Since there has been some interest in a thread like this, and I had some free time on my hands, I decided to take a crack at laying out the groundwork on this thread. I hope that those interested in the field of EMS find it informative. Old guys, if you have suggestions, by all means let me know so I can add them to the OP



I have worked in EMS for 6 years now, 2 years as an EMT and 4 as a Medic. My first job was for a hospital-based ambulance service running both emergency and non-emergency calls. I now work as a Firefighter/Paramedic running only emergency calls, in addition to fire calls, while rotating between the ambulance and fire apparatus.



Editor's Note

I touch upon this a little in the following, but I'll add this:

It takes a special person to work as an EMT or Paramedic. We aren't heroes or supermen, but we are expected to deal with and work under stressful conditions, while reacting to situations that aren't covered in textbooks. You will get covered with blood, brains, shit, piss, and worse. You will have patients try to hit, bite, and scratch you while verbally abusing you. While working for about the same wage as a McDonald's employee in many cases.

Before you make the jump into the abyss, try riding out with a local ambulance service. Ride more than once, with more than one crew, so you can get an idea of what this job really entails. Some people are simply not cut out for this job, and even those of us that are have bad days when we question what got us here in the first place. I'm not saying this to discourage anyone from becoming an EMT or Paramedic, but I don't want anyone to think this is like on TV where everything is peachy at the end of every shift.
Nature of the Work

People’s lives often depend on the quick reaction and competent care of emergency medical technicians (EMTs) and paramedics. Incidents as varied as automobile accidents, heart attacks, slips and falls, childbirth, and gunshot wounds all require immediate medical attention. EMTs and paramedics provide this vital service as they care for and transport the sick or injured to a medical facility. In an emergency, EMTs and paramedics are typically dispatched by a 911 operator to the scene, where they often work with police and fire fighters.



Once they arrive, EMTs and paramedics assess the nature of the patient’s condition while trying to determine whether the patient has any pre-existing medical conditions. Following medical protocols and guidelines, they provide appropriate emergency care and, when necessary, transport the patient. Some paramedics are trained to treat patients with minor injuries on the scene of an accident or they may treat them at their home without transporting them to a medical facility.



Emergency treatment is carried out under the medical direction of physicians. The lead physician is called the Medical Director and signs off on the protocols the EMS system operates under. The protocol outlines the procedures and medications that the EMT/Paramedic may perform. They come in two forms. Online medical control, direct verbal contact with a physician, and offline medical control under written protocols. Depending on the area, each EMS service may have their own protocol, or each state or region may have a standardized set. Protocols vary widely in their scope and a Medic in one area may not be able to perform a skill that a Medic in another area can.



EMTs and paramedics may use special equipment, such as backboards, to immobilize patients before placing them on stretchers and securing them in the ambulance for transport to a medical facility. These workers generally work in teams. During the transport of a patient, one EMT or paramedic drives while the other monitors the patient’s vital signs and gives additional care as needed. Some paramedics work as part of a helicopter’s flight crew to transport critically ill or injured patients to hospital trauma centers.



At the medical facility, EMTs and paramedics help transfer patients to the emergency department, report their observations and actions to emergency department staff, and may provide additional emergency treatment. After each run, EMTs and paramedics replace used supplies and check equipment. If a transported patient had a contagious disease, EMTs and paramedics decontaminate the interior of the ambulance and report cases to the proper authorities.



EMTs and paramedics also provide transportation for patients from one medical facility to another, particularly if they work for private ambulance services. Patients often need to be transferred to a hospital that specializes in their injury or illness or to a nursing home.



Beyond these general duties, the specific responsibilities of EMTs and paramedics depend on their level of qualification and training. The National Registry of Emergency Medical Technicians (NREMT) certifies emergency medical service providers at five levels: First Responder; EMT-Basic; EMT-Intermediate, which has two levels called 1985 and 1999; and Paramedic. Some States, however, have their own certification programs and use distinct names and titles.



