emergency medical technician

EMTs are exposed to a variety of hazards such as lifting patients and equipment, treating those with infectious disease, handling hazardous substances, and transportation via ground or air vehicles. Employers can prevent occupational illness or injury by providing safe patient handling equipment, implementing a training program to educate EMTs on job hazards, and supplying PPE such as respirators, gloves, and isolation gowns when dealing with biological hazards.{{Cite journal|date=July 2017|website=The National Institute for Occupational Safety and Health |publisher=United States Department of Health and Human Services, Centers for Disease Control and Prevention|title=Emergency Medical Services Workers: How Employers Can Prevent Injuries and Exposures|url=https://www.cdc.gov/niosh/docs/2017-194/default.html|language=en-us|doi=10.26616/NIOSHPUB2017194|doi-access=free |url-status=live |archive-url=https://web.archive.org/web/20230405051047/https://www.cdc.gov/niosh/docs/2017-194/default.html |archive-date= Apr 5, 2023|first1=A.|last1=Reichard|first2=S.|last2=Marsh|first3=R.|last3=Olsavsky|location=Morgantown, West Virginia}}

Infectious disease has become a major concern in light of the COVID-19 pandemic. In response, the U.S. Centers for Disease Control and Prevention and other agencies and organizations have issued guidance regarding workplace hazard controls for COVID-19. Some specific recommendations include modified call queries, symptom screening, universal PPE use, hand hygiene, physical distancing, and stringent disinfection protocols.{{Cite web|last=CDC|date=11 February 2020|title=Interim Recommendations for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points/Emergency Communication Centers (PSAP/ECCs) in the United States During the Coronavirus Disease (COVID-19) Pandemic|url=https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html|access-date=23 July 2020|website=Centers for Disease Control and Prevention|language=en-us}}{{Cite web|last=CDC|date=30 April 2020|title=First Responders, Law Enforcement, and Public Services|url=https://www.cdc.gov/coronavirus/2019-ncov/community/first-responders.html|access-date=23 July 2020|website=Centers for Disease Control and Prevention|language=en-us}} Research on ambulance ventilation systems found that aerosols often recirculate throughout the compartment, creating a health hazard for EMTs when transporting sick patients capable of airborne transmission.{{Cite journal|last1=Lindsley|first1=William G.|last2=Blachere|first2=Francoise M.|last3=McClelland|first3=Tia L.|last4=Neu|first4=Dylan T.|last5=Mnatsakanova|first5=Anna|last6=Martin|first6=Stephen B.|last7=Mead|first7=Kenneth R.|last8=Noti|first8=John D.|date=2 December 2019|title=Efficacy of an ambulance ventilation system in reducing EMS worker exposure to airborne particles from a patient cough aerosol simulator|journal=Journal of Occupational and Environmental Hygiene|language=en|volume=16|issue=12|pages=804–816|doi=10.1080/15459624.2019.1674858|pmid=31638865|s2cid=204849623|issn=1545-9624}} Unidirectional airflow design can better protect workers.

{{Main|Paramedics in Canada}}

There is considerable degree of inter-provincial variation in the Canadian paramedic practice. 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 practices 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.

In Canada, the levels of paramedic practice as defined by the National Occupational Competency Profile are: emergency medical responder (EMR), primary care paramedic, advanced care paramedic, and critical care paramedic.

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. In Alberta, for instance, only someone registered with the Alberta College of Paramedics can call themselves a paramedic; the title is legally protected. Almost all provinces have moved 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.

