As it matures as a profession, emergency medical services grows more complex and diverse. The recent definition of new practitioner levels--replacing the traditional hierarchy of First Responder, EMT-Basic, EMT-Intermediate and EMT-Paramedic--marks an important step in this process. Practitioners wishing to advance in their careers and help drive their profession forward should be familiar with this new structure, as well as the full breadth of professional options proliferating across EMS.
The new EMS practitioner levels, as described in the 2006 National EMS Scope of Practice Model are:
Emergency Medical Responder: The lowest level of responder, the EMR possesses simple skills to provide immediate lifesaving care for critical patients. The EMR can render on-scene interventions while awaiting additional resources and may serve as part of a transport crew, but generally will not be the primary caregiver. Licensure as an EMR requires completion of an accredited training program.
Emergency Medical Technician: The EMT conducts basic, noninvasive interventions to reduce the morbidity and mortality of acute out-of-hospital emergencies. They have all the EMR's capabilities, plus additional skills associated with patient transport. In many places EMTs provide the majority of out-of-hospital care, and in some places the highest level. Licensure as an EMT requires completion of an accredited course.
Advanced Emergency Medical Technician: The AEMT has all the skills of the EMR and EMT, and can also conduct limited advanced and pharmacological interventions. This level allows provision of high-benefit, lower-risk advanced skills by systems that can't support Paramedic-level care. In some jurisdictions, AEMTs may represent the highest level of out-of-hospital care. Licensure requires completion of an accredited course.
Paramedic: The Paramedic is an allied health professional who can conduct invasive and pharmacological interventions. Possessing all the skills of the lower-level providers, Paramedics can also conduct a broader range of interventions based on skills that are harder to maintain and pose greater risk to patients if done incorrectly. Paramedic care is based on advanced assessment and formulating a field impression. Licensure requires successful completion of a nationally accredited Paramedic program at the certificate or associate's degree level.
Beyond providing care in the field, many EMS practitioners seek positions in management. EMS systems are diverse in structure and scope, and may have unique positions and designations. A title such as Field Training Officer can mean different things in different organizations. Whatever positions are called, as systems grow, they are likely to develop increased vertical promotional opportunities. The National EMS Management Association has developed a framework to standardize EMS officer levels (supervising, managing and executive) and competencies, which it hopes will be nationally accepted.
Opportunities to increase the quality and scope of a practitioner's medical knowledge, and thus their career opportunities, are plentiful. Practitioners can pursue formal licensure in areas like critical care or flight medicine, or seek additional education and certifications from organizations like the National Association of Emergency Medical Technicians and American Heart Association. NAEMT offers popular courses like Advanced Medical Life Support (AMLS), Emergency Pediatric Care (EPC) and Prehospital Trauma Life Support (PHTLS), which typically come with instructor opportunities as well. The AHA also offers numerous courses (ACLS, PALS, CPR, AED, etc.) and opportunities to teach.
Call-taking and dispatch remain a vital first link of the emergency response chain and come with increasing responsibilities. Depending on a system and its coverage area, career opportunities may also exist in areas like wilderness EMS, special operations, special events, hazardous materials, quality management and other areas. EMS in America is only going to grow in coming years, and will have no shortage of ways for willing providers to embrace, advance and support their profession.