EMT-Basic (EMT-B) represents the first component of the emergency medical technician system. An EMT trained at this level is prepared to care for patients at the scene of an accident and while transporting patients by ambulance to the hospital under medical direction. The EMT-B has the emergency skills to assess a patient’s condition and manage respiratory, cardiac, and trauma emergencies using only Basic Life Support (BLS) techniques.



EMT-Intermediate (EMT-I) has more advanced training. Generally, they are allowed to intubate and start IVs as well as give a limited number of medications. However, the specific tasks that those certified at this level are allowed to perform varies greatly from State to State.



EMT-Paramedic (EMT-P) provides the most extensive pre-hospital care. In addition to carrying out the procedures of the other levels, paramedics may administer drugs orally and intravenously, interpret electrocardiograms (EKGs), perform endotracheal intubations, and use monitors and other complex equipment. However, like EMT-Intermediate, what paramedics are permitted to do varies by State.





Working Conditions

EMTs and Paramedics work both indoors and out, in all types of weather. They are required to do considerable kneeling, bending, and heavy lifting. These workers risk noise-induced hearing loss from sirens and back injuries from lifting patients. In addition, EMTs and paramedics may be exposed to diseases such as hepatitis-B and AIDS, as well as violence from mentally unstable patients. The work is not only physically strenuous but can be stressful, sometimes involving life-or-death situations and suffering patients.



The working hours for EMTs and Paramedics vary wildly. Many services use the 24 hours on/48 hours off shift schedule, but 8, 10, 12, and 16 hour shift schedules are used as well. You will work on holidays, birthdays, and anniversaries. You will be awake when everyone else is asleep, and asleep when everyone else is awake. Because emergency services function 24 hours a day, EMTs and Paramedics have irregular working hours.





Training, Other Qualifications, and Advancement

A high school diploma is usually required to enter a formal emergency medical technician training program. Community colleges, Hospitals, and EMS agencies all may offer EMT and Paramedic training programs.



EMT-B school is usually about 3-months long, although there are accelerated programs out there. It consists of both classroom and clinical rotations (riding on the ambulance), after you finish you will be eligible to take the National Registry or state test, depending on how your state certifies EMS providers. EVERY EMS provider was once an EMT-B.



At the EMT-I level, training requirements vary by State. The nationally defined levels (EMT-Intermediate 1985 and EMT-Intermediate 1999) typically require 30 to 350 hours of training based on scope of practice. Students learn advanced skills such the use of advanced airway devices, intravenous fluids, and some medications.



The most advanced level of training for this occupation is EMT-P. At this level, the caregiver receives training in anatomy and physiology as well as advanced medical skills. Most commonly, the training is conducted in community colleges and technical schools over 1 to 2 years and may result in an associate’s degree. Such education prepares the graduate to take the NREMT examination and become certified as a Paramedic. Extensive related coursework and clinical and field experience is required. Refresher courses and continuing education are available for EMTs and paramedics at all levels.



Licensure All 50 States require certification for each of the EMT levels. In most States and the District of Columbia registration with the NREMT is required at some or all levels of certification. Other states administer their own certification examination or provide the option of taking either the NREMT or State examination. To maintain certification, EMTs and paramedics must recertify, usually every 2 years. Generally, they must be working as an EMT or paramedic and meet a continuing education requirement.





Advanced Certifications

There are also some advanced certifications available for EMTs and Paramedics, generally these are not 'official' certifications recognized by the state, but might be required for certain jobs.



Flight Medic/Critical Care Paramedic - these certs generally go more in depth on things like pathopysiology and teach the Paramedic some even more advanced skills. Critical Care generally focuses on inter-facility (hospital-to-hospital), while Flight Medics make scene calls and run inter-facility calls. Often work in conjunction with a Nurse and sometimes other medical professionals like Respiratory therapists. While I have no experience with flight medicine, those I have talked to say the FP-C exam is THE hardest exam they have ever taken.