{{Main|Emergency medical responder}}

Most providers that work in ambulances are identified as "paramedics" by the public. However, in many cases, the most prevalent level of emergency pre-hospital care is that which is provided by an emergency medical responder (EMR). This is a level of practice recognized under the National Occupational Competency Profile, although unlike the next three successive levels of practice, 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 and oxygen therapy, administration of ASA, I.M. epinephrine and glucagon, oral glucose and administration of intranasal Narcan with the exception of automated external defibrillation (which is still considered a regulated medical act in most provinces in Canada).{{citation needed|date=February 2017}}

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 ECGs, administration of symptom relief medications for a variety of emergency medical conditions (these include oxygen, epinephrine, dextrose, 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 provinces of Ontario, Quebec and Newfoundland and Labrador, many paramedic services allow primary care paramedics to perform 12-lead ECG interpretation, or initiate intravenous therapy to deliver a few additional medications.

Advanced care paramedic (ACP) is a level of practitioner that is in high demand by many services across Canada. However, Quebec only utilizes this level of practice in a very limited fashion as part of a pilot program in Montreal. The ACP typically carries approximately 20 different medications, although the number and type of medications may vary substantially from region to region. ACPs perform advanced airway management including intubation, surgical airways, intravenous therapy, place external jugular IV lines, perform needle thoracotomy, perform and interpret 12-lead ECGs, perform synchronized and chemical cardioversion, transcutaneous pacing, perform obstetrical assessments, and provide pharmacological pain relief for various conditions. Several sites in Canada have adopted pre-hospital fibrinolytics and rapid sequence induction, and prehospital medical research has permitted a great number of variations in the scope of practice for ACPs. Current programs include providing ACPs with discretionary direct 24-hour access to PCI labs, bypassing the emergency department, and representing a fundamental change in both the way that patients with S-T segment elevation myocardial infarctions (STEMI) are treated, but also profoundly affecting survival rates, as well as bypassing closer hospitals to get an identified stroke patient to a stroke centre.

File:Toronto Paramedic Services Critical Care Transport ambulance.jpg critical care ambulance]]

Critical care paramedics (CCPs) are paramedics who generally do not respond to 9-1-1 emergency calls, with the exception of helicopter "scene" calls. Instead they focus on transferring patients from the hospital they are currently in to other hospitals that can provide a higher level of care. CCPs often work in collaboration with registered nurses and respiratory therapists during hospital transfers. This ensures continuity of care. However, when acuity is manageable by a CCP or a registered nurse or respiratory therapist is not available, CCPs will work alone. Providing this care to the patient allows the sending hospital to avoid losing highly trained staff on hospital transfers.

CCPs are able to provide all of the care that PCPs and ACPs provide. That being said, CCPs significantly lack practical experience with advanced skills such as IV initiation, peripheral access to cardiovascular system for fluid and drug administration, advanced airway, and many other techniques. While a PCP and ACP may run 40–50 medical codes per year, a CCP may run 1–2 in an entire career. IV/IO starts are nearly non-existent in the field and for this reason CCPs are required to attend nearly double the amount of time in classroom situations or in hospital to keep current. In addition to this, they are trained for other skills such as medication infusion pumps, mechanical ventilation, and arterial line monitoring.

CCPs often work in fixed and rotary wing aircraft when the weather permits and staff are available, but systems such as the Toronto EMS Critical Care Transport Program work in land ambulances. ORNGE transport operates both land and aircraft in Ontario. In British Columbia, CCPs work primarily in aircraft with a dedicated critical care transport crew in Trail for long-distance transfers and a regular CCP street crew stationed in South Vancouver that often also performs medevacs when necessary.

Paramedic training in Canada varies regionally; for example, the length of training may be eight months{{cite web|url=http://www.jibc.ca/programs-courses/schools-departments/school-health-community-social-justice/paramedic-academy/programs-and-courses/primary-care-paramedic|title=Primary Care Paramedic - Justice Institute of British Columbia|website=www.jibc.ca|access-date=2017-03-24|archive-date=2017-03-14|archive-url=https://web.archive.org/web/20170314141834/http://www.jibc.ca/programs-courses/schools-departments/school-health-community-social-justice/paramedic-academy/programs-and-courses/primary-care-paramedic|url-status=dead}} in British Columbia or two to four years in Ontario, Alberta, and Quebec. The nature of training and how it is regulated, like actual paramedic practice, varies from province to province.

