Emergency medical technicians ( EMT ) and ambulance technicians are terms used in some countries to indicate emergency medical care health care providers. EMT is a doctor, trained to respond quickly to emergency situations regarding medical problems, traumatic injuries and accident scenes.
EMT is most commonly found working in ambulances, but should not be equated with "ambulance drivers" or "ambulance officers" - ambulance staff who were not previously trained in emergency or driving care. EMT is often employed by private ambulance services, government and hospitals, but is also often employed by fire departments (and visible in fire apparatuses), in police departments (and seen in police vehicles), and there are many firefighters/EMTs and police officer/EMT. EMT operates under a limited scope of practice. EMT is usually supervised by a medical director, who is a doctor.
Some EMTs are paid employees, while others (especially in rural areas) are volunteers.
Video Emergency medical technician
Canada
There are many variations between provinces in Canadian Paramedic practice. Although national consensus (through the National Occupational Competency Profile) identifies certain knowledge, skills and abilities as most identical to the level of certain Paramedic practices, each province has the highest authority in administering the actual administration and delivery of emergency medical services within its own borders. For this reason, any discussion of the Paramedical Practice in Canada is broad, and general. The specific regulatory framework and questions relating to Paramedical practice can only be answered with certainty in consultation with relevant provincial laws, although Provincial Paramedic Association may often offer a simpler overview of the topic when it is limited to province-by-province.
In Canada, the level of paramedical practice as defined by the National Occupational Competency Profile is: Emergency Medical Response (EMR), Paramedic Primary Care, Advanced Treatment Paramedics, and Paramedic Critical Care.
The regulatory framework varies from one province to another, and includes direct government regulations (such as Ontario's method of crediting practitioners with A-EMCA degrees, or Advanced Emergency Medical Assistants) to professionally arranged agencies such as Schools High Alberta from the Paramedics. Although the title of Paramedics is a common description of the category of practitioners, provincial variability in the regulatory method contributes to continuing differences in actual titles that are thought to come from different levels of practitioners. For example, the province of Alberta has legally adopted the title of "Emergency Medical Technician", or "EMT", for Primary Care Paramedics; and 'Paramedics' only for those who qualify as Advanced Care Paramedics Advanced Life Support (ALS) providers. Only someone registered in Alberta can call themselves EMT or Paramedic in Alberta, the title is legally protected. Almost all other provinces are gradually moving to adopt new titles, or at least recognizing NOCP documents as a benchmarking document to enable inter-provincial labor mobility of practitioners, regardless of how positions are specifically regulated in their own provincial system. In this way, confusing titles and job descriptions can be at least discussed using the same language for comparison.
Emergency Medical Response
Most providers working in ambulances will be identified as 'Paramedic' by the public. However, in most cases, the most common level of emergency pre-hospital treatment is provided by Emergency Medical Responder (EMR). This is the level of practice recognized under the National Occupational Competency Profile, although unlike the next three successive levels of practice, the high number of EMRs in Canada can not be ignored as an important role contribution to the survival chain, although the least comprehensive level of practice (clinically), and is also generally inconsistent with any medical measures other than advanced first aid and oxygen therapy, ASA and oral glucose administration and narcan delivery with the exception of automatic external defibrillation (which is still considered a medical measure regulated in most provinces in Canada).
Paramedic Primary Care
Primary Paramedic Treatment (PCP) is an entry-level paramedical practice in the Canadian province. The scope of practice includes performing semi-automatic external defibrillation, 4-lead interpretation of ECGs, administration of symptom-relief drugs for a variety of emergency medical conditions (including oxygen, epinephrine, dextrose, glucagon, salbutamol, ASA and nitroglycerin), immobilizing trauma cervical immobilization), and other basic basic medical treatments. Primary Care Paramedics may also receive additional training to perform certain skills that are normally within the scope of Advanced Paramedical Care practice. It is regulated both provinceally (by law) and locally (by medical director), and usually requires aspects of medical supervision by a particular body or group of physicians. This is often referred to as Medical Control, or the role played by the base hospital. For example, in the provinces of Ontario and Newfoundland and Labrador, many paramedical services allow Primary Care Paramedics to perform 12-lead ECG interpretations, or initiate intravenous therapy to provide some additional medication.