Wilderness - basically remote/austere medical provider, takes into consideration factors like prolonged extraction / transport times (hours or days instead of minutes); may include a neat thing known as an "Expanded Scope of Practice" (XSOP) that allows the provider to perform additional skills, treatments, and/or meds that would be outside the purview of a normal, transport based EMT; things like Toradol, suturing, or reduction of fractures to enable moving the pt.



Coal Mine - adds a lot of confined space training and addresses the operational problems of working in a mine environment (in Illinois it actually used to be a state recognized certification level)



Industrial - the training for this recognizes the provider in a non-transporting occupational health care setting, say as a replacement for the old "factory nurse". Usually able to provide (or "offer") OTC medications for the patient to self-administer, apply ice packs, band aids, and know when to involve the established EMS for the area.



Tactical - a close cousin of the Wilderness training, this specialty evolved from the military in a much closer style than the way the original EMT program did.



This specialty has many alphabets:

TEMS (Tactical Emergency Medical Support)

TOMS (Tactical Operations Medical Support)

EMT-T



TEMS folks are taught that it's OK to not sit 3 blocks down the road waiting for the scene to be safe as indoctrinated in class. Their patient demographic is generally the SWAT guys, hostages/victims, and the bad guys while they're in the area of operations. Once they're removed from the scene, they usually get released or turned over to the "regular" EMS for Xport to the  ER.



The training for this specialty recognizes that gunshot wounds generate specific injuries, and are treated differently on the battlefield or in an active tactical environment, especially when the patient needs to be able to still function to a large degree and cannot revert to the conventional incapacitated patient model normal EMS assigns to most injured people. As an example, tourniquets (which have been proven - again - to be highly effective and non damaging <6 hours by the military), the bane of EMT instructors since the first orange book, are not only accepted, but recommended. Needle Chest Decompression, normally a  "P" level skill, may be taught to a "B" as part of their "Expanded Scope of Practice" (XSOP).



The training also recognizes that in a prolonged setting (SWAT stands for Sit, Wait And Talk after all ) folks that are standing around in full body armor and associated kit may need "maintenance" medicines like Immodium, Tums, or Tylenol - OTC medications that traditional providers cannot administer. TEMS folks can generally provide these to folks on scene as part of their XSOP.



TEMS folks may be armed or unarmed; they may be used as a fluid members of the team and rotate through the various positions or be stationed in a defined spot in the stack; they may move with the team or they may establish a "stronghold" (usually the first room or defined defendable area the team enters) and have the SWAT guys bring any patients to them.





Employment

EMTs and paramedics held about 210,700 jobs in 2008. Most career EMTs and paramedics work in metropolitan areas. Volunteer EMTs and paramedics are more common in small cities, towns, and rural areas. These individuals volunteer for fire departments, emergency medical services, or hospitals and may respond to only a few calls per month. About 30 percent of EMTs or paramedics belong to a union.



There are several types of EMS services:

Volunteer- run by unpaid volunteers, usually seen only in rural areas. 911 calls only for the most part.

Private- not associated with a government agency or hospital, usually has the least stringent employment standards. Run a LOT of non-emergency transports taking Grandma from the nursing home to the Dr. office, dialysis, etc. May have some 911 contracts.

Hospital-Based- associated with a hospital or hospital(s). A lot of non-emergency transports, some critical care and 911 (emergency) transports.

3rd Service- run by the government, but separate from Fire and Police (hence '3rd Service'). Mostly 911 calls, some non-emergency calls

Fire-based- run as part of the Fire Dept. May be staffed by cross-trained firefighters or by single-certified EMS providers that only ride on the ambulance. Almost completely 911 calls, very few FDs run non-emergency transports

Police-based- like fire-based, but run by the police dept. Very rare to find this type of EMS service.