{{main|PHECC}}

Emergency medical technician (EMT), paramedic (P) and advanced paramedic (AP) are legally defined and protected titles in Ireland based on the standard set down by the Pre-Hospital Emergency Care Council (PHECC). Emergency medical technician is the entry-level standard of practitioner for employment within the ambulance service. Currently, EMTs are authorized to work on non-emergency ambulances only as the standard for emergency (999) calls is a minimum of a two-paramedic crew, although this minimum requirement was relaxed to and EMT - paramedic crew during the COVID-19 crisis. EMTs are a vital part of the private, voluntary and auxiliary services where a practitioner must be on board any ambulance in the process of transporting a patient to hospital.

Emergency medical technician (EMT), paramedic (P) and advanced paramedic (AP) are legally defined and protected titles in the Philippines based on the standard set down by the Department of Health.

Técnico en Emergencias Sanitarias (TES) are trained a total of 2000hrs in 2 years with 3 months of internship in ambulances at the very end. It's the only level of EMS worker. BLS ambulances can be driven with a B license, ALS with a C1.

ALS ambulances also carry an Emergency Physician and an Emergency Nurse.

{{main|Emergency medical personnel in the United Kingdom}}

Emergency medical technician is a term that has existed for many years in the United Kingdom, but has no single defined scope. They may be known as emergency medical technician or simply, ambulance technician. Most EMTs hold an Institute for Healthcare Development Ambulance Technician Certificate and are employed in private ambulance companies or in National Health Service ambulance trusts.

As of 2016, The IHCD Ambulance Technician Certificate was replaced with the FAQ Level 4 Diploma for Associate Ambulance Practitioners & QA Level 5 Diploma in First Response Emergency and Urgent Care (RQF){{Cite web|url=https://www.futurequals.com/qualifications/level-4-diploma-associate-ambulance-practitioner/|title=Ambulance Practitioner Qualification {{!}} Ambulance Technician {{!}} Emergency Medical Technician EMT|website=FutureQuals|language=en-GB|access-date=11 February 2020}} This provided a defined scope of practice agreed nationally by ambulance service trusts. Their role title, however, may still be defined by their employer as emergency medical technician.

They can work autonomously, making their own clinical decisions within their training and remit. They may also work as a clinical lead working alongside an emergency care assistant or as assistants themselves to a paramedic.

As the role does not have a single defined scope, the skills they have can include:

• Administration of select general sales list, pharmacy and prescription only medicines under provision of the Human Medicines Regulations 2012{{Cite web|url=http://www.legislation.gov.uk/uksi/2012/1916/contents/made/data.htm|title=The Human Medicines Regulations 2012|website=www.legislation.gov.uk|access-date=11 February 2020}}
• Administration of medicines by select parenteral or non-parenteral routes; typically oral, intramuscular, inhaled, nebulised or sublingual
• Intermediate life support, including manual defibrillation and supraglottic airway placement
• Ability to discharge patients to different care pathways

The term emergency medical technician is not commonly used by members of the public in the United Kingdom. Instead, it is common for all ambulance personnel to be referred to as "paramedics", although the paramedic title is protected under registration of the Health and Care Professions Council.