Advanced Paramedic Treatment
The Advanced Care Paramedic is a level of practitioner who is in great demand by many services in Canada. However, not all provinces and jurisdictions have ACP (Quebec, New Brunswick). ACP typically carries about 20 different drugs, although the number and type of drugs may vary substantially from one region to another. ACPs perform advanced airway management including intubation, surgical airway, intravenous therapy, external IV jugular spots, thoracotomy of the needle, perform and interpret 12-lead ECG, synchronize and chemical cardioversion, transcutaneous transfer, and provide pharmacologic pain relief for various conditions. Several sites in Canada have adopted pre-hospital fibrinolytics and fast-sequence induction, and pre-hospital medical research has allowed a considerable amount of variation within the scope of practice for ACP. The current program includes providing ACP with 24-hour direct access to the PCI laboratory, through the emergency department, and represents a fundamental change in the way patients with increased ST myocardial infarction (STEMI) segments are treated, but also greatly affect survival rates. , as well as passing a closer hospital to get stroke patients identified to the center of the stroke.
Paramedic Critical Care
Critical Care Paramedics (CCPs) are paramedics who generally do not respond to 9-1-1 emergency calls, with the exception of "scene" helicopter calls. Instead, they focus on removing patients from hospitals who are currently admitted to other hospitals that can provide a higher level of care. The CCP often works in collaboration with registered nurses and respiratory therapists during hospital transfers. This ensures continuity of care. However, when acuity is managed by CCP or registered nurses or respiratory therapists are not available, the CCP will work alone. Providing this care to the patient enables the hospital sending to avoid the loss of highly trained staff in hospital transfers.
CCPs can provide all the care provided by PCP and ACPs. That said, the CCP significantly lacks practical experience with advanced skills such as IV initiation, peripheral access to the cardiovascular system for fluid and drug delivery, advanced airway, and many other techniques. Where PCP and ACP can run 40-50 medical codes per year, the CCP can run 1-2 in the entire career. IV/IO starts almost non-existent on the ground and for this reason, the CCP is required to attend almost twice the amount of time in the classroom situation or in the hospital to keep current. In addition to this they are trained for other skills such as drug infusion pumps, mechanical ventilation and arterial lane monitoring.
The CCP often works on fixed wing aircraft and spins when weather permits and staff is available, but systems like the Toronto EMS Critical Care Transportation Program work in a land ambulance. ORNGE Transport operates land and aircraft in Ontario. In British Columbia, the CCP works primarily on planes with specialized Critical Care Transport crews on the Trail for long hauls and regular CCP street crews stationed in South Vancouver that often also perform Medevac, when necessary.
Training
Paramedic training in Canada varies regionally; for example, maybe eight months of training (British Columbia) or two to four years (Ontario, Alberta) in length. The nature of training and how it is organized, like actual paramedical practice, varies from one province to another.
Maps Emergency medical technician
ireland
The Emergency Medical Technician is a legally prescribed degree in the Republic of Ireland based on the standards set by the Pre-Hospital Emergency Care Council (PHECC). Emergency Medical Technicians are entry-level practitioners standard for employment in ambulance services. Currently, EMT is authorized to work on non-emergency ambulances simply because the standard for emergency calls (999) is a minimum of two paramedical crew members. EMT is a vital part of the voluntary and additional services in which a practitioner must be on any ambulance in the process of transporting a patient to a hospital.
United Kingdom
Emergency Medical Technicians are terms that have been around for years in the UK. Some National Health Service ambulance services run EMT conversion courses for staff trained by the Institute of Healthcare Development (IHCD) as Ambulance Technicians and Ambulance Practitioners Assistants. Ambulance trusts such as the London Ambulance Service and the North West Ambulance Service are in the process of turning their existing Ambulance Technicians into Emergency Medical technicians grade 1, 2, 3 or 4, based on their level of experience; in many cases giving the same level of care as the Paramedics.
Emergency Medical Technicians are still widely used in private ambulance companies with IHCD NHS trained as highly sought after Emergency Technicians. There are also many newer EMT training courses. IHCD Ambulance Technician and Ambulance Assistant Practitioners are still present in other UK ambulance services with Emergency Care Assistants used in some areas as support, however, this staff level is now being removed and replaced by a much better quality emergency assistant. The exception to this is the East of England Ambulance Service, which has been actively stopping Emergency Care Assistant training, and upgrading their skills to Emergency Medical Technician level. For the purpose of turning EMT into Paramedic, thereby increasing the entire workforce.
