What is the difference between an EMT and a paramedic?

  1. I found a show called third watch whilst I was channel hopping and was wondering, what is the difference between an EMT and a paramedic?

    And is the ambulance service in the US, always part of the fire brigade or is that just in New York?


  2. 13 Comments

  3. by   WalMart_ADN
    now, correct me if i'm wrong....

    an EMT is trained by the company, and has limitations as to what they can do on the ambulance. A paramedic is certified by the state, and has to take exams similar to our boards (at least in NY) and they can take on more responsibility. (Start IV's, intubate, give meds). i'm sure there's more to it, but there's the basics.
  4. by   Whisper
    It was just puzzling me
  5. by   ShortFuse_LPN
    Some ambulance services are within the fire department and we have independant companies too.
  6. by   kavi
    i have run on an ambulance for almost eight years. Some credential requirements vary from state to state, but almost everyone in EMS now follows National Standards.

    EMS = Emergency Medical Services
    EMT = Emergency Medical Technician

    There are different levels of EMT certification/licensure. Paramedic is the highest level. Levels included:

    EMT-B (basic)
    EMT-D (defibrillator certified)
    EMT-I (Intermediate)
    EMT-S (Specialist)
    EMT-P (Paramedic)

    All EMT's are state licensed, and most are nationally certified/registered/licensed too. A Paramedic is one of the LEVELS of EMT.

    Some states allow company training programs. Most require college programs. But where you receive your training does not determine your level.

    Each level requires additional classroom hours, clinical hours, and continuing education requirements. Each level must take State Boards (which are now National Standards), and the test is both written and 'practical'. Practical meaning you must demonstrate your 'hands on' skills in various scenarios. Like Nursing Boards, most of the testing is based on the 'best right answer'.

    Each level marks an increase in an ability to do invasive/sterile procedures and push certain types of drugs. For example: An EMT-B can push Epinephrine, Albuterol, Oxygen--basics. When you get to Paramedic level you can push narcotics, etc.

    Tying in EMS and Fire Dept. are one of those variants from community to community. In some areas, members of the Police Department are also required to be EMS certified. Some ambulance companies are affiliated with hospitals, others with cities or towns, others are private. I work for a private company that the city hires to handle their emergency care.

    In Michigan, the level of care you receive on an ambulance is based on the Ambulance's certification, not the personnel's. So if the ambulance is certified 'Basic', even a Paramedic on board may only practice "Basic" procedures.

    And just an added note. I've seen Third Watch, E.R., and the various 'Paramedic' programs on Discover Health. None of them really get it right. The closest to reality I've ever seen (although it's the dark side) was the movie "Bringing Out the Dead" with Nicholas Cage.

    Hope this helps! Kavi
    Last edit by kavi on Mar 5, '03
  7. by   CCL"Babe"
    kavi haas it right.
    In Pennsylvania we also have a certification of HP which is Health care Provider and covers pre-hospital nurses or other state liscensed professionals to work in a pre-hospital setting.
    Unlike RNs in my state EMTs, Paramedics, and HPs must do CEUs to maintain their liscense.
    You can obtain a master's level degree in EMS.
  8. by   Whisper
    I didn't realise how different the US and the UK's ambulance services were.

    I doubt if I'll watch third watch again as I am not usually in when it is showing, but I nticed on the back of some jackets they had paramedics and on some EMT.

    It is just a good job I am not feline, or I would be six feet under!
  9. by   RN2B2005
    Here in King County, WA the only way to become a paramedic is through the county Medic One programme.

    To even be considered, you must have a four-year degree, three years of pre-hospital field experience as an EMT-B (certification is obtained by completing a six-to-eighteen month community college course AND having a sponsoring employer) or higher, and meet assorted other requirements. The competition is insane--the county only admits one paramedic class per year, sometimes less often. You have to commit to working for the county for 3 years after graduation.

    Since there are very few volunteer fire departments in this area and only one major private ambulance service, it is very difficult even to obtain the EMT-B certification. The EMT-B's that I know all did their training in the military, and then certified as an EMT-B after discharge. The few private ambulance services in the county and western half of the state almost never advertise open positions; there's no need to, since the applicant pool is enormous.

    The advantage is, our Medic One service is one of the best in the country, because unlike some states, our paramedics are trained by one agency and train through the University of Washington and with one of the country's best trauma directors, Dr. Michael Copass. Not coincidentally, the per-capita CPR certification rate is the highest in the nation--one out of three King County residents is trained in CPR, making this a great place to have a heart attack.

