fire service and emergency medical care, or first
aid, have a long standing relationship. From the
contact with fire there has been the need to
minister to those who have been injured by it. It
the firefighters who rescued people from buildings
which were on fire. Fire engines carried first
aid equipment for most of the twentieth century.
advanced emergency procedures were developed
for first aid providers it was only natural to involve
service. While some cities, or other areas, have
placed the responsibility on private industry, or
of emergency service, EMS still is a large part
of any fire department. Fire apparatus now respond
to a large list of potential, or known, medical calls.
Fire companies respond on traffic accidents and heart
attacks, just to name two examples. For better or
worse, many cities are beginning to view medical
runs as a source of revenue that helps to support
or improve the level of care they can offer. No matter
how one may feel about the subject, EMS and the fire
is probably here to stay.
in the fire service has not come without resistance
and problems. Many departments, with strong unions
or other forces, have resisted the trend to have
their members trained as paramedics. In many departments
the older members would express that paramedics were
not "real firefighters". I have heard it
said that paramedics were afraid to fight fire and
why they volunteered for the job. But that thinking
is dying out as the old guys leave. EMS has been
in many fire departments since the mid 70's or early
80's. A very large percentage of today's fire officers
paramedics on an MICU. Many fire chiefs are now also
former paramedics. This is something almost unheard
ten years ago.
Types of EMS Workers
Texas EMS format can be used as a model for most EMS
systems. While there are variations between Texas and
other states, there is even enough variation within Texas
alone to give you that we could consider this just a basic understanding of EMS in general.
Medical Services, in general, appears to be a misunderstood
concept. But this is not just in Texas. People all
the U.S. sometimes seem to not know the difference
between an “EMT” and a “Paramedic”.
The following is how EMS is organized and run in Texas.
It is similar for just about everywhere in the U.S.
are national standards for EMS, but states can vary
some of the requirements and procedures. The medical
director for a system has the final say about many
things. He or she can forbid or allow just about whatever
they choose. There are national standards for things
like Advanced Cardiac Life Support (ACLS) and these
standards are adhered to in almost all jurisdictions.
states, including Texas, have adopted the standards
and tests of The National Registry of Emergency Medical
Note: Passing a NREMT exam does not automatically give
one a license or certification to work as an EMT. A
state or other jurisdiction can use this as just part of it's certification
process. A city might require that a paramedic be certified by the National Registry, the state and then tested and approved by the county or other medical director.
with the lowest amount of training, the following is
a description of the different levels of (Pre-hospital)
Services in Texas.
Care Attendant (ECA)
Basic First Aid - This is about the same as you would
get at a Red Cross first aid class. This usually includes CPR etc. They are often trained in the use of AED's on cardiac arrest patients. This
level is sometimes referred to as "First Responder" training. People
who may come in contact with the sick or injured, but patient care is
NOT their primary function, may be trained to this level. People such
as police officers and helicopter pilots often receive this training.
I recently received an email questioning this description of the "ECA"
certification. The email stated that ECA and "EMT-B" were about the
same and that "ECA's everywhere would be appalled to see
that your site says
they are trained. Especially after attending over 70 hours of classroom
time over many weeks." They also compared ECA to EMT-B. "The only 2
differences are Combi-Tube airways, and EMT-B's have many clinical hours
Please allow me to quote a couple other sites and I will let you decide.
of Texas -
"Texas has four levels of certification. The highest is paramedic,
followed by EMT-intermediate, EMT-basic and
emergency care attendant (ECA)." http://www.dshs.state.tx.us
"Emergency Care Attendant (ECA). Skills include: CPR,
bandaging and splinting, traction splints,
mechanical aids to breathing (oxygen, bag-mask, suctioning,
oral and nasal airways, pocket masks), patient assessment,
vital signs, spinal immobilization. Hours of training:
40 minimum." "First Responder exam
administered by National Registry." http://www.texasemt.com/
you Google - Red Cross ECA - you will see that they
offer what they consider to be an equivalent course.
Check out: http://www.lifesavercourses.com/academy_eca.html
It is possible that some jurisdictions train ECA's in special skills. Local medical directors can do whatever they want. It is also possible that the term has a different definition elsewhere. But I still don't think that the training described by the email I received pertains to "ECAs everywhere."
Medical Technician (EMT)
More training in anatomy - Can administer
Oxygen and recognize more serious conditions. They
are trained to provide spinal protection and will
often carry AEDs for heart defibrillation. Depending
upon the state, training consists of up to 280 hours
of training which includes hospital work and riding
on an ambulance. Some departments may refer to this
level as "EMT-B". This does not imply that
there is an "EMT-A" or an "EMT-C" level
of training. This usually means "EMT-Basic".
