The development of EMS systems and qualifications is primarily managed by each state’s Office of Emergency Medical Services. However, these offices rely on the federal government’s National Highway Traffic Safety Administration (NHTSA) EMS Education Agenda for the Future. This document was developed collaboratively with stakeholders from all aspects of EMS. States use it as a framework while developing and revising the curriculum, qualifications, and scope of practice for each level of EMS provider within their jurisdiction. Although state-specific curriculums may vary slightly, they all adhere to some general accepted practices. EMS programs are typically administered through community colleges, local or regional EMS systems, or hospitals.

In general, the curriculum for an entry level EMS program (EMT) requires approximately 200 hours of training. This program covers non-invasive care for sick and injured individuals. EMTs have a limited range of life-saving medications that they can administer, typically using auto-dose delivery systems.

Advanced emergency medical technicians (AEMTs) undergo an additional 200-300 hours of training on top of the EMT training. This training allows AEMTs to administer certain essential medications, manage airways, and provide care for common medical and trauma emergencies.

Core paramedic certification takes an additional 1,080 to 2,000 hours of education, including classroom instruction, laboratory work, hospital clinical training, and a field internship. Paramedics can earn certificates, associate degrees, or bachelor’s degrees in EMS. They are trained to perform intensive, life-saving invasive procedures in the prehospital environment. These procedures may include advanced airway management, critical care pharmacology, intensive cardiology, and advanced trauma management. The scope of practice for paramedics is governed by the state office of EMS (OEMS), regional EMS agencies, and local medical directors.

The information below is taken directly from the State of Washington OEMS website at the time of this publication, although it is generally applicable to most states.

Professional Requirements and Qualifications for EMTs, AEMTs, and Paramedics

To work as an EMT, AEMT, or paramedic, appropriate training is required. For all three roles, successful completion of a department-approved training course is required in most states. In Washington State, applicants who graduated from paramedic training after June 30, 1996, are required to have graduated from a paramedic training program accredited by the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP).

For all three careers (EMT, AEMT, and paramedic), applicants must meet the following criteria:

• Be at least 18 years of age
• Possess a high school diploma or GED
• Have professional work experience

Applicants are also required to be associated with one of the following:

• An EMS agency licensed by the Department of Health (e.g., aid or ambulance service)
• A law enforcement agency
• A business with an organized industrial safety team
• A senior EMS Instructor or coordinator teaching in a department-approved EMS training program who is not affiliated with any of the above agencies

Applicants must also be recommended for certification by the Medical Program Director (MPD) of the county in which they will be working.

EMTs must successfully complete the paramedic certification examination, which includes both written and practical skills exams. This exam is developed and administered by the National Registry of EMTs (NREMT). Upon successful completion of the exam, applicants must provides proof of certification to the Department of Health in Washington State (WAC 246-976-141).

AEMTs must first pass the EMT exam before completing an additional AEMT course. After successfully finishing the AEMT course, they must pass the NREMT exam for AEMTs. AEMT programs are less common and tend to be located in more rural settings, but it is important to note that you do not have to become an AEMT prior to becoming a paramedic. Many EMTs go directly into paramedic coursework if they pursue that career path.

Skill Stitch: Blood Pressure

Blood pressure is a critical vital sign that provides valuable insight into a patient’s health, particularly regarding their cardiovascular system. It measures the force of blood pushing against the walls of the blood vessels. High blood pressure, or hypertension, is an early indicator of heart disease. If you work directly with patients, it is likely that you will be taking blood pressure on a regular basis. Let’s take a closer look at what blood pressure entails and why it is so important.

Blood pressure is typically measured using a blood pressure cuff and a stethoscope. The cuff is placed around the patient’s upper arm and inflated to a to a pressure that temporarily cuts off blood flow. The healthcare professional then slowly deflates the cuff until blood begins to flow again while listening for the korotkoff sounds.

• The first sound heard is associated with systolic pressure, representing the maximum arterial pressure during the contraction of the left ventricle of the heart.
• The Korotkoff sounds continue through various phases as the cuff deflates. Once the sounds stop, diastolic pressure is recorded, representing the relaxed pressure in the arteries between heartbeats.

Blood pressure is stated as a fraction of systolic over diastolic readings, such as 120/80 mmHg. These measurements can provide important information about a person’s risk of heart disease and stroke. A higher systolic or diastolic pressure is linked to an increased risk of mortality. Health professionals use blood pressure standards set by the American Heart Association and the American College of Cardiology to determine whether a patient’s blood pressure is healthy or concerning.

From EMTs to nurses and medical assistants, blood pressure is a standard vital sign used by health professionals to measure how well a person’s cardiovascular system is functioning. While high blood pressure (hypertension) can be an indicator of heart disease, low blood pressure (hypotension) can lead to a poor prognosis as well. Healthcare professionals must be familiar with the blood pressure categories linked above to apply early interventions for patients at risk for heart disease.

Attributions

1. Figure 6.6: image released under the Pexels License