{{See also|Emergency medical services in the United States}}

{{Overly detailed|date=December 2016|section=yes}}

=== 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's) standards for curriculum.{{cite web |url=http://www.nhtsa.dot.gov/portal/site/nhtsa/template.MAXIMIZE/menuitem.2a0771e91315babbbf30811060008a0c/?javax.portlet.tpst=4670b93a0b088a006bc1d6b760008a0c_ws_MX&javax.portlet.prp_4670b93a0b088a006bc1d6b760008a0c_viewID=detail_view&itemID=1822abcc80c81010VgnVCM1000002c567798RCRD&overrideViewName=Article |title=National Standard Curriculum |access-date=10 March 2008 |publisher=National Highway Transportation Safety Administration |url-status=dead |archive-url=https://web.archive.org/web/20080916221721/http://www.nhtsa.dot.gov/portal/site/nhtsa/template.MAXIMIZE/menuitem.2a0771e91315babbbf30811060008a0c/?javax.portlet.tpst=4670b93a0b088a006bc1d6b760008a0c_ws_MX&javax.portlet.prp_4670b93a0b088a006bc1d6b760008a0c_viewID=detail_view&itemID=1822abcc80c81010VgnVCM1000002c567798RCRD&overrideViewName=Article |archive-date=16 September 2008 }} The National Registry of Emergency Medical Technicians (NREMT) is a nonprofit organization{{cite web |url=http://nremt.org/about/Legal_Opinion.asp |title= Legal Opinion: Certification v. Licensure|access-date=10 March 2008 |author=Abram, T |publisher=National Registry of Emergency Medical Technicians |archive-url = https://web.archive.org/web/20071027161221/http://www.nremt.org/about/Legal_Opinion.asp |archive-date = 27 October 2007}} which offers certification exams based on NHTSA education guidelines and has been around since the 1970s.{{cite web |url=http://nremt.org/about/about_exams.asp |title= About NREMT Examinations|access-date=10 March 2008 |publisher= National Registry of Emergency Medical Technicians |archive-url = https://web.archive.org/web/20071027161226/http://www.nremt.org/about/about_exams.asp |archive-date = 27 October 2007}}{{Cite web|url=https://wvde.state.wv.us/abe/Public%20Service%20Personnel/HistoryofEMS.html|title=History of EMS|website=wvde.state.wv.us|access-date=2 November 2016}} Currently, NREMT exams are used by 46 states as the sole basis for certification at one or more EMT certification levels.{{cite web |url= http://www.nremt.org/EMTServices/emt_cand_state_offices.asp|title=State Office Information |access-date=10 March 2008 |publisher=National Registry of Emergency Medical Technicians |archive-url = https://web.archive.org/web/20071026051111/http://www.nremt.org/EMTServices/emt_cand_state_offices.asp |archive-date = 26 October 2007}} A NREMT exam consists of skills and patient assessments as well as a written portion.

On June 12, 2019, the NREMT changed the rules regarding age limits for EMTs, AEMTs, and paramedics. There is no longer an age limit for registered personnel. However, applicants must successfully complete a state-approved EMT course that meets or exceeds the NREMT standards within the past two years of applying. Those applying for the NREMT certification must also complete a state-approved EMT psychomotor exam. It is possible for the candidate to be refused access to a state-approved course due to their age within the state. {{Cite web|title = NREMT – EMT|url = https://www.nremt.org/nremt/about/reg_basic_history.asp|website = www.nremt.org|access-date = 27 April 2015|archive-date = 12 May 2015|archive-url = https://web.archive.org/web/20150512195908/http://www.nremt.org/nremt/about/reg_basic_history.asp|url-status = dead}}

{{See also|Emergency medical responder levels by U.S. state|Paramedics in the United States}}

NHTSA recognizes four levels of certification:

• Emergency medical responder (EMR)
• Emergency medical technician (EMT)
• Advanced emergency medical technician (AEMT)
• Paramedic

Some states also recognize the advanced practice paramedic{{cite web |url=http://www.wakegov.com/ems/staff/app.htm |title=Advanced Practice Paramedic |access-date=18 September 2011 |archive-date=6 October 2011 |archive-url=https://web.archive.org/web/20111006210953/http://www.wakegov.com/ems/staff/app.htm |url-status=dead }} or critical care paramedic{{cite web |url=http://www.state.tn.us/sos/rules/1200/1200-12/1200-12-05.pdf |title=Tennessee Critical Care Paramedic |access-date=18 September 2011}} level as a state-specific licensure above that of paramedic. These critical care paramedics generally perform high acuity transports that require skills outside the scope of a standard paramedic (such as mechanical ventilation and management of cardiac assist devices).{{cite web|url=http://ehs.umbc.edu/CE/CCEMT-P/ |title=Critical Care Emergency Medical Transport Program |access-date=11 May 2014 |url-status=dead |archive-url=https://web.archive.org/web/20080621174320/http://ehs.umbc.edu/CE/CCEMT-P/ |archive-date=21 June 2008 }} In addition, EMTs can seek out specialty certifications such as wilderness EMT, wilderness paramedic, tactical EMT, and flight paramedic.