    I know in other states, like California, there are formal schools where you can go and become a paramedic without all the hurdles, but not here.
  10. by   tattooednursie
    I have taken an EMT course. It lasted for about 6 months. I took the state boards in May, and failed by only a few points. I was sapposed to get 80% on my test and I got 77%. I got angry and gave up. One of the dumber things I have done, but I'm going to take it again sometime soon. An EMT 1 does basic ambulance stuff, and are limited to what they can do, an EMT 2 can do more, such as IV's and stuff. A paramedic can do just about everything. I want to be a paramedic. It has always been one of my dreams to do that. I am a first responder, which is basicly the same thing as an EMT, but not nearly as much training. I do medical calls with a fire department. It's fun, I like it.
  11. by   kavi
    A few notes to previous responders----

    Hi! You mentioned there was a huge difference between EMS in the U.K. and in the States. Just curious as to what some of those differences are. Care to elaborate? I'm just curious. Kavi

    CCL "Babe"
    Hi! That's interesting about the Pre-Hospital Licensure in PA. Here it's not a separate licensure, but Paramedics are performing the same function--working in ER's, Clinics, etc. assisting the Nurses.
    It's definitely interesting to see how different places handle things.
    What about the ambulance licensure thing? (Where in Michigan level of care is based on the license of the ambulance, not the personnel.) I've always disliked that about Michigan. Thanks. kavi

    Future RNMandee
    Hi! What State are you in? Here there is a HUGE difference between First Responders and EMT's.
    Here, First Responders basically supply first aid. They are not as trained, licensed, nor do they take State/National exams. They are not allowed to administer most procedures that Emergency Medical Technicians provide. They cannot make onsite decisions other than basic life support (such as CPR), nor can they write or sign reports. There are few (if any) ambulance companies who will hire them to run in Emergency Medical Services. Just curious as to what State is doing things so differently. Thanks, Kavi
    Last edit by kavi on Mar 5, '03
  12. by   Whisper
    I only have limited knowledge of paramedics in the UK, but here goes... they work for the ambulance service and are a public emergency service, seperate from the fire brigade.

    A Paramedic sounds pretty similar to a US paramedic, although I think there a fewer medications a UK paramedic can use. There are Ambulance technicians, but in my experience they are either training to be paramedics, and are generally there to help lift the stretcher, and to drive. (if I am wrong I am sorry, but I have only seen one tech, and that was all he did, which is why the EMT starting Iv's through me)

    Many paramedics, work their way up from PTS to techs to paramedics, the only private ambulances I have encountered don't answer 999 calls, and are generally used for PTS purposes.
    I am sure a UK A&E nurse would be able to give a better answer.

    I bet that was as clear as mud, hope you can pick something up out of the babble.

  13. by   WalMart_ADN
    basically, another difference around here is a paramedic gets paid, not well, but paid, and EMT's are usually volunteer. you know, for the greater good and all that jazz.
  14. by   CCL"Babe"
    Kavi The HP thing was very volitile in my state at the begining. I had gone to EMT in my first year of nursing school. I actually went to school to become a medic after nursing school. It was the only way I could use some of my skills pre-hospital as a volunteer. I never bothered to take my State cert exam, there was just too much going on in my life then. Years later I got called on the carpet for starting an IV and giving meds in a code situatiuon pre hospital. This was with an MD at the scene and a friend who was the medic in charge of the call. A EMT with the ambulance went after my nursing liscense. The state was just starting to firm up the HP liscense. It was strongly suggested to me to do this. I did. I was grandfathered. I had to prove all my previous certs CEN, EMT ACLS, Firefighting I , etc Then I had to do street time, and take the state paramedic exam. Every time I got close to finishing the requirements they would add to or change them. I finally got my medical command. Then medics who I had known for years started giving me grief, they acted as if I just walked up and asked for this liscense. I was called a "skirt" and alot of other not so nice names. I did work as a HP for a short time, but the experience left a bitter taste. Besides getting it from the EMS side, I was spoken to by the VP of nursing and counselled that I better not try any of that "medic" stuff in the hospital. Now from what I understand you have to be an HP to work as a nurse on an ambulance or flight program in PA. Now it is a class/cert that you must take, not sure how long. It covers things that just don't get covered in nursing school, besides entubation and other emergency airway techniques.