Examples of skills that may be owned by Emergency Medical Technicians in the UK are:
- Administration of selected drugs (usually not IV drugs)
- Middle life support, including additional manual and superglottic defibrillation of the air ducts
- Ability to remove patients to different pathways
- IV kanulasi (usually hospital EMT skills).
United States
History
The concept of modern Emergency Medical Service (EMS) care is widely noted to begin with an academic paper, "The Death and the Sometimes Disabled: the Abandoned Disease of Modern Communities" (or "White Book") in 1966, according to EMS textbooks and academics relevant in the field. This paper details road crash statistics resulting in injuries and deaths in the mid-1960s, as well as other causes of injury and death, and uses statistics to confirm that reforms are needed in the United States, particularly on public education and the number of CPR and BLS/First Aid received by police officers, firefighters, and ambulance services at the time.
The EMT program in the United States began as part of the "Alexandria Plan" in the early 1970s, in addition to the growing problems with injuries associated with car accidents. Emergency treatment (EM) as a relatively young medical specialty. Prior to the 1960s and 1970s, the hospital emergency departments were generally managed by doctors on rotating hospital staff, including general surgeons, internists, psychiatrists and dermatologists. Doctors in training (internships and residents), foreign medical graduates and sometimes nurses also manage the Emergency Department (ED). EM was born as a specialist to meet the time commitment required by doctors to work in the emergency department that is increasingly expired at the time. During this period, a group of doctors began emerging who had abandoned their respective practices to devote fully their work to the ED. The first group led by Dr. James DeWitt Mills who, along with four associate physicians: Dr. Chalmers A. Loughridge, Dr. William Weaver, Dr. John McDade, and Dr. Steven Bednar at Alexandria Hospital in Alexandria, Virginia, established 24/7 emergency care throughout the years which came to be known as the "Alexandria Plan". It was not until the establishment of the American College of Emergency Physicians (ACEP), the recognition of the emergency treatment training program by the AMA and AOA, and in 1979 the historic vote by the American Board of Medical Specialties that EM became a recognized medical specialty. The nation's first EMT was derived from Alexandria's plans to work as an Emergency Treatment Technician who served in the emergency department of Alexandria Hospital. Training for these technicians was modeled after the "Doctor Assistant" training program was established and then restructured to meet basic needs for emergency pre-hospital care. On June 24, 2011, Alexandria Hospital celebrated the 50th Anniversary of Alexandria Plan. The attendees were the first three ECT/EMT countries: David Stover, Larry Jackson, and Kenneth Weaver.
Certification
In the United States, EMT is certified according to their training level. Each country sets its own certification standards (or licenses, in some cases) and all EMT training must meet the minimum requirements set by the National Highway Traffic Safety Administration (NHTSA) standards for the curriculum. The National Registry of Emergency Medical Technicians (NREMT) is a private organization that offers certification exams based on NHTSA education guidelines and has existed since the 1970s. Currently, the NREMT exam is used by 46 countries as the sole basis for certification at one or more EMT certification levels. The NREMT exam consists of patient skills and assessments as well as written sections.
To apply for NREMT Certification applicants must be 18 years of age or older. Some countries allow 16 and 17 years of age. Applicants must also successfully complete an approved state-approved EMT course that meets or exceeds the NREMT Standard within the past 2 years. Those applying for the NREMT Certification must also complete a state-approved EMT psychomotor exam.
The Veteran Emergency Medical Technician Support Act 2013, HR 235 at the United States Congress 113, will amend the Public Health Service Act to direct the Secretary of Health and Human Services to establish a demonstration program for countries with a shortage of emergency medical technicians to streamline state requirements and procedures for assist veterans who complete EMT military training while on duty in the Armed Forces to meet state EMT certification and licensing requirements. The bill was passed in the United States House of Representatives, but has not been elected in the United States Senate.