In 2009, the NREMT posted information about a transition to a new system of levels for emergency care providers developed by NHTSA with the National EMS Scope of Practice Project.{{cite web |url=http://www.nasemso.org/documents/FINALEMSSept2006_PMS314.pdf |title=National EMS Scope of Practice Model |access-date=18 September 2011 |publisher=NHTSA |date=September 2006 |archive-url=https://web.archive.org/web/20120131200052/http://www.nasemso.org/documents/FINALEMSSept2006_PMS314.pdf |archive-date=31 January 2012 |url-status=dead }} By 2014, these new levels replaced the fragmented system found around the United States. The new classification includes emergency medical responder (replacing first responder), emergency medical technician (replacing EMT-basic), advanced emergency medical technician (replacing EMT-intermediate/85), and paramedic (replacing EMT-intermediate/99 and EMT-paramedic). Education requirements in transitioning to the new levels are substantially similar.{{cite web |url=http://www.pacificmedicalacls.com/ems-recertification.html |title= EMT Recertification Cheat Sheet and Information Recertification Cheat Sheet |access-date=14 June 2016}}

EMR is the most basic level of training, and is considered the bare minimum certification for rescuers that respond to medical emergencies. EMRs are typically on-call volunteers in rural communities, or are primarily employed as firefighters or search and rescue personnel. EMRs typically arrive quickly and assess and stabilize the patient before the transporting ambulance arrives, and then assist the crew with patient care and packaging.

EMRs provide advanced first aid-level care, CPR, semi-automatic defibrillation, basic airway management (suction/oropharyngeal airway), oxygen therapy, and administration of basic, life-saving medications such as epinephrine and naloxone.

EMT is the next level of EMS certification and is considered the most common entry level of training.{{cite web |url= http://www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pdf |title= Emergency Medical Technician-Basic National Standard Curriculum|access-date=10 March 2008 |publisher= National Highway Transportation Safety Administration}} The procedures and skills allowed at this level include bleeding control, management of burns, splinting of suspected fractures and spinal injuries, childbirth, cardiopulmonary resuscitation, semi-automatic defibrillation, oral suctioning, insertion of oropharyngeal and nasopharyngeal airways, pulse oximetry, blood glucose monitoring, auscultation of lung sounds, and administration of a limited set of medications (including oxygen, epinephrine, dextrose, naloxone, albuterol, ipratropium bromide, glucagon, nitroglycerin, nitrous oxide, and acetylsalicylic acid). Some areas may add to the scope of practice, including intravenous access, insertion of supraglottic airway devices, and CPAP. Training requirements and treatment protocols vary from area to area.{{cite web|url=http://www.emsa.ca.gov/legislation/FinalApprovedChapter3242007.pdf |title=EMT (1) Regulations |access-date=10 March 2008 |publisher=California EMSA |pages=6–7, 11–23 |url-status=dead |archive-url=https://web.archive.org/web/20070620062125/http://www.emsa.ca.gov/legislation/FinalApprovedChapter3242007.pdf |archive-date=20 June 2007 }}{{cite web |url=http://www.scdhec.gov/health/ems/cskills.pdf |title=SC EMT Skills |access-date=10 March 2008 |publisher=South Carolina Department of Health and Environmental Control |archive-url=https://web.archive.org/web/20080102232010/http://www.scdhec.gov/health/ems/cskills.pdf |archive-date=2 January 2008 |url-status=dead }}

