Emergency Medical Technician
An Emergency Medical Technician (EMT) is a medical first responder trained in Basic Life Support (BLS) and, depending on the training level, Advanced Life Support (ALS). The discipline's focus is on prehospital care, including immediate assessment, stabilization, and transport, with continuing life support, to an appropriate hospital. Some EMTs may also work in hospital emergency rooms, but it is primarily a field specialty.
Medical control for Emergency Medical Services is within the scope of the physician specialty of Emergency Medicine.
This function had long existed with the "corpsmen" and "medics" of military medicine, but has become an essential part of civilian emergency medical services. EMT's most often work on ambulance or fire rescue teams, either for privately-owned ambulance services, publicly-operated ambulance services, or fire departments. EMT's may also be employed by private organizations with a need for on-scene medical expertise.
In the United States, three levels of EMT exist nationally, the EMT-Basic, EMT-Intermediate, and EMT-Paramedic, though states may create additional levels or types of certifications. The National Registry of Emergency Medical Technicians manages EMT registration and testing at the national level, and most states accept the National Registry exam for state certification.
Additional certifications exist in some areas, such as wilderness or maritime emergency services. Some EMTs are not only qualified as underwater rescue divers, but are also qualified to operate recompression chambers or to work as part of a medical hyperbaric oxygen team. Combat search and rescue personnel often are certified at the EMT/Paramedic or Physician Assistant levels. There are closely related nursing specializations including flight nurse, trauma nurse, and emergency nurse; some workers choose to dual-certify in EMS and nursing.
Many EMTs are part of fire and rescue organizations, and have relevant firefighting skills including search and rescue inside a burning building, and extrication of victims from wreckage. Extrication has two components: the physical steps taken to remove a patient from a car twisted around him, and the emergency medical techniques to avoid further injury as a result of the extrication process. EMTs, sometimes with remote medical advice, may be the on-the-scene experts on balancing risk: if a car is on fire and there is a danger of explosion, the EMT may have to decide if the need for speed in extrication justifies potentially aggravating a spinal inury.
Other fire-EMS joint skills include operations in the presence of hazardous substances or radiation.
The EMT-Basic specializes on immediate life-saving treatment to amintain a patient's life for and during transport to a medical facility. This includes "The ABC's": Airway, Breathing, and Circulation. EMT-Basic training focuses on maintaining the patency of a patient's airway and maintaining breathing and blood circulation and, when these are stable, attending to other life-threatening injuries (such as shock) and lesser injuries (such as bone fractures or minor-to-moderate bleeding). Training also includes transport procedures, vital signs such as blood pressure and respiratory rate, attaining a medical history, emergency childbirth, cervical (neck) immobilization, rapid extracation, blood glucose measurement, and advanced first aid interventions. Generally speaking, an EMT-Basic is very limited in administration of medications, but is trained and - depending on local protocols - authorized to administer or assist in the patient's administration of epinephrine, albuterol and other inhalers, glucose, activated charcoal, nitroglycerin, and others.
The EMT-Intermediate is further divided into two types of EMT-I, the I85 and the I99, with the latter a higher rating. An I85 EMT may, as allowed by state regulations and local protocols, administer limited IV therapy or perform advanced airway techniques. An I99 EMT is very near to a Paramedic in training, and is able to perform most of the procedures and interventions of a Paramedic.
A Paramedic is the top-level Emergency Medical Technician and most often the highest-trained medical provider to treat an emergency patient prior to arrival at a hospital. Paramedics are trained in advanced airway techniques, medication delivery, and other procedures that otherwise would only be available at the hospital.
Different states may add or adjust levels of training or certifications. For instance, the "EMT-Critical Care" in the state of New York.