Level
NHTSA recognizes four levels of Emergency Medical Technicians:
- EMR (Emergency Medical Response)
- EMT (Emergency Medical Technician)
- AEMT (Advanced Emergency Medical Technician)
- Paramedic
Some states also recognize the level of Paramedic or Advanced Practice Critical Care as a state-specific license over Paramedics. These Critical Care Paramedics generally transport high acuity requiring skills beyond the scope of standard paramedics. In addition, EMT can seek special certifications such as Wilderness EMT, Wilderness Paramedic, Tactical EMT, and Flight Paramedic.
Transition to new level
In 2009, NREMT posted information on the transition to a new level system for emergency care providers developed by NHTSA with the National EMS Practice Scope project. By 2014, this "new" level will replace the fragmented systems found throughout the United States. The new classification will include Emergency Medical Respondents (replacing the first respondent), Emergency Medical Technician (replacing EMT-Basic), Advanced Emergency Medical Technician (replacing EMT-Intermediate/85), and Paramedic (replacing EMT-Intermediate/99 and EMT-Paramedic ). Educational requirements in transition to new levels are substantially similar.
EMR
EMR (Emergency Medical Responder) is the first, most basic level of EMS. EMRs, many of which are volunteers, provide immediate basic care, including bleeding control, manual stabilization of limb fractures and suspected cervical cervical injury, eye irrigation, vital signs, supplemental oxygen administration, oral suction, positive pressure ventilation with valve bag. mask, cardio-pulmonary resuscitation (CPR), the use of an automatic external defibrillator (AED), helps in normal labor, and administration of certain basic drugs such as epinephrine auto-injectors and oral glucose. Due to the opioid crisis, more and more EMRs are now being trained and allowed to manage intranasal naloxone. An EMR can assume care for patients while more advanced resources are on the way, and then can help EMT and Paramedic when they arrive. Training requirements and care protocols vary from one area to another.
EMT
EMT is the next EMS level. The procedures and skills allowed at this level include all EMR skills as well as nasopharyngeal airway, pulse oximetry, glucometry, splinting, cervical collar use, splinting traction, complicated labor delivery and drug delivery (such as epinephrine auto-injector, oral glucose gel, aspirin (ASA), nitroglycerin, and albuterol). Some areas may increase the scope of practice for EMT, including the provision of intranasal nalaxone, the use of mechanical CPR devices, administration of intramuscular epinephrine and glucagon, insertion of additional airway devices, and CPAP. Training requirements and care protocols vary from one area to another.
Advanced EMT
Advanced EMT is the level of training between EMT and Paramedic. They can provide limited life support (ALS) care including obtaining intravenous/intraosseous access, use of advanced airway devices, limited drug administration, and basic cardiac monitoring.
Paramedic
Paramedics represent the highest EMT level and, in general, the highest level of pre-hospital medical providers, although some areas make use of doctors as an air ambulance provider or as a ground provider. Paramedics perform various medical procedures such as endotracheal intubation, fluid resuscitation, drug administration, intravenous access, cardiac monitoring (continuous and 12-lead), cardioversion, transcutaneous transfer, cricothyrotomy, manual defibrillation, needle decompression, and other advanced procedures. and assessment.
Staffing level
An ambulance with only EMT is considered a Basic Life Support (BLS) unit, an ambulance using AEMT referred to as Medium Life Support (ILS), or Livesurest Support Unit (LALS) is limited, and an ambulance with Paramedics dubbed the Advanced Life Support (ALS) unit. Some states allow ambulance crew to load a mixed crew rate (eg EMT and Paramedic or AEMT and Paramedic) to ambulance staff and operate at the highest trained provider level. Nothing stops additional crew members from becoming a particular certification, although (eg if an ALS ambulance is required to have two paramedics, it is acceptable to have two paramedics and EMT). An emergency vehicle with only EMR or EMR and EMT combinations is still dubbed as the Basic Life Support (BLS) unit. An EMR must be supervised by EMT or higher to work on an ambulance. Unlike most of Europe or Canada, many countries like New York, need an ambulance to have at least one paramedic on board, especially when responding to a potentially life threatening 911 call. This is still debatable in many countries like California, which does not limit ambulance training as long as it is a BLS.