Advanced EMT is the level of training between EMT and paramedic. They can provide intermediate life support (ILS) care including obtaining intravenous or intraosseous access, basic cardiac monitoring, fluid resuscitation, capnography, and administration of some additional medications. {{Cite web|title = NREMT – Advanced Psychomotor Exam|url = https://www.nremt.org/nremt/about/psychomotor_exam_advanced.asp|website = www.nremt.org|access-date = 2 December 2015|archive-date = 12 January 2016|archive-url = https://web.archive.org/web/20160112081704/http://www.nremt.org/nremt/About/psychomotor_exam_advanced.asp|url-status = dead}}

Paramedics typically represent the highest degree of pre-hospital medical provider, providing advanced life support (ALS) care. Paramedics perform a variety of medical procedures such as endotracheal intubation, rapid sequence induction, cricothyrotomy, fluid resuscitation, drug administration, obtaining intravenous and intraosseous access, manual defibrillation, electrocardiogram interpretation, capnography, cardioversion, transcutaneous pacing, pericardiocentesis, thoracostomy, ultrasonography, and blood chemistry interpretation.{{cite web|url=http://ochealthinfo.com/medical/ems/procedures.htm |title=BLS/ALS Procedures |access-date=18 September 2011 |publisher=Orange County EMS Agency |url-status=dead |archive-url=https://web.archive.org/web/20110929121430/http://www.ochealthinfo.com/medical/ems/procedures.htm |archive-date=29 September 2011 }}

An ambulance with only EMTs is considered a basic life support (BLS) unit, an ambulance utilizing AEMTs is dubbed an "intermediate life support" (ILS), or "limited advanced life support" (LALS) unit, and an ambulance with paramedics is dubbed an "advanced life support" (ALS) unit. Many states allow ambulance crews to contain a mix of crews levels (e.g. an EMT and a paramedic or an AEMT and a paramedic) to staff ambulances and operate at the level of the highest trained provider. There is nothing stopping supplemental crew members to be of a certain certification, though (e.g. if an ALS ambulance is required to have two paramedics, then it is acceptable to have two paramedics and an EMT). An emergency vehicle with only EMRs or a combination of both EMRs and EMTs is still dubbed a "basic life support" (BLS) unit. An EMR must usually be overseen by an EMT-level provider or higher to work on a transporting ambulance.

EMT training programs for certification vary greatly from course to course, provided that each course at least meets local and national requirements. In the United States, EMRs receive at least 40–80 hours of classroom training and EMTs receive at least 120–300 hours of classroom training. AEMTs generally have 100-300 hours of additional classroom training beyond the standard EMT training. Paramedics are trained for 1,500–2,500 hours or more.

In addition to each level's didactic education, clinical rotations are typically also required. Similar in a sense to medical school clinical rotations, EMT students are required to spend a required amount of time in an ambulance and on a variety of hospital services (e.g. obstetrics, emergency medicine, surgery, intensive care unit, psychiatry) in order to complete a course and become eligible for the certification and licensure exams.

The number of clinical hours for both time in an ambulance and time in the hospital vary depending on local requirements, the level the student is obtaining, and the amount of time it takes the student to show competency.{{cite web|url = http://www.link2life.org/pricing.asp#EMTonlyCLASSESFOR19992000|title = 2008 EMT-Basic Course Schedule|access-date = 10 March 2008|publisher = Link 2 Life|url-status = dead|archive-url = https://web.archive.org/web/20080310205414/http://www.link2life.org/pricing.asp#EMTonlyCLASSESFOR19992000|archive-date = 10 March 2008}}{{cite web |url=http://www.drexel.edu/catalog/ABOUT/ems.htm |title= Emergency Medical Services Program |access-date=10 March 2008 |publisher=Drexel University }}

