Chapter 6: Pre-Hospital Care
Karen Piette
While ultimately the development of EMS systems and qualifications are the purview of the States Offices of Emergency Medical Services, each state relies on the federal government’s National Highway Traffic Safety Administration’s (NHTSA’s) EMS education agenda for the future document that was developed in cooperation with stakeholders from all aspects of EMS. The states develop and revise the different curriculums, qualifications, scope of practices for each level of EMS provider within their state. While the curriculums may have subtle differences, they all adhere to some general accepted practices. In most cases EMS programs are administered in the Community College system, local or Regional EMS systems or hospitals.
In general, the curriculum for an entry level EMS program (EMT) is approximately two hundred (200) hours in total length. This curriculum covers care to the sick and injured using non-invasive techniques. The EMT has a limited amount of life saving medications that can be administered usually in an auto-dose type of delivery system.
Advanced Emergency Medical Technicians (AEMTs) training adds an additional 200-300 hours of training on top of the EMT training. This training allows the AEMT to administer certain essential medications, provider airway management and provide care for the common medical and trauma emergencies.
Core Paramedic certification takes an additional 1080 to 2000 hours education including classroom, laboratory, hospital clinical and field internship. Paramedics can obtain a certificate, associates, and baccalaureate degrees in EMS. Paramedics perform intensive life saving invasive procedures in the prehospital environment. These may include advanced airway management, critical care pharmacology, intensive cardiology, and advanced trauma management. Specific scope of practices is governed by the State office of EMS, 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 but is similar to most states.
Professional Requirements and Qualifications for EMTs, AEMTs, and Paramedics
In order to work as an EMT, AEMT or a paramedic, the appropriate training is required. For all three, successful completion of a department approved paramedic training course is an educational requirement to work 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 that is 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 possess a high school diploma or GED, have postgraduate professional work experience and be 18 years of age. Applicants are required to be associated with one of the following: 1) an EMS agency licensed by the Department of Health (aid or ambulance service), 2) a law enforcement agency, 3) business with an organized industrial safety team, or 4) a senior EMS Instructors or coordinators teaching at department approved EMS training programs who are unable to be associated with approved agencies above and 5) applicants must be recommended for certification by the Medical Program Director (MPD) of the county in which the applicant will be working.
EMT’s must have successfully completed the Paramedic certification examination which include written and practical skills exams. Examination is developed and administered by the National Registry of EMT’s (NREMT). Upon successful completion of the exam, the applicant provides proof of successful completion of the NREMT exam to the Department of Health in Washington state (WAC 246-976-141).
AEMT’s are required to pass the EMT exam first, then they take an additional AEMT course. After they successfully complete the AEMT course they sit for the NREMT exam for AEMT. There are less AEMT programs throughout the nation. AEMT programs tend to be in more rural settings. It is important to note that you do not have to become an AEMT prior to becoming a paramedic. Many EMT’s go directly into paramedic coursework if that is their desired career path.
Skill Stitch: Blood Pressure
A critical vital sign that is critically important for understanding what is going on inside a patient is blood pressure. Blood pressure is a measurement of the force of your blood pushing against the walls of your blood vessels. High blood pressure or hypertension is an early sign of heart disease. If you work directly with patients chances are you will be taking blood pressure on a regular basis. Next let’s look at what blood pressure entails and why those measurements are so important.
Blood pressure is taken with the aid of a blood pressure cuff and stethoscope. During the measurement, the cuff is placed on the patient’s upper arm and inflated to a top pressure, cutting off blood flow in the arm. Next, the health professional will deflate the cuff, slowly letting air out until blood begins to flow again. It is important to listen as the cuff deflates for the korotkoff sounds. This first sound heard is known as systolic pressure, representing the maximum arterial pressure during contraction of the left ventricle of the heart. The Korotkoff sounds continue through various phases changing the sounds heard through the stethoscope. Once the sound stops, diastolic pressure is measured representing the relaxed pressure in the arteries between heart beats.
Blood pressure is stated as a fraction of systolic over diastolic readings. For example, 120/80 mmHg. Depending on this fraction it can tell us a lot about someone’s risk of heart disease and stroke, with a higher pressure for either systolic or diastolic being linked to increased mortality rates. Health professionals use blood pressure standards set by the American Heart Association/American College of Cardiology to determine what a healthy vs unhealthy blood pressure might be.
The above table provides blood pressure ranges that correspond to various risk factors for chronic or acute disease. From EMT’s to nurses and medical assistants, blood pressure is one of the standard vital signs health professionals utilize to measure how a person’s cardiovascular system is functioning. It is important to note that hypertension is a measurement of heart disease, however, hypotension (low blood pressure) can lead to poor prognosis as well. Healthcare professionals must be familiar with the chart above in order to apply early intervention for heart disease patients.
Attributions
- Figure 6.6: image released under the Pexels License
The distinct sounds heard through a stethescope while taking blood pressure signifying different phses of a heart beat.
The phase during a heart beat where the heart is contracted, pushing blood out of the heart.
The phase during a heart beat where the heart is relaxed and filling with blood.
The state of being dead, or the rate of deaths within a specific population or group over a particular period.