Saturday, April 12, 2014

What's the Difference Between an EMT and a Paramedic?

Someone recently asked me to explain the difference between an EMT -- Emergency Medical Technician -- and a paramedic. Here in Illinois, the answer is simple; the term "EMT" covers all men and women who have completed state mandated EMT courses and have passed the licensure tests associated with those courses. 

But don't tell that to a Illinois paramedic. They can get a little touchy if called an EMT because they have worked long and hard to rise to the top of their profession. You see, there are three levels of EMT recognition in my state. 

Illinois EMT-Basic (EMT-B)
1.       Cannot intubate
2.       Can assist patient with the following medications: Albuterol (patient assist in using MDI); Epinephrine (Epi Pen) for adults and children for application in treatment of allergic reactions and anaphylaxis; nitroglycerin (patient assist).
Illinois EMT-Intermediate (EMT-I)
1.       Can intubate
2.       Can give the following medications: Aspirin; Epinephrine (1:1000); Adenosine; Epinephrine (1:10,000); Atropine sulfate; Furosemide (Lasix); Bronchodilators (Beta 2 agonists) e.g. Albuteral; Lidocaine Hcl 2%; Morphine sulfate; 50% dextrose; Naloxone (Narcan); Diazepam; Nitroglycerin.
Illinois EMT-Paramedic (EMT-P)
1.       Can intubate and perform needle cricothyrotomy
2.       Can give the following medications: adenosine
    (Adenocard); albuterol(Proventil) (2.5 mg usual first dose); amiodarone (may be mentioned with Lidocaine for Rx of ventricular dysrhythmias); aspirin; atropine; dextrose 50% 50ml IVP (adult dose for hypoglycemia); diazepam(Valium) (peds dose: 0.2/0.5mg IVP/IR); diphenhydramine (Benadryl); dopamine; epinephrine 1:1000 0.3-0.5mg for bronchospasm; epinephrine 1:10,000 1mg IVP/IO for code mgt.; furosemide (Lasix); glucagon; lidocaine; midazolam(Versed); morphine; naloxone (Narcan); nitroglycerin; sodium bicarbonate; vasopressin (may be mentioned with Epi 1:10,000 for Rx of V-fib and asystole); verapamil (offered as an alternative to diltiazem).

EMT-Basic training courses typically range from 120 to 150 hours and concentrate on the basics of pre-hospital care, including airway management, CPR, and control of shock and bleeding and splinting of fractures fracture.
EMT-Intermediate courses cover intubation, administration of some medications, and general ALS principles of care. 
EMT-Paramedic courses range between 1000 and 1200 hours and cover administration of medications, IV therapy, cardiac monitoring and defibrillation, and trauma care. Paramedics provide ALS -- Advanced Life Support -- services.

As you can see, there's quite a difference in the services provided by EMTs at different levels. Paramedics can expand their training by taking other specific courses, such as classes in trauma transport needed for air ambulance service jobs.

If you're writing a story the requires a scene with an EMT character, the above gives you an idea of what he/she can do for your victim. Remember, though, that what I've written here applies to Illinois EMTs. While Illinois recognizes three levels of EMT licensure, other states may recognize more levels or fewer levels. For example, Texas has five levels of certification, the highest being licensed paramedic followed by EMT-P, EMT-I, EMT-B, and ECA (emergency care attendant). To gain the highest level of licensed paramedic, a Texas applicant must hold either a two-year EMS degree or a four-year degree in any field.

State by state EMT levels and requirements can be found by searching the Internet using the above underlined words. It may take you a little time to find the answers you need for your state, but it's worth it if you want your stories to reflect accuracy and credibility.

More next time on EMS regions and differences in care from one region to another.



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