In addition, a minimum of continuing education (CE) hours is required to maintain certification. For example, to maintain NREMT certification, EMTs must obtain at least 48 hours of additional education and either complete a 24-hour refresher course or complete an additional 24 hours of CE that cover, on an hour by hour basis, the same topics as the refresher course would.{{cite web |url=https://www.nremt.org/nremt/EMTServices/rereg_pol_proc.asp |title=Recertification Policies and Procedures |access-date=14 June 2016 |publisher=National Registry of Emergency Medical Technicians |archive-date=30 March 2016 |archive-url=https://web.archive.org/web/20160330140859/https://www.nremt.org/nremt/EMTServices/rereg_pol_proc.asp |url-status=dead }}{{cite web |url=https://www.nremt.org/nremt/about/brochuresRecertification.asp |title=Recertification Brochures |access-date=14 June 2016 |publisher=National Registry of Emergency Medical Technicians |archive-date=20 May 2016 |archive-url=https://web.archive.org/web/20160520112118/http://www.nremt.org/nremt/about/brochuresRecertification.asp |url-status=dead }} Recertification for other levels follows a similar pattern.

EMT training programs vary greatly in calendar length (number of days or months). For example, fast track programs are available for EMTs that are completed in two weeks by holding class for 8 to 12 hours a day for at least two weeks. Other training programs are months long, or up to two years for paramedics in associate degree programs.

EMT training programs take place at numerous locations, such as universities, community colleges, technical schools, hospitals or EMS academies. Every state in the United States has an EMS lead agency or state office of emergency medical services that regulates and accredits EMT training programs. Most of these offices have web sites to provide information to the public and individuals who are interested in becoming an EMT.

In the United States, an EMT's actions in the field are governed by state regulations, local regulations, and by the policies of their EMS organization. The development of these policies are guided by a physician medical director, often with the advice of a medical advisory committee composed of paramedics and other health professionals.{{cite web |url=http://www.ochealthinfo.com/medical/ems/ |title=About us |access-date=18 September 2011|publisher=Orange County EMS Agency |url-status=dead |archive-url=https://web.archive.org/web/20110903235813/http://ochealthinfo.com/medical/ems/ |archive-date=3 September 2011}}

In California, for example, each county's local emergency medical service agency (LEMSA) issues a list of standard operating procedures or protocols, under the supervision of the California Emergency Medical Services Authority. These procedures often vary from county to county based on local needs, levels of training and clinical experiences.{{cite web|url=http://www.emsa.ca.gov/aboutemsa/mandate.asp |title=EMS Authority's Mandates Summary |access-date=11 March 2008 |publisher=California Emergency Medical Services Authority |url-status=dead |archive-url=https://web.archive.org/web/20070711160118/http://www.emsa.ca.gov/aboutemsa/mandate.asp |archive-date=11 July 2007 }} New York State has similar procedures, whereas a regional medical-advisory council (REMAC) determines protocols for one or more counties in a geographical section of the state.{{cite web |url= http://www.health.state.ny.us/nysdoh/ems/about.htm|title=What is the Bureau of Emergency Medical Services |access-date=11 March 2008 |publisher= New York State Department of Health }}