Remote Paramedic - works in remote locations. Commonly employed in the
oil and gas industry. Typical assignment is offshore on board a
drilling rig or production platform working a 7/7, 14/14 or 21/21
schedule. In addition to the standard certifications, remote paramedics
are often required by their employers to have several years of
experience as well as PHTLS, AMLS or other similar training. Also,
remote paramedics usually receive additional training in suturing and
antibiotic therapies and have access to several other emergency
medications not typically carried on an ambulance. Remote paramedics
mainly practice clinical-type medicine, however traumatic injuries can
be fairly common. Remote paramedics are usually assigned various other
non-EMS related duties while working. Remote paramedic pay tends to be
fairly higher than that of a paramedic working on an ambulance.



Getting a job in EMS

Some of this may be a repeat from sections above.



Most places will require you to be certified before they will hire you. Some EMS services will train you as an EMT/Medic in exchange for a term of employment there (usually private or volunteer services), and a few will train you completely on their own dime (usually limited to Fire Departments). Most community colleges will have an EMS program, and many hospitals and ambulance services will offer them as well. If you are interested in becoming an EMT, call whoever runs EMS in your area and ask if you can ride along in your area. Some places will let you, some places won't. Many EMS programs are designed so you can work full-time while you are in school, especially once you are in Paramedic school, since you should be working to get experience anyway.

Testing sucks. Most states use National Registry for certification. I hate them, you will too once you have to deal with them, but they are the only game in town and you don't have a choice. They have gone to computer-based testing since I took my Medic test so I do not know how it all works now.

Once you are finally certified you will need to find a job. You will probably have to start out like most folks working for the local ambulance service running gomer totes (non-emergency transports) taking people from the ER back to the nursing home, taking people from the nursing home to the doctor's office, dialysis, etc. I hated every second of it, but it was worth it to get where I am now. Usually the 3rd Service and Fire-based EMS services pay the best, have the best working conditions, and run mostly 911 calls (which is why you got in EMS right?), but they are also the hardest to get into. You will have to test with others competing for a limited number of spots, take and pass physical agility tests, psychological exams, polygraphs, and interviews.



Job Outlook:

If you are certified as an EMT or Paramedic, you can find a job pretty easily. However, if you are inexperienced, you will start at the bottom of the rung like in every other profession, doing the jobs no one else wants to do. Also, the pay, well it sucks. As a green EMT you will probably not make much more than minimum wage. As a Paramedic, you might make a couple of dollars more. Usually the Fire Departments and 3rd Services pay the most and have the best benefits, which is why they are more competitive to get into.

There is really no advancement in EMS after Paramedic. You can go on to be a supervisor or flight medic, but that's about the extent of it, which is why you don't see a lot of older folks in EMS.
Helpful Links

National Registry of Emergency Medical Technicians

National Association of Emergency Medical Technicians
Special thanks to Tango7 and JBE for specific contributions.

Thats it for now guys, I'm sure I will find things to add/edit later and others will be pointed out to me. We have a great crew of experienced EMTs and Paramedics here and we are happy to answer any questions anyone might have




 

I'd humbly suggest that those considering it as a career check and see about 3rd riding with local agencies.  Lots of EMT's made it through school, clinicals, and the NR practicals and test only to find out later that couldn't deal with some of it.  And they had no clue because like a lotta people, they didn't run into much at all in clinicals.

Oh, and great job, that's a ton of great information.

Excellent post.

But please heed Dusty's advice. I have seen too many folks who kicked ass in school, but fell apart on the street. EMT's, Paramedics, and RN's.

It ain't all Johnny and Roy (Squad 51 for you youngsters). It's real. Be ready.

Florence Nightingale died of syphilis by the way.

Great writeup Zoot!

