An 'emergency medical technician' ('EMT') is an emergency-responder trained to provide emergency medical services (EMS) to the critically ill and injured. EMTs may work as an unpaid volunteer for a volunteer ambulance service, volunteer rescue squad or volunteer fire department, especially in rural areas. Unfortunately, may rural communities have great difficulty financing emergency medical services, as well as in recruiting, training and retaining volunteers. EMTs may be employed by a commercial, hospital or municipal EMS (Emergency Medical Service) agency or fire department. Some EMTs may be employed by commercial ambulance services (usually) providing non-emergency patient transportation, or providing emergency medical services to "911" emergency calls under contract with municipalities or county goverments. Some EMTs may work in clinical settings, such as a hospital's emergency department, while others may be employed in an industrial setting, or for 'home health care' providers.
Once thought of as an "ambulance driver or attendant," the modern EMT performs many more duties than in the past, and responds to many types of emergency calls, including medical emergencies, hazardous materials exposure, childbirth, child abuse, fires, injuries trauma and psychiatric crises. Many firefighters and some police officers are now also trained as EMTs.
EMTs are trained in basic medical knowledge and skills. Patient treatment guidelines are described in protocols following both national guidelines and local medical policies. The goal of EMT intervention is to rapidly evaluate a patient's condition and to maintain a patient's airway, breathing and circulation [C.P.R.], defibrillation, control external bleeding and prevent shock, and prevent furthur injury or diability by immobilizing potential spinal or other bone fractures, while expediting the safe and timely transport of the patient to an hospital emergency department for definitive medical care or surgery.
EMTs may be employed by private ambulance services, which usually provide non-emergency transportation of in-hospital patients. Many ambulance services provide transport for patients not experiencing an emergency, but nonetheless requiring medically supervised transportation. Such patients may include those being transferred between hospitals, bedridden patients being discharged to nursing homes or patients who are to undergo specialized treatment, therapy or diagnostic procedures.
In the United States, EMTs are certified according to their level of training. Individual states set their own standards of certification (or licensure, in some cases). All EMT training must meet the minimum requirements as set forth in the U.S. Department of Transportation's standards for the EMT-B (Emergency Medical Technician - Basic) curriculum.
The National Registry, a voluntary standards and testing body, recognizes three levels of EMT: EMT-B (Basic), EMT-I (Intermediate) and EMT-P (Paramedic). Some states such as California use an EMT-I or "EMT-One" Roman numeral designation which is equivalent to the National EMT-Basic; this should not be confused with the EMT-Intermediate (hereafter EMT-I). An ambulance with only EMT-Bs is considered a BLS or Basic Life Support unit whereas an ambulance with EMT-Ps is dubbed an ALS or Advanced Life Support unit.
EMT-B skills include CPR, first aid, airway management, oxygen administration, spinal immobilization, bleeding control and traction splinting. EMT-I skills add IV therapy, endotracheal intubation and initial cardiac drug therapy. Both EMT-I and EMT-P require something like a residency to attain; an EMT-B is the highest level of training one can receive without being employed as an EMT and sponsored by one's employer or a hospital.
Regardless of the level of an EMT, what they are allowed to do in the field is governed by an "Acts Allowed" list and protocols that are unique for each state or locality and are set forth by the supervising physician usually with the advice of a medical advisory committee.
Some EMTs may be authorized to perform advanced skills. EMTs in the field are usually able to contact with a physician while they are caring for a patient and they can receive permission to perform certain advanced procedures which they have been trained in, such as establishing an IV, after consultation with the physician.
The invasiveness of the permitted advanced procedures is dependent on training, and authorization of the state or regional medical authority and a local medical director or committee, and treatment protocols. Paramedics (EMT-Ps) receive more advanced education and training, and are (usually) allowed to administer drugs and may be allowed to intubate the patient's airway with a breathing tube [endotrachial tube] to assist in ventilation of the patient's lungs, and may be permitted to stick a needle directly into the chest in certain cases; for example, if the pericardium, the sac surrounding the heart, starts filling with blood (cardiac tamponade), where that blood must be drained from around the heart for it to have room to beat; or if air in the chest (outside of the lungs) [pneumothorax | tension pneumothorax] is preventing the lungs from expanding, the chest must be decompressed to allow the lungs to expand normally and allow inspired air to reach the alveoli so that oxygen can enter the bloodstream.
In response to nursing shortages, EMTs are being increasingly used in the emergency rooms and Intensive Care Units of hospitals.
Currently, in the United States of America, the busiest EMS service per ambulance is New Orleans' Health Department EMS, which responds to approximately 4,000 "911" calls per month, utilizing six ambulances for the entire city of about 500,000 people.
EMTs and paramedics of the New York City Fire Department's Emergency Medical Service Command, along with hospital employed EMTs and paramedics under it's juristiction, responds to over 3,000 requests for 911 assistance daily; over 1.3 million calls annually (2003).
original contribution(s) re-edited by:/RDH/