Treatments and procedures administered by paramedics fall under one of two categories, off-line medical orders (standing orders) and on-line medical orders. On-line medical orders refers to procedures that must be explicitly approved by a base hospital physician or registered nurse through voice communication (generally by phone or radio) and are generally rare or high risk procedures (e.g. vasopressor initiation).{{cite web |url=http://www.ochealthinfo.com/medical/ems/guidelines/ |title=Treatment Guidelines |access-date=11 March 2008 |publisher=Orange County EMS Agency |url-status=dead |archive-url=https://web.archive.org/web/20081012215549/http://www.ochealthinfo.com/medical/ems/guidelines/ |archive-date=12 October 2008 }} In addition, when multiple levels can perform the same procedure (e.g. AEMT-critical care and paramedics in New York), a procedure can be both an on-line and a standing order depending on the level of the provider.{{cite web |url=http://www.aarems.org/regionalALS.php|title=AAREMS 2007 Regional ALS Treatment Protocols |access-date=18 September 2011 |publisher= Adirondack - Appalachian Regional Emergency Medical Services Council}} Since no set of protocols can cover every patient situation, many systems work with protocols as guidelines.{{cite web|url=http://www.rivcoems.org/downloads/downloads_documents/Protocol102904/7000.pdf |title=Patient Care Policy (ALS) |access-date=11 March 2008|publisher=Riverside County Emergency Medical Services Agency |page=1 |url-status=dead |archive-url=https://web.archive.org/web/20080724033742/http://www.rivcoems.org/downloads/downloads_documents/Protocol102904/7000.pdf |archive-date=24 July 2008}} Systems also have policies in place to handle medical direction when communication failures happen or in disaster situations.{{cite web |url=http://www.ochealthinfo.com/docs/medical/ems/P&P/330.15.pdf |title=Advanced Life Support Treatment In Communication Failure or Without Base Hospital contact |access-date=11 March 2008 |publisher=Orange County Emergency Medical Services Agency |url-status=dead |archive-url=https://web.archive.org/web/20080817013116/http://www.ochealthinfo.com/docs/medical/ems/P%26P/330.15.pdf |archive-date=17 August 2008}} The NHTSA curriculum is the foundation Standard of Care for EMS providers in the US.

EMTs and paramedics are employed in varied settings, mainly the prehospital environment such as in EMS, fire, and police agencies. They can also be found in positions ranging from hospital and health care settings, to industrial and entertainment positions. The prehospital environment is loosely divided into non-emergency (e.g. patient transport) and emergency (9-1-1 calls) services, but many ambulance services and EMS agencies operate both non-emergency and emergency care.

In many places across the United States, it is not uncommon for the primary employer of EMRs, EMTs, and paramedics to be a fire department, with the fire department providing the primary emergency medical system response including "first responder" fire apparatus, as well as ambulances.{{cite web|url=http://medicalassistantclassesonline.net/ems-tribute/ |title=Emergency Medical Services |access-date=13 March 2008|publisher=City of Santa Ana |url-status=dead |archive-url=https://web.archive.org/web/20140523230744/http://medicalassistantclassesonline.net/ems-tribute/ |archive-date=23 May 2014}} In many other locations, emergency medical services are provided by a separate, or "third-party", municipal government emergency agency (e.g. Boston EMS, Austin-Travis County EMS).{{cite web |url=http://www.bostonems.com/ |title=Boston EMS |access-date=13 March 2008|url-status=dead |archive-url=https://web.archive.org/web/20080325162459/http://www.bostonems.com/ |archive-date=25 March 2008}} In still other locations, emergency medical services are provided by volunteer agencies. College and university campuses may provide emergency medical responses on their own campus using students.{{cite web|url=https://www.ncemsf.org/resources/ems-organization-database/groups-listed-by-region |title=National Collegiate Emergency Medical Services Foundation, Groups Listed by Region |access-date=25 December 2016}}

In some states of the US, many EMS agencies are run by independent non-profit volunteer first aid squads that are their own corporations set up as separate entities from fire departments. In this environment, volunteers are hired to fill certain blocks of time to cover emergency calls. These volunteers have the same state certification as their paid counterparts.{{cite web |url=http://www.njsfac.org/index.shtml |title=NJ State First Aid Council |access-date=21 March 2010|publisher=NJ State First Aid Council |url-status=dead |archive-url=https://web.archive.org/web/20100327142727/http://www.njsfac.org/index.shtml |archive-date=27 March 2010}}

• Combat medic
• List of EMS provider credentials

{{reflist}}

• [http://www.nhtsa.dot.gov/portal/site/nhtsa/menuitem.2a0771e91315babbbf30811060008a0c/ National Highway Traffic Safety Agency, Office of Emergency Medical Services]
• [http://www.nremt.org United States National Registry of Emergency Medical Technicians]

{{Emergency medical services}}

{{First aid topics}}

{{Authority control}}

Category:Technicians