambulances and can be found in public and private sectors. EMT-B’s are not only skilled in CPR, AEDs, and Wound Care, but are also taught Anatomy and Physiology and learn how Oxygen therapy works and have the ability to administer O2. Depending on the state’s protocols they are also skilled in a variety of pre-hospital skills such as IV administration and in some cases even endotracheal intubation. In most states, however, IV’s and ET Intubation are regulated to the more advanced license levels. EMT’s at this level are also expected to have a working knowledge of common medical problems and be able to identify would possibly be wrong and how to treat the patient both traumatically and medically.
The Advanced EMT or AEMT
This level of EMT is a middle ground between the Basic and Paramedic level EMTs. At this level, the AEMT receives additional training and it is usually this level of EMT that is taught and allowed to start IOs, IV, administer CPAP, certain prehospital medications and other advanced techniques. The AEMT commonly works alongside the Paramedic and has a working knowledge of Paramedicine. Anatomy and Physiology are reinforced. An AEMT usually works under the direction of his or her paramedic partner. They Possess all of the skill sets of the lower level EMS personnel as well.
The Paramedic or EMT-P
The Paramedic is the highest level of license in the EMS system. The EMT-P is trained beyond the lower levels and has skills that include but are not limited to: IV, IO, Cardiac Monitoring, Medicine Administration, ACLS Protocols, PALS, Advanced Airways like Endotracheal Intubation. They have their working knowledge of Anatomy and Physiology reinforced and begin looking at the body at a cellular level. They are taught some surgical interventions like a cricothyrotomy as a last ditch effort to gain an airway or a pericardiocentesis in cases of pericardial tamponade. A Paramedic has the ability to stabilize patients before transport and can perform many of the same functions an ER can but in the back of an Ambulance. Protocols vary from state to state as does the level of care a Paramedic can give.
Why Should You Become an EMT?
Emergency Medical Services is a demanding career field. It is high stress and dangerous. EMTs see people at their worst. They deal with blood and gore, fractures and pain. They deal with the suicidal and the drug user. EMS personnel are on the front lines and the job can be unforgiving. You will work long hours, and not receive the best pay. So why then would a person choose to be an EMT? There are several reasons. The first and most common reason people chose to enter EMS is that they feel it is a calling.
EMS is not just a job or a career choice it is a lifestyle. EMS personnel are some of the most caring people in the medical field. Most enter with a genuine interest in helping people. One of my old station managers told me one time that he “Did not want people to get hurt or have a heart attack, but wanted to be there when they did. Because someone has to.” This statement stuck with me for the 10 years I have been involved in the EMS field.
Without EMTs and Paramedics, the mortality rate of the sick and injured would be a lot higher than it is now. Remember the reason Jean Larrey started transporting the wounded in the 1700s, Rapid medical intervention improves the patient outlook. The sooner a trained EMT can render aid the better chance that the patient has in not only surviving but returning to a normal life. An EMT will deal with a lot of bullshit, let’s be frank, a good number of calls are for nonemergent problems that should be seen at a doctor’s office and not an ER.
However, it’s the emergent cases, the first time a patient says thank you and the knowledge that you made a difference in a person’s life that are the reasons why EMS is such rewarding field. Another reason why you should enter the field of EMS is that emergency medical service jobs are great entry points into the medical job field. Many EMT’s and Paramedics go on to become Firefighters. In fact, many cities require their firefighters to be trained as EMTs or even as Paramedics to even land a full-time job in a city department.
Another job field that many EMTs and Paramedics can move into is becoming a registered nurse or RN. There are college programs that offer a Paramedic to RN bridge course. The flight is another option. Flight Nurses typically also have to be flight Paramedics. Physician Assistant programs typically require some form of medical experience in order to gain entry into the course, many of them prefer that experience come from being EMS. Other jobs that EMS can lead to include: Public Safety Officer, SWAT Medic, ER Tech, ER Paramedic, Home Health Care, as well as overseas opportunities.
EMS Job Outlook
No one can deny that landing a steady and durable job is a challenge in today’s economy. The medical field is a very durable field. People are always getting sick and people are always getting injured. According to the the Bureau of Labor and Statistics the field of EMS is expected to grow more than any other occupation and more than any health field job. This will be an increase of 24% between 2014 and 2024. The average median pay as of 2014 is $32,000 or about $15.24 an hour. I should mention that EMS is one of the few fields that tend to offer unlimited overtime so an EMT or Paramedic has the potential to make much more than this median pay if Overtime is accounted for.
Emergency Medical Services is a rewarding but difficult medical field. However, the job itself presents opportunities that few other fields can. Where else can a person be involved with other people on a daily basis at a level where they have the opportunity to make a positive impact on their lives. The EMS field offers an entry point into the medical field. Firefighters require EMS, PA programs require medical experience to take the class and prefer EMS. Not to mention the EMS culture. Being a first responder is joining a society of people that sacrifice much so others can live.