Emergency Medical Technicians: Levels and Responsibilities

1. Health care careers Therapeutic services Emergency medical services

2. Emergency medical technicians… An emergency medical technician, or EMT, works as part of the emergency medical services system. Each state has their own certifications, but all types of technicians respond to calls for help… from gunshot wounds to workplace injuries, to childbirth.

3. First responders… The ‘first responder’ is the first to arrive at a scene. They have received approximately 40 hours in an approved training program, and usually work for industry, police, or fire departments.

4. First responders… • The first responder has 4 major responsibilities: • They safely gain access to the client, using hand tools if necessary • They identify what is wrong…the cause of the injury or the nature of the illness • They determine the number of clients • They request additional help when necessary

5. First responders… The first responder does not move or lift a client unless required, and then must do so without causing further injury.

6. Emergency medical technician: EMT-B There are three levels of emergency medical technicians: basic, intermediate, and paramedic. The “EMT – Basic” has received a minimum of 120 hours of approved training, including an internship. They are sometimes the first on the scene; they sometimes arrive in response to a call from first responders.

7. Emergency medical technician: EMT-B The EMT-B is the minimum level of certification for ambulance personnel. They are certified to provide basic life support… the use of oral and nasal airways, applying a cervical spine immobilization collar, use of an automatic external defibrillator, assisting a client in taking their own medications (such as nitroglycerine, Epi-pen, or inhaler) and immobilization of injuries to arms and legs

8. Emergency medical technician: EMT-B • The EMT-B has 6 major responsibilities: • Ensuring the safety of everyone in the area • Examining and interviewing the client • Provides basic client care • Lifting, moving, and transporting the client to a medical facility • Transferring care of client to medical facility • Speaking on behalf of the client by reporting • concerns/ findings to receiving medical staff

9. Emergency medical technician: EMT- I The “EMT – Intermediate” has received a minimum of 300-400 hours of approved training, including an internship. They perform all the same life support services as the EMT-B, and more.

10. Emergency medical technician: EMT- I The EMT – I can perform tasks above and beyond what the EMT-B is trained to do: • They can start an IV • They can perform advanced airline techniques • They can use a manual defibrillator to provide shocks to the heart • They can administer medications beyond those at the EMT-B level

11. Emergency medical technician: EMT- I The EMT – I can evaluate and manage clients that have been involved in accidents, cardiac, respiratory, and other medical emergencies.

12. Emergency medical technician: paramedic They have completed 1,000 or more hours of classroom, clinical, practical, and internship training. They may have an associate degree. The paramedic is the highest level of EMS professional.

13. Emergency medical technician: paramedic The paramedic can administer oral, intravenous, subcutaneous, and intramuscular medications. They can use monitors and more complex medical equipment.

14. Emergency medical technician: paramedic The paramedic uses all local communication tools to coordinate services, and has a thorough understanding of policies and procedures. They can assign care priorities, and develop an action plan. They possess strong leadership and decision-making skills.

15. Evaluating the scene… As the EMT arrives at the scene, they must assess safety for the provider, other responders, the client, and any bystanders in the area. The EMT must follow body substance isolation precautions. This includes the use of any personal protective equipment deemed necessary, such as gloves, face shields, eye protection, or protective gowns.

16. Evaluating the scene… The EMT must note the mechanism of injury. What caused the injuries or illness? A bomb? A gun? A car? No use of a seatbelt? The nature of the illness is also assessed by the EMT. What is the problem? Shortness of breath? Abdominal pain? Chest pain? Wounds?

17. Evaluating the scene… The EMT must determine the number of clients needing assistance, and then determine whether additional resources and personnel are needed.

18. Assessing the client… Once the scene has been evaluated, the EMT must 1. Form a general impression of the client’s condition and 2. Determine their level of responsiveness. Can they talk? Are there abnormalities in skin color? What is their facial expression? Are they in pain? How old are they? What are their living conditions like?

19. Assessing the client… 3. Determine if the airway open? In an unconscious or nearly unconscious person, the tongue may fall back and block the airway. There are two types of airway adjuncts (Ǎ junkts)(aids) that help maintain an airway. The oropharyngeal adjunct is inserted in the unresponsive client (with no gag reflex).

20. Assessing the client… The nasopharyngeal adjunct is inserted in the client who might gag on the oropharyngeal airway.

21. Assessing the client… 4. Determine if the client breathing adequately? If breathing is not present, the client will need breathing assistance. Oxygen therapy Bag-Valve-Mask Assistance

22. Assessing the client… 5. Assess circulation: pulse and bleeding If there is no pulse, the EMT would start chest compressions. If there is heavy external bleeding, apply direct pressure and dressings. A defibrillator detects an abnormal heart rhythm and shocks it back into a good rhythm.

23. Assessing the client… 6. The EMT must lastly assess priority. They must determine the urgency of the client’s condition and arrange for the immediate transport to a medical facility.

24. The EMT may take a client’s medical history… • The EMT might use the mnemonic ‘SAMPLE’ to take a patient’s history: • S… signs and symptoms • A… allergies • M… medications • P… pertinent past medical history • L… Last oral intake • E…Event preceding

25. Ongoing assessments… The EMT must continue to assess the client’s condition until they are transferred to receivers at the medical facility. It may not be until the patient is loaded into an ambulance that the EMT can re-evaluate vital signs and take a more thorough history.

26. EMTs need to communicate… The EMT must communicate with both the client and their families at a time of crisis. • Know and use the client’s first and last name. • Be respectful. • Try to be at eye-level. Watch body language. • Use eye contact. • Be honest. Tell the patient and family what procedures you are doing and if they are going to be painful. • Listen.

27. EMTs need to document… EMT’s do paperwork as documentation of information and actions. They must provide written reports that include the name, age, and address of the client. They must describe any information they gained by examining the client, any medications given, procedures performed, and vital signs.

28. EMTs may need special skills… The EMT may need many special skills to deal with many special situations, such as: Water & Diving accidents Emergency childbirth Spinal injury accidents

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