When I was growing up, we always referred to ambulance personnel who conducted emergency medical service as “paramedics.” These days, those people always correct me to “E.M.T.” or “emergency medical technician.” But none of them have actually been able to give me a clear description of the differences. What difference is there between a paramedic and an E.M.T., or is it merely that the relevant credentialing organizations have altered their nomenclature?
I’ve Googled for this, but found so many sites for active EMT/Paramedics, that I couldn’t get to any useful sites. 
I was an EMT in Virginia. I worked on a basic ambulance crew, administered aid, performed cpr etc.
A paramedic is a more highly trained professional. S/he could use defibrilators, insert IVs, administer some drugs (with authorization from an MD in emergency room via radio), and perform emergency measures such as a tracheotomy.
Being more highly trained, there were less of them. They were on specially designated ambulances called medic units. On a call, I could request a medic unit for support.
When I went through EMT and Paramedical training years ago, the basic difference was that EMTs did not become involved in invasive therapies. Everything done for a patient was outside the body. With Paramedical certification, I was trained to start IVs, administer drugs, place an esophageal airway, run ECGs, and cardiovert. Military Anti Shock Trousers or MAST used to be in the Paramedical domain, but has since been conferred to EMTs with appropriate training.
Former EMT checking in.
A paramedic has more training than an EMT and can, therefore, do more for a patient.
A paramedic, for example, can administer certain drugs to a patient under the supervision of a doctor. An EMT cannot do that. A paramedic can intubate patients, but EMTs don’t (or at least they did as of when I was an EMT – things may have changed since then).
The two terms are not interchangeable.
Zev Steinhardt
We were trained in MAST and intubating that tube with the ballon thingy that inflates so you can make sure the air doesn’t go in the stomach when you use a bag mask (it’s been 15 years), but none of the other things you guys mentioned.
There are actually 4 levels of prehospital emergency care in the United States. First Responder, EMT-Basic, EMT-Intermediate, and EMT-Paramedic. The differences between the levels vary from state to state. However, the basic education curricula are set by the U.S. Dept. of Transportation. They can be found at this site.
In general, danceswithcats has it right about the differences. However, it varies greatly from state to state, and even from city to city depending on protocols. For example, in Michigan combitubes are a basic skill. Here in Denver, they just became an ALS (paramedic) skill.
Basically, EMT-Basics can do the following: c-spine control, CPR, automatic/semi-automatic defibrillation, administer oxygen, assist a pt with already prescribed medications, deliver babies, and a wide variety of splinting and bandaging skills. In addition to the EMT-B license, basics must also be certified in CPR. Some states (CO, WI, etc.) have an EMT-IV program, where EMT-Bs can take a class to become certified to start IVs and administer fluids (but not drugs).
Paramedics can do all the EMT-B skills plus: IVs, endotracheal tubes, 12-lead EKGs, manual defibrillation, cardioversion, IV meds (either by standing order or direct order from a physician), nebulized medications (albuterol, atrovent), intraosseous lines, needle thoracotomies, and surgical crichs. In addition to the paramedic license, medics must also be certified in Advanced Cardiac Life Support (ACLS). Many services also require Pediatric Advanced Life Support (PALS) and Prehospital Trauma Life Support (PHTLS) or Basic Trauma Life Support (BTLS).
MAST pants have generally fallen out of favor in EMS because they only autotransfuse about 300ccs of blood and have a high risk of complications.
Lastly, my paramedic license says EMT-Paramedic on it, so it’s perfectly appropriate to call paramedics EMTs. It’s definitely better than “ambulance driver” :rolleyes:
Hope that helps,
St. Urho
Paramedic
Excellent, helpful description of all that – but… you brought up the ambulance driver thing, and I see no mention about training/qualifications for all that. I assume there’s an EMT driving, right? Not like someone who only drives. So what training do EMT’s receive for that? It’s not just a matter of getting a choffeurs’ license at the SecState, right?
Not necessarily. When I was doing the Saturday night overnight shift at a local private ambulance service here in New York, my driver was not an EMT or even trained in first aid at all.
Zev Steinhardt
We had to be certified as an ambulance driver. My normal shift partner was also an EMT and we took turns driving, but if he was out, a firefighter who was certified as a driver, but not an EMT could drive.
Actually, the training for driving an ambulance is pretty spotty. Many states (including Michigan, where I did my EMT-B training) do not require anything! If you’re licensed as an EMT, you can drive an ambulance. (interesting fact: in Minnesota, volunteer firefighters can operate FD vehicles without even having a driver’s license:eek:)
There are some training programs out there the Emergency Vehicle Operator Course (EVOC) and Coaching the Emergency Vehicle Operator (CEVO) are the 2 big ones that I know of. We took EVOC as part of my paramedic program, and my current employer requires CEVO. It’s basically the same class, just sponsored by different groups.
As far as who’s driving that also depends on the service. If it’s a 2 medic ambulance (or a 2 basic ambulance) they’ll usually take turns driving and attending. If it’s medic/basic then it depends on the company. Some agencies only let EMTs drive, they can’t attend on calls. The agency I work for, if it’s a BLS call I can drive. If it’s ALS, my EMT partner must drive. Either one of us can drive to a call.
EMT is used in my hospital’s community as a generic term for anyone certified to be out on the road picking patients up, or the ER staff who assess and treat the incoming patients. It’s not a precise usage perhaps, but it signifies an EMT “family” of work-related people. Some are paramedics, some nurses, some are physicians.
D’oh! That should have been this smilie: :eek:
I don’t know how I screwed that up.