Provider levels and the EMT's role

1. You findYou arrive at a scene with hazards: leaking fuel and moving traffic.You doPersonal safety comes first, then the safety of your crew, the patient and bystanders. You work alongside the other public safety professionals on scene to make it safe.
2. You findYou reach the patient.You doAssess before you treat. Patient assessment always comes before patient care, because you cannot treat what you have not found.
3. You findYour findings do not give you enough to decide what to do.You doAsk more questions or examine the patient further before you act. Critical decision making means gathering information from the scene, the assessment and other sources, and putting it all together.
4. You findThe patient has been assessed and cared for and needs to go to a hospital.You doLift and move the patient safely, then transport. Think about the destination: the closest hospital is not always the right one when a specialty center is available.
5. You findYou arrive at the hospital.You doTransfer care to the hospital staff. A patient is never abandoned before that transfer is complete. Throughout the call you act as the patient's advocate.

• Four national levels, least to most training: emergency medical responder (EMR), emergency medical technician (EMT), advanced EMT (AEMT), paramedic.
• EMR: often first on scene; activates EMS, gives basic care for life threats and controls the scene. EMT: the minimum certification for ambulance staff; basic medical and trauma care, and transport.
• AEMT: everything an EMT does, plus advanced airway devices, IV and IO fluids, and some medications. Paramedic: all of that plus advanced assessment and decision making; the highest prehospital level.
• Order of responsibilities: your safety; the safety of crew, patient and bystanders; assessment; care; lifting and moving; transport; transfer of care; patient advocacy throughout.
• Physical traits: good health and fitness, able to lift and carry 125 lb (57 kg), good near and distance vision, functional color vision (skin, lip and nail bed color are clues), clear speech and good hearing.
• Personal traits: pleasant, sincere, cooperative, resourceful, a self-starter, emotionally stable, able to lead, neat and clean, a good listener who is nonjudgmental and fair. No alcohol within 8 hours of duty and no smoking on duty.
• The role reaches past the call: community health and injury prevention, such as noticing fall hazards or poisoning risks in a patient's home.

The wrong idea: The patient always comes first. A good EMT runs straight to the person who needs help.

What is actually true: Your own safety comes first, then your crew, then the patient and bystanders. An EMT who is hurt cannot help anyone and becomes a second patient. Putting the patient first comes after the scene is safe, and it shows up as assessment, care and advocacy.

Prehospital providers are trained to four national levels: EMR, EMT, AEMT and paramedic. The EMT is the minimum certification for ambulance staff and gives basic medical and trauma care and transport. An EMT thinks by gathering information from the scene and the assessment, putting it together, and getting more when it is not enough. Responsibilities run in order: personal safety, the safety of others, assessment before care, safe lifting and moving, transport, and transfer of care without abandonment, with patient advocacy throughout. The job asks for fitness (lifting and carrying 125 lb), good vision including color vision, clear speech and hearing, and steady, fair, professional conduct.

Education, the Registry, quality improvement and medical direction →