They consider the other levels as "Advanced" training.
There are states that refer to the different levels
of EMS training as "EMT I", "EMT II" and "EMT
III". Some areas may also call a basic EMT an "EMT-1".
In Canada you will find the term "EMA" which
stands for Emergency Medical Attendant. The different
levels are indicated by "EMA-1", "EMA-2" etc.
Medical Technician - Intermediate (EMT-I)
Assistant to Paramedic-Also sometimes called “EMT
Special Skills”. This person is trained to
start IV’s and perform other important tasks to assist
the Paramedic in performing Advanced Life Support. In truth, at times there might be very little difference between an EMT-I and a paramedic because the "special skills" they possess might be very similar to a paramedic's skills.
Medical Technician - Paramedic (EMT-P or “Paramedic”)
Performs “Advanced Life Support” (ALS) - Training is roughly
five to ten times that of an EMT. (Up to 1800 hours.) In order to enter
paramedic training one usually must already be trained as an EMT and in many
areas have completed classes in anatomy & physiology prior to enrolling. There
are EMS degree programs at some colleges. At least one state (Washington) is
reported to require a minimum of a two year degree to be a paramedic. Paramedics
are the eyes and
on the emergency scene. They can perform
certain medications prior to contacting a physician. The basic difference between
EMTs and Paramedics is what is called "invasive therapy". More plainly
put, this is the ability to break the skin or invade the body. They can also
interpret certain findings such as ECG's and some lab work that is done in
the field. After contacting their medical direction they can obtain permission
to perform even more procedures and administer additional medications. When
an “Ambulance” has paramedics and the proper equipment, it essentially
becomes a hospital emergency room on wheels, known as an “M.I.C.U.” (Mobile Intensive Care Unit)
confuse things more, there are several distinctions
Paramedics - They have completed a certified
training program. This includes training in anatomy
and physiology etc. They have also passed the nationally
prescribed exam for paramedic. These paramedics must
retake an exam every 2-4 years. (Depending upon national
certification and medical director.) They are also
required to complete 40 hours of continuing education
Paramedics - This person has received all
the required training and has a degree that includes
anatomy and physiology etc. The requirements for
regular retesting and continuing education are different
at this level. Note: Just because you see the "Certified" style
of patch does not mean that your paramedic is not
licensed or have a huge amount of training. The "licensed" patch
is new and many are not bothering to change it on
uniforms. Often cities do not pay for these patches
or the money that must go to the department of health
for the license. There is no difference in the level
or quality of care.
Paramedics - Trained for tactical operations.
These are usually part of a police tactical weapons
team. The patch is usually "subdued" in
color. This means gray and black colors only. The state certification for "Tactical Paramedic" has been around since the early 90's or before. (Although the use of them has been very slow to catch on.) These can be members of the police department or the fire or EMS department. They typically have to go through the SWAT / Tactical Weapons Training and SWAT tactics training. If fire department personel are used they can drive the SWAT armored vehicle since they already have the proper state lisense for that.
Practitioners - A somewhat new category. Highly trained.
Will be able to perform more advanced procedures
such as administering antibiotics and suturing. They
might have the ability to prescribe a limited list
of medications. These will probably be deployed in
areas of the state where medical attention or facilities
are scarce. (Anyone seen a patch yet?)
Charge of All the Paramedics is the "Medical
EMS system is under the watchful eye of a "Medical
This physician oversees the program. Prescription meds
and devices, under federal law, can't be purchased
or used without a doctor's orders. The Medical
is who authorizes all use of prescriptions. Sometimes
it is described as though all the EMS workers are
practicing medicine on this doctor's license. For
this reason the medical director has a right to
insist that he or she know that the workers are trained
and qualified to do the job. Medical directors
complete control over who works in their system.
If a medical director wants the people in their
system to be trained over and above the state minimum,
that is the way it will be.
directors will taylor a system for their area. For
example: Some Texas counties are hundreds of miles
across and may have a population of less than 10,000.
A medical response may take an hour to arrive and be
an hour (or more) to the nearest hospital. In these
counties, snakebites are common. EMS personnel need
to know how to deal with this and carry treatments.
But in other counties an MICU may never be more than
five minutes from a major hospital. For certain conditions,
such as the very rare snake bite, the treatment will
be just transport. Every region has it's own needs