ABOUT EMERGENCY MEDICAL SERVICES (EMS)

What is EMS?

EMS stands for Emergency Medical Services. EMS provides medical care outside of the hospital or medical office setting. Most often, people call EMS when they have had an accident or are experiencing a medical emergency. Emergencies might include heart attack, difficulty breathing, falls, accidents, drowning, cardiac arrest, stroke, drug overdose and acute illnesses. EMS services may provide both basic and advanced medical care at the scene of an emergency and en route to a hospital.

When a call is placed to '911' for an illness or injury, the call is typically answered by an Emergency Medical Services (EMS) Dispatcher. This person normally has first-hand EMS experience and training in priority dispatching of medical emergencies. The dispatcher may ask a number of questions to help assess the nature and severity of the injury or illness.
At times the dispatcher may give the caller specific patient care instructions to maximize the success of the injury or illness outcome.

The EMS Dispatcher then sends the appropriate EMS professionals to the scene. These professionals may be educated as First Responders (requires about 40 hours of training), EMT-Basics (requires about 110 hours of training), EMT-Intermediates (requires 200-400 hours of training) or Paramedics (requires 1,000 or more hours of training). The make-up of an EMS response team is a local decision based upon local resources and the priorities of those who fund the resources. EMS professionals are serious about providing the best possible care under the best possible circumstances.

When EMS professionals are called, the injured or ill person is often transported to the hospital in an ambulance. EMS professionals work under protocols approved by local physicians. The doctor oversees the care of patients in EMS systems, and is knowledgeable about patient care interventions and how EMS systems deliver care. Typically the doctors work in conjunction with local EMS leaders to assure quality patient care.

Emergency Medical Services may be provided by a fire department, an ambulance service, a county or government-based service, a hospital, or a combination of the above. EMS professionals may be paid or serve as volunteers in the community.


What is an EMS system?

EMS is much more than an ambulance service. The delivery of emergency medical care is made up of many parts,
together which are called the EMS system. The EMS system includes the call center that receives the call for and dispatches help, those who respond first (such as police officers and firefighters), an ambulance transportation team of EMTs and/or paramedics, physicians and nurses who provide advice via radio or phone, air medical services (helicopters and small airplanes), hospital receiving facilities, governmental and medical oversight.
The components of an EMS System include:

    ManpowerTraining   Communications

   Transportation Facilities Critical care units

   Public safety agencies  Consumer participation       Access to care

    Patient transferCoordinated patient record keeping Public information and education

    Review and evaluation   Disaster plan         Mutual aid

The Emergency Medical Services Act of 1973 established standards for the organization of emergency services. Prior to 1974, government involvement in emergency medical services was primarily limited to providing an emergency department in the public hospital. Private operators, predominantly funeral homes, provided emergency transportation.
Who provides EMS?

When a person becomes ill or injured and dials 911 or another emergency phone number, the call is answered by an EMS dispatcher, who is trained to obtain important information from the call-taker about the location and type of emergency. The dispatcher also may give the caller patient care instructions while sending emergency responders to the scene of the emergency. These responders may be trained to different levels:

* Emergency Medical Responders (who have about 40 hours of training)
;
* EMTs (who have about 110 hours of training);

* Advanced EMTs (who have about 200-400 hours of training); and

* Paramedics (who have 1,000 or more hours of training).

The training level of responders is a local decision and based upon local resources and the priorities of those who fund the EMS system. Each of these levels of EMS responders is trained to perform different kinds of skills to assist the patient

EMS responders work under protocols approved by a physician medical director. Many of these medical directors are members of the National Association of EMS Physicians. The medical director oversees the care of patients in the EMS system, and he or she is knowledgeable about patient care interventions and how EMS systems deliver care. Typically, EMS medical directors work in conjunction with local EMS leaders to assure quality patient care.

EMS care may be provided by a private ambulance company, fire departments, police departments, a public EMS agency, a private ambulance company, a hospital or by a combination of the above. EMS responders may be paid or volunteers in the community. 
What is a tiered EMS system?

Often EMS systems are "tiered." This means that different levels of providers may respond to a scene. In many EMS systems, it is common to have basic level EMS professionals (First Responders and EMTs) respond to a scene first. They are then followed by Advanced Life Support responders (paramedics). The structure of EMS response varies greatly around the United States based on location, resources, local leadership and history. 
How can I get a job in EMS?