Education and training
EMT training programs for certification vary widely from course to course, provided that each course at least meets local and national requirements. In the United States, EMR receives at least 40-80 hours of classroom training, EMT receives at least 120-180 hours of training in the classroom. AEMTs generally have 200-500 hours of training, and Paramedics are trained for 1,000-1,800 hours or more. In addition, a minimum of continuing education (CE) is required to maintain certification. For example, in order to maintain NREMT certification, EMT must obtain at least 48 additional hours of education and complete a 24-hour refresher course or complete an additional 24 hours of CEs that will include, hourly hourly, the same topic as the Refresh course. Re-certification for another level follows the same pattern.
EMT training programs vary greatly in calendar time (number of days or months). For example, a fast track program is available for EMT completed within two weeks by holding classes for 8 to 12 hours a day for at least two weeks. Other training programs are months, or up to 2 years for the Paramedic in an associate degree program. In addition to didactic education at every level, clinical rotation may also be needed (especially for levels above EMT). Similar in the sense of rotation of medical schools, EMT students are required to spend the amount of time required in ambulances and various hospital services (eg obstetrics, emergency medicine, surgery, psychiatry) to complete the course and become eligible for the certification exam. The number of clinical hours for both the time in the ambulance and the time within the hour varies depending on local requirements, the level obtained by the student, and the amount of time it takes the student to demonstrate competence. EMT training programs take place in various locations, such as universities, community colleges, engineering schools, hospitals or EMS academies. Each state in the United States has a primary EMS agent or state office of emergency medical services that regulates and accredits EMT training programs. Most of these offices have websites to provide information to the public and individuals interested in becoming EMT.
Medical directives
In the United States, EMT actions in the field are governed by state regulations, local regulations, and by the policies of their EMS organizations. The development of this policy is guided by the medical director's physician, often with advice from the medical advisory committee.
In California, for example, each Local Emergency Medical Service Agency (LEMSA) issues a list of standard operating procedures or protocols, under the supervision of the California Emergency Medical Services Authority. These procedures often vary from one region to another based on local needs, level of training and clinical experience. The State of New York has a similar procedure, while the regional medical advisory board ("REMAC") defines the protocol for one or more districts in the geographical part of the country.
Treatments and procedures administered by the Paramedics fall into one of two categories, off-line medical orders (standing orders) or on-line medical orders. On-line medical orders refer to procedures that must be explicitly approved by a basic hospital physician or registered nurse through voice communications (generally by telephone or radio) and generally rare or high-risk procedures (eg rapid sequence induction or cricothyrotomy). Additionally, when multiple levels can perform the same procedure (eg AEMT-Critical Care and Paramedic in New York), the procedure can be on-line and standing orders depending on the provider level. Since no protocol can cover every patient situation, many systems work with protocols as a guide and not a "cookbook" care plan. Finally, the system also has a policy to handle medical direction when a communication failure occurs or in a disaster situation. The NHTSA curriculum is the basic Standard of Care for EMS providers in the US.
Jobs
EMT and Paramedics are employed in a variety of settings, especially pre-hospital environments such as the EMS, fires, and police agencies. They can also be found in positions ranging from hospital settings and health care, to industry and entertainment positions. Pre-hospital environments are loosely divided into non-emergency services (eg patient transport) and emergency (call 9-1-1), but many ambulance services and EMS institutions operate emergency and emergency care services.
In many places throughout the United States, it is not uncommon for major EMR, EMT, and Paramedic firms to be firefighters, with the fire department providing the main emergency medical response system including the "first responders" to the fire apparatus, as well as ambulances. In other locations, such as Boston, Massachusetts, emergency medical services are provided by separate government emergency agencies, or "third parties" (eg Boston EMS). In other locations, emergency medical services are provided by volunteer agencies. College campuses and university campuses can provide emergency medical responses on their own campus using students.
In some US states, many EMS institutions are run by the First Non Volunteers Non-Profit Relief Team, which is their own company formed as a separate entity from the fire department. In this environment, volunteers are employed to fill certain time blocks to close emergency calls. These volunteers have the same state certification as their paid companions.
See also
- Medical fighter
- Emergency medical services
- Emergency Medical Services in the United States
- Emergency medical services in the United Kingdom
- Paramedics in Canada
- List of EMS provider credentials
References and notes
External links
- National Highway Traffic Safety Agency, Office of Emergency Medical Services
- United States National Registry of Emergency Medical Technicians
- The basics for Emergency Medical Technician training
Source of the article : Wikipedia
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