EMS (emergency medical services) can be an exciting, rewarding job for those who enjoy helping others, but there’s a lot to know before deciding if it’s a career for you. Here are answers to some frequently asked questions about the EMS profession.
What does EMS stand for?
One of three primary branches of the emergency services (along with police and firefighters), emergency medical services, commonly known as EMS, is the provision of emergency and unscheduled medical care outside the hospital setting, typically by specially trained paramedical professionals.
EMS operates within a limited scope of practice defined by state law, and its providers generally stabilize and transport sick and injured patients to definitive care at hospital emergency departments. Under modern delivery models, they may also assist patients in managing ongoing issues in their homes. Since the COVID-19 pandemic, efforts have also grown to let EMS treat some patients and refer them to advanced care without transport or take them to alternative facilities.
In many advanced countries EMS is summoned by calling a universal three-digit emergency number. In the United States that number is 911.
When did EMS begin?
EMS has its roots in battlefield medicine and the care of combat casualties. Baron Dominique Jean Larrey, surgeon to Napoleon’s Imperial Guard, first developed many of its concepts, including the use of ambulances to take the wounded to field hospitals. Larrey also pioneered the practice of triage.
The first American ambulance corps emerged in 1862, established by Major Jonathan Letterman to evacuate battlefield casualties during the Civil War. The idea was successful and spread throughout the Union army. The first civilian ambulance service followed in Cincinnati in 1865.
Into the 20th century, EMS in America was delivered by first aid and lifesaving services, hospitals, funeral homes, fire departments, tow companies and other volunteers. What is considered the modern era of American EMS began with the 1966 publication of the National Academy of Sciences’ defining “white paper,” “Accidental Death and Disability: The Neglected Disease of Modern Society.”
The paper’s gist was that accidents, including those on roadways, were the leading cause of death for young Americans, and their emergency trauma care was insufficient, leading to lives needlessly lost to treatment delays and lack of organized response. The paper recommended the creation of formal systems of emergency medical care, better training for providers and improved collection of data. This subsequently led to major reforms and the establishment of modern EMS care systems in the U.S.
What is EMS?
EMS is the provision of emergency and unscheduled medical care outside the hospital environment. In addition to the EMTs and paramedics who deliver such care, the term may also encompass the call-takers, dispatchers, first responders such as firefighters and others involved in patients’ broader care continuum.
EMS providers stay ready to respond to calls requiring medical assistance; assess patients’ conditions and determine immediate courses of treatment; provide appropriate life support, first aid and/or care in the field to sustain life and reduce suffering; transport patients who require further care to hospitals or definitive destinations; transfer their care to higher-level personnel, providing reports that outline their findings and interventions; and then clean, restock and prepare their vehicles for further calls.
As their capabilities and equipment have advanced, EMS providers have come to offer higher levels of care than the historical “scoop and run.” EMS personnel are now recognized as an essential line of early defense against time-critical conditions like cardiac arrest, stroke and severe trauma.
Who delivers EMS?
The National EMS Scope of Practice Model, published in 2019, defines four levels of emergency medical services providers:
Emergency Medical Responder (EMR) – EMRs “initiate immediate lifesaving care to patients while ensuring patient access to the emergency medical services system.” Often the first-arriving responders to scenes, they have the basic training to act against immediate life threats while awaiting the arrival of higher-trained EMS providers. In rural areas and places with low call volumes, EMRs may provide the only care patients receive for long periods. The limited scope of EMR education makes it a viable certification for those who may be required to provide emergency care but for whom it’s not a primary job function, such as police, firefighters, lifeguards, wilderness personnel, etc.
Emergency Medical Technician (EMT) – The EMT’s primary duties are to “respond to, assess and triage emergent, urgent and nonurgent requests for medical care, apply basic knowledge and skills necessary to provide patient care and medical transportation to/from an emergency or health care facility.” They may be the highest level of provider to care for patients in some EMS systems. With proper supervision, they may also work in hospitals and health care facilities, and in community paramedicine settings, they may also visit patients at their homes for ongoing care and oversight. EMTs comprise most American EMS providers.
Advanced Emergency Medical Technician (AEMT) – AEMTs’ focus is to “respond to, assess and triage nonurgent, urgent and emergent requests for medical care, apply basic and focused advanced knowledge and skills necessary to provide patient care and/or medical transportation, and facilitate access to a higher level of care when the needs of the patient exceed the capability level of the AEMT.” Additional training beyond the EMT level allows AEMTs to deliver care for common conditions in which “reasonably safe, targeted, and evidence-based interventions exist,” including pharmacological interventions. These interventions may come with more risk if done incorrectly than those of the EMR and EMT. Besides EMS, AEMTs may also work in hospitals and other health care settings.
Paramedic – The highest level of EMS provider (though specializations and additional certifications exist), paramedics “respond to, assess and triage emergent, urgent and nonurgent requests for medical care, apply basic and advanced knowledge and skills necessary to determine patient physiologic, psychological and psychosocial needs, administer medications, interpret and use diagnostic findings to implement treatment, provide complex patient care, and facilitate referrals and/or access to a higher level of care when the needs of the patient exceed the capability level of the paramedic.” They may work in a variety of health care and community settings.
Their high levels of academic preparation equip paramedics to operate various pharmacology, airway and monitoring devices and use their critical thinking and decision-making skills to make difficult care decisions. EMS systems are increasingly requiring college degrees for paramedics.
How do I get a job in EMS?
While there may be some variations to the process in some places, the path to EMS employment generally starts with a high school diploma or GED. EMS training programs may also require certification in CPR. Enroll in an EMT training program to learn core skills. This will involve both classroom and hands-on instruction and can take around six months. Then take (and pass) the National Registry of Emergency Medical Technicians’ examination.
You will need to be licensed to provide EMS by the state where you intend to work. This often involves passing a background check and paying a fee. Once that’s complete, you can start applying for jobs. Higher levels of certification, obviously, bring expanded career options.
What are EMS charts?
EMS charts are the patient care reports developed by EMS providers as they assist patients on calls. They will typically include information from dispatch; the patient’s name, identifying information and relevant medical history (where it can be obtained); vital signs and other assessment findings; any interventions provided; transport information; and an overarching narrative, or written section where the EMS provider recounts the call in their own words.
EMS charts are important to hospital personnel who continue patients’ care, for billing and reimbursement purposes, for internal quality assurance and improvement efforts, and for potential legal reasons.
