Paramedic, EMT, ALS, First Responder, BLS, EMR, and ambulance driver — so many titles, but what is the difference? This month’s article is going to focus on the certification levels of Emergency Medical Services. The acronyms for the EMS levels of certification are EMR, EMT, AEMT, and EMT-P, respectively. What do those acronyms really mean?
EMRs or Emergency Medical Responders: This individual possesses the basic knowledge and skills necessary to provide lifesaving interventions while awaiting additional EMS response and/or to assist higher-level personnel at the scene and during transport. Some of their skills include obtaining accurate blood pressures and assisting with a patient’s breathing along with administration of oxygen. EMRs can provide High Performance CPR competently, use an AED or Automated External Defibrillator, and assist a choking adult, child or infant. An EMR knows emergency bleeding control procedures and can perform neck spinal stabilization and splinting of broken bones. They may assist a patient with their EPI Pen or rescue inhaler or administer Narcan to an opioid overdose. On rare occasions they may also assist with an uncomplicated birth. The amount of schooling is approximately 48-65 hours and the individual must be at least 18 years old.
EMTs or Emergency Medical Technicians: Most Emergency Medical Services careers start at the EMT level and are certified to do all the EMR skills listed above, and have more extensive training. EMT certification is the minimum licensure level for caring of patients during ambulance transports to hospitals. They may do more advanced airway treatments, including placing basic airway devices; monitoring oxygen levels; acquiring cardiac monitoring; use of spinal immobilization techniques, including long board and extrication devices; use of traction splints; intramuscular injections of certain medications; blood sugar monitoring and automated blood pressure monitoring along with limited emergency oral medication administration, such as aspirin or nitroglycerin for chest pain; and oral glucose for certain diabetic issues. EMTs may also occasionally assist with a complicated birth. The amount of education is approximately four months and a minimum of 150 hours of training. This level also has the ability to add to their credentials with additional training such as IV and IO (intraosseous or “bone”) technician as well as EMS Evaluator certifications.
AEMTs or Advanced Emergency Medical Technicians may practice all the above listed in EMR and EMT levels of training. They also have a larger medication administration privilege, in addition to the ability to monitor and interpret CO2 (carbon dioxide) levels; immunizations; subcutaneous (under the skin) and IV medication delivery. The instruction time increases with an additional 200 hours of training.
Paramedics have a much more in-depth level of training and can perform many emergency medical procedures. In addition to all the above skills, some of the other procedures they are trained to do include needle decompression of a lung or chest; cricothyrotomy procedure; DAI, or Drug-Assisted Intubation, using paralytic and sedation medications; cardiac monitoring and interpretation and treatment of life-threatening rhythms; expanded medication for pain control; infusion of blood and blood products; and administration of medicated IV fluids. Paramedic initial training in Washington State requires attending a Paramedic Program which may last anywhere from 10 months to two years, depending on the agency or school doing the teaching. It is a very intensive course that prepares the paramedic for a broad range of medical and trauma emergencies. The training consists of 1,200-1,800 total hours. Approximately 700 hours of classroom time, at least 270 hours of supervised hospital clinic time, and 360 hours of supervised field internship.
A recent Coyote Trail rescue in the Lyle Fire District, with other mutual aid fire districts and Klickitat County Search & Rescue.
Photo courtesy Suzanne Gilmer
Each level of certification in Washington State is required to practice under the direct or indirect supervision of a county Medical Program Director or MPD. MPDs are licensed physicians. Each level has nationally recognized skills and follows their MPDs protocols for their certification level. Regular ongoing training is also required throughout the three-year certification cycle.
As for the differences between BLS and ALS and a First Responders role, look to one of the upcoming articles when we will dive into these subjects!
KCEMS1 Fun Fact: Directly from EMS.gov, May 19-25 marks the 50th Anniversary of EMS Week. This year’s theme, “Honoring Our Past. Forging Our Future,” reminds us to acknowledge the foundational work of those who came before us, while also striving to build and lead the EMS system we envision for our future. In the 50 years since we’ve been celebrating EMS Week, our profession has made enormous strides in pre-hospital care, data collection, emergency management and community-based healthcare. We’ve developed comprehensive EMS systems that are ready for any kind of emergency–seven days a week, 24 hours a day–whether or not that includes going to the hospital.
KCEMS1 Safety Tip: May is Motorcycle Safety Month and Bicycle Safety Month. The absolute number one piece of advice is to BE VISIBLE. Stay aware and make sure other drivers and users of the roadways can easily see you. Remember you are smaller than other vehicles and less protected in the event of a crash. Bright clothing and helmets help, as do lights and reflectors. Both motorcyclists and bicyclists must follow the same rules as cars. This means stopping completely at all stop signs, adhering to traffic signals, indicating an intent to turn, watching carefully for obstacles and yielding the right of way to pedestrians at legal street crossings. Good information for both motorcyclists and bicyclists can be found at the National Highway Traffic Safety Administration, NHTSA.gov and the National Safety Council at NSC.org. Stay safe out there!
KCEMS1 statistic: In Washington State 1,955 motorcycle crashes happened in 2022. Of those crashes, 131 were fatal.
•••
Katharina Larson is a paramedic and Suzanne Gilmer an EMT-IV technician with Klickitat County EMS District No. 1. Additionally, both are members of the IAFF Local 5172, Professional EMS Providers of Klickitat County.
Commented