Like Dusty said, make sure its something you can handle first. Getting your EMT-Basic and running as a volunteer is a great way to see if its something you want to do as a career. Also keep in mind if you have zero desire to become a firefighter, it is becoming harder and harder to find non fire based EMS jobs that respond to strictly 911 calls. Most departments, at least in my area, require both Firefighter II and EMT-Paramedic for full time, and EMT-Basic and Firefighter I for part time. More and more, EMS and firefighting are become the flip side of the same coin.

like already stated, it takes a special person to do this job...the stress is amazing, the human element (empathy, compassion, bystanders, family members), these things can really get quite overwhelming and it takes a lot of stress management skill to get past some of them. You will see terrible things and you will see amazing things, and people will amaze you.

thanks for the write up man, much appreciated!

Great post, thanks

Great write up!  I've run EMS for 6 years and love it.  You gotta have the guts for it though.  Can't be afraid of blood.

CMS

Tango, I will add that stuff to the OP, but it will be a couple of days because I gotta work tomorrow and don't have time to do it now  

Just remember the NUMBER ONE rule of EMS (After don't piss off the dispatcher).  If it's wet, warm and sticky and it ain't yours DONT TOCH IT!

Can't make this shit up - I love it :P

I am trying to get into EMS. Got my Basic and have applied with everyone around. One company interviewed my, but the pay is at poverty level. My in hospital job pays much better. The other company here treats their people like crap. I finally found a volunteer position to get the experience in. Hopefully one day I can get into a Paramedic program. But the options in this area suck.

My 2 rules of EMS taught to me long ago:
1.  People Die
2.  You can't change rule number 1

Great post.  I have been in EMS for quite awhile starting with a volunteer department than a private 1st tier service and now on a fire department as a ff/paramedic.  It's a long, boring, hard and sometimes shitty road but for the most part is a very rewarding career and plus it can be downright fun!  Don't expect to get rich however!  Goodluck to anyone looking to make this a career!

I've seen it done.  I know a medic that runs with about 5 different services in 2 counties.  He works 100-110hrs a week.  He loves it though and he's single so he can make it his life.  If you want to have a family and expect to stay married...I dont' think this would last very long so yeah...you're right.  Unless you get in on a bigger city dept (read pop. of over 100K) you're probably not going to get paid shit.  Nearest city to me of about 60k people only pays $16 an hour for Paramedics, and like $11/hr for techs.  Unless you're shooting for a supervisor position you probably don't want to make it a career in a smaller town.

It is very hard to make a living working solely as a paramedic. I worked hard and got on with a good-paying fire dept., but some guys just don't want to do fire. Unfortunately, outside of a few 3rd service EMS services and maybe some hospitals the pay is very low. Before I got on the FD I worked at a hospital based EMS service and when I left I was making $9.00/hr as a Paramedic. Granted it was in an area with a very low cost of living but that is still a pathetic wage. How does anyone expect to hire and retain GOOD paramedics and EMTs, especially when you can get your RN and make $25/hr minimum (I know that is what the ER at my hospital paid their nurses).
Unfortunately this means there are a lot of mediocre Medics and EMTs that shouldn't really be working but no one else would work for that kind of chump change. Plus nursing has a LOT more upward mobility and is a lot less stressful physically on your body.
Most of the people from my Medic class either went to work for a FD or went on to nursing school, and those that didn't fall into the 'mediocre' category.
It is a vicious circle because people don't want to pay lazy and poor-performing people good money, but the motivated EMTs and Medics quickly move on because of the low pay and they get tired of working with idiots.

Great Post!

You are definitely right about it being an uderappreciated and under compensated profession. If you are serious about EMS you will have to go FD if you want a long term career. Burnout factor is very high and FD can give you better upward mobility, pay and benefits. I have been an FD medic for 17 years now and have finally got enough time to fly in our departments aviation unit. Flight medic for FD is the ultimate EMS job IMHO.

I put in 15 years and the highest I was paid was $9.50/hr for 24/48 shifts. As an EMT-Paramedic level.

It came a time I had to just lay it down and walk away. I make no apologies as I have served my time.

Mine was mostly all private services because no one wanted to hire someone with hearing-aids in a public service, and pray that you heed, private companies with few exceptions will treat you like pure dirt. Work 24 hrs and transport 19-20 patients and be forced to be held over another 4 hours mandatory overtime because call volume is too high to allow shift change.