In most locations in the United States, the first step you must take to work in EMS is to take courses to become a Emergency Medical Responder or Emergency Medical Technician (EMT). This is the minimum level of education that most EMS professionals have before entering the workforce. Individuals who work as firefighters or police officers may perform some emergency medical work when trained as Emergency Medical Responders. Some paramedic programs provide an all inclusive program that includes both EMT and paramedic training in one program. All levels of EMS training are set by the federal government through the National Highway Traffic Safety Administration. 
Where can I obtain EMT training?

EMT training is offered at many community colleges, technical schools, hospitals, universities and EMS, fire and police academies. If you are interested in EMT training, you should contact your state EMS office. If you are interested in paramedic training, you should contact the Committee on Accreditation for EMS Professionals. Both of these agencies will help you find local training in your area. .
How long is EMS training?

EMT training varies from two to six months, depending on the training site and hours of class scheduled per week. Some training programs have class every day for a couple of months for those interested in getting done quickly, while other, longer programs accommodate those students who have family, a full-time job or other responsibilities that limit their time available for education. Approximate training requirements are:

* Emergency Medical Responders - 40 hours of training
* EMTs - 110 hours of training
* Advanced EMTs - 200 to 400 hours of training
* Paramedics - 1,000 or more hours of training 
What does an EMT learn?

An EMT must be proficient in CPR, and training is centered on recognizing and treating life-threatening emergencies outside the hospital environment. An EMT learns the basics in how to handle cardiac and respiratory arrest, heart attacks, seizures, diabetic emergencies, respiratory problems and other medical emergencies. He or she also learns how to manage traumatic injuries such as falls, fractures, lacerations and burns. An EMT is also introduced into patient assessment, history taking and vital signs. 
What skills does an EMT perform?

An EMT can perform CPR, artificial ventilations, oxygen administration, basic airway management, defibrillation using an AED, spinal immobilization, vital signs and bandaging/splinting. An EMT may administer nitroglycerin, glucose, epinephrine and albuterol in special circumstances. 
What skills does a paramedic perform?

A paramedic performs all of the skills performed by an EMT. In addition, he or she performs advanced airway management such as endotracheal intubation. A paramedic obtains electrocardiographs (ECGs), introduces intravenous lines and administers numerous emergency medications. A paramedic assesses ECG tracings and defibrillates. He or she has extensive training in patient assessment and is exposed to a variety of clinical experiences during training.
Do EMTs and paramedics need a license?

Every state in the Unites States has a lead EMS agency or state office of EMS that determines requirements of EMS professionals in their state. Some state EMS offices issue licenses to EMS providers; others do not. All EMTs have to complete continuing education classes. 
How much do EMTs and paramedics earn?

According to the U.S. Department of Labor Bureau of Labor Statistics, EMT and paramedic earnings depend on their employment setting, geographic location, and training and experience. Median annual earnings of EMTs and paramedics were $25,310 in May 2004. The middle 50 percent earned between $19,970 and $33,210. The lowest 10 percent earned less than $16,090, and the highest 10 percent earned more than $43,240. Those EMS workers who are employed by fire or police departments receive the same benefits as other department workers.

Volunteers in general are not paid but some receive nominal monies for their services and some are able to earn pensions. Most EMS workers across the United States are volunteers. 
How many EMTs are there in the United States?

Estimates about the US market suggest that it has:

* 17,000 transporting ambulance services (includes fire departments)
* 26,000 fire departments (most of which provide some sort of EMS and about half of which offer ambulance          transport)
* 52,000 ambulances
* 600,000 EMTs
* 142,000 paramedics
* 1,009,000 firefighters (many of whom are cross-trained in EMS)

It is not known how many individuals are involved in providing EMS worldwide.

Are emergency response vehicles allowed to ignore traffic laws, such as stop lights?

Ambulance operations are governed by local and state laws, so there is not one answer that applies to all communities. That said, contrary to popular belief, emergency vehicles in most communities are not granted unrestricted right of way. In most cases, emergency vehicles must obey all signs and signals. For example, they must stop at a red light or stop sign before proceeding through an intersection. Sometimes, emergency vehicles operate contrary to traffic control devices when responding to an emergency, and sometimes, they exceed posted speed limits. However, even during these times, emergency vehicle operators must drive with due regard for the safety of the public.