No wonder a lot of folks working there have anger issues and are on medication for high blood pressure, diabetes, and 35 year old heart patients.

Wouldn't trade the experience for anything and happy I did it, but if I knew.....I would have stuck to welding.

My textbook says the following:

In this job, you will be the first person some people see when they are born. And you will be the last person some people see when they die. Every one of these times is an honor.


Both of them are very stressful in their own way, especially on the side of the road.  

Just BTT and keeping it outta the archives for those that are still thinking about being a Hose Dragger or a Duct Tape Medic.  

-SleeperShooter

Local volunteer ems is hurting bad for bodies, and since I don't do anything on weekends (geo bachelor), and always wanted to do it, I'm seriously looking into it.  Any advice?



Orange County NY.

You just have to look around for the good paying jobs and be willing to relocate.  There's a 3rd service in the county I work in that starts brand new, fresh out of medic school medics at 43k/year on 24 hour shifts.

Are you wanting to get paid at some point, or just stay as a volunteer? Most volunteer outfits will put you through EMT-Basic training in exchange for two years of volunteering or something like that. It would definitely be a good way to get experience.

You will not earn very good money as an EMT-B, so if you make it a career you will probably want to go to Medic school.



 

Not looking to get paid, I have a very well paying job and career that I'm not interested in leaving.  The motivation to do this is, the department is hurting for volunteers and the training and experience is in my opinion worth its weight in gold.





 

No reason not to do it then. Show up or call them up and get details.

I notice there's no mention of working as an offshore (a.k.a. "remote" or "advanced-practice") paramedic....

Well I don't really know a lot about it, other than you can work on oil rigs, so if you want to write a blurb about it up I'll edit it into the OP.



 

I don't mind....I'll work on it over the weekend while things are slower out here....It's a good, alternative job pathway for a paramedic who's ready to get off the streets or just do something completely different...Pay is much better too.....

I IM'd you on the site with what I wrote up. Let me know if you didn't get it.

OP updated with some new info, minor edits, etc. Anyone with input I'm always open to improving the thread. As always thanks to those who have contributed.

two more basic rules that I learned recently.

1. Air goes in and out
2. Blood goes round and round.

If one of those isn't happening, FIX IT!!

This thread has been highly disappointing for me, I am in my early 20's currently working in the home healthcare field, but I have started to research the process of becoming a Paramedic, but from what I'm reading it sounds like it isn't even a career choice.

I can only speak for Texas, but there are few places you can go and only do EMS that have real career progression and decent benefits. I work for a fire department that also does EMS so I have career opportunities (in fact I just promoted and no longer ride the ambulance) and benefits. There are some third-service providers that do, though.

Outside of that, I'm seeing a lot of the more experienced medics with any sort of career goals go on to nursing school, PA school etc. As you get older the idea of lifting 300+ lbs with only one other person @ 3 am gets less appealing. Back injuries are extremely common in EMS.



 

Thank you very much for taking the time to write all of that up. I just started a thread basically asking for all of this info

I'm starting courses to get my EMT-basic cert this fall. My goal is to hopefully become a medic at a fire department.

Thank you again!

Hey zoot, just a suggestion, take it for what it's worth. You may want to insert some things about EAP. I know of a couple of people who got themselves in over their head early and had no idea how to cope. I realize this isn't exactly the scope of what you posted, but may be a helpful thing for newbies that don't understand what they have gotten into til it's too late. You may inadvertently save someone from themselves.

Although I've got no problem with adding it to the OP, I think that might be a better thing to have its own thread in BOTS, since it would be relevant to everyone.

 

Valid point. I guess a better point might be made in letting people know that you may find calls that stick with you and one way or another you need to find positive ways to cope. I am lucky in that I am basically Teflon, but many new emt's and medics are not that lucky. I think it is important for people to figure out that support system before they really need it.

Awesome thread by the way.