Because emergency services function 24 hours a day, emergency
medical technicians and paramedics have irregular working hours.
Emergency medical technicians and paramedics need formal training
and certification, but requirements vary by State.
Employment is projected to grow much faster than average as
paid emergency medical technician positions replace unpaid volunteers.
Competition will be greater for jobs in local fire, police,
and rescue squad departments than in private ambulance services;
opportunities will be best for those who have advanced certification.
Nature of the Work
People’s lives often depend on the quick reaction and competent
care of emergency medical technicians (EMTs) and paramedics—EMTs
with additional advanced training to perform more difficult prehospital
medical procedures. Incidents as varied as automobile accidents,
heart attacks, drownings, childbirth, and gunshot wounds all require
immediate medical attention. EMTs and paramedics provide this
vital attention as they care for and transport the sick or injured
to a medical facility.
In an emergency, EMTs and paramedics typically are dispatched
to the scene by a 911 operator, and often work with police and
fire department personnel. Once they arrive, they determine the
nature and extent of the patient’s condition while trying to ascertain
whether the patient has preexisting medical problems. Following
strict rules and guidelines, they give appropriate emergency care
and, when necessary, transport the patient. Some paramedics are
trained to treat patients with minor injuries on the scene of
an accident or at their home without transporting them to a medical
facility. Emergency treatment for more complicated problems is
carried out under the direction of medical doctors by radio preceding
or during transport.
EMTs and paramedics may use special equipment, such as backboards,
to immobilize patients before placing them on stretchers and securing
them in the ambulance for transport to a medical facility. Usually,
one EMT or paramedic drives while the other monitors the patient’s
vital signs and gives additional care as needed. Some EMTs work
as part of the flight crew of helicopters that transport critically
ill or injured patients to hospital trauma centers.
At the medical facility, EMTs and paramedics help transfer patients
to the emergency department, report their observations and actions
to emergency room staff, and may provide additional emergency
treatment. After each run, EMTs and paramedics replace used supplies
and check equipment. If a transported patient had a contagious
disease, EMTs and paramedics decontaminate the interior of the
ambulance and report cases to the proper authorities.
Beyond these general duties, the specific responsibilities of
EMTs and paramedics depend on their level of qualification and
training. To determine this, the National Registry of Emergency
Medical Technicians (NREMT) registers emergency medical service
(EMS) providers at four levels: First Responder, EMT-Basic, EMT-Intermediate,
and EMT-Paramedic. Some States, however, do their own certification
and use numeric ratings from 1 to 4 to distinguish levels of proficiency.
The lowest-level workers—First Responders—are trained to provide
basic emergency medical care because they tend to be the first
persons to arrive at the scene of an incident. Many firefighters,
police officers, and other emergency workers have this level of
training. The EMT-Basic, also known as EMT-1, represents the first
component of the emergency medical technician system. An EMT-1
is trained to care for patients at the scene of an accident and
while transporting patients by ambulance to the hospital under
medical direction. The EMT-1 has the emergency skills to assess
a patient’s condition and manage respiratory, cardiac, and trauma
The EMT-Intermediate (EMT-2 and EMT-3) has more advanced training
that allows the administration of intravenous fluids, the use
of manual defibrillators to give lifesaving shocks to a stopped
heart, and the application of advanced airway techniques and equipment
to assist patients experiencing respiratory emergencies. EMT-Paramedics
(EMT-4) provide the most extensive prehospital care. In addition
to carrying out the procedures already described, paramedics may
administer drugs orally and intravenously, interpret electrocardiograms
(EKGs), perform endotracheal intubations, and use monitors and
other complex equipment.
EMTs and paramedics work both indoors and outdoors, in all types
of weather. They are required to do considerable kneeling, bending,
and heavy lifting. These workers risk noise-induced hearing loss
from sirens and back injuries from lifting patients. In addition,
EMTs and paramedics may be exposed to diseases such as hepatitis-B
and AIDS, as well as violence from drug overdose victims or mentally
unstable patients. The work is not only physically strenuous,
but can be stressful, sometimes involving life-or-death situations
and suffering patients. Nonetheless, many people find the work
exciting and challenging and enjoy the opportunity to help others.
EMTs and paramedics employed by fire departments work about 50
hours a week. Those employed by hospitals frequently work between
45 and 60 hours a week, and those in private ambulance services,
between 45 and 50 hours. Some of these workers, especially those
in police and fire departments, are on call for extended periods.
Because emergency services function 24 hours a day, EMTs and paramedics
have irregular working hours.
Training, Other Qualifications, and Advancement
Formal training and certification is needed to become an EMT
or paramedic. A high school diploma is typically required to enter
a formal training program. Some programs offer an associate degree
along with the formal EMT training. All 50 States have a certification
procedure. In most States and the District of Columbia, registration
with the NREMT is required at some or all levels of certification.
Other States administer their own certification examination or
provide the option of taking the NREMT examination. To maintain
certification, EMTs and paramedics must reregister, usually every
2 years. In order to reregister, an individual must be working
as an EMT or paramedic and meet a continuing education requirement.
Training is offered at progressive levels: EMT-Basic, also known
as EMT-1; EMT-Intermediate, or EMT-2 and EMT-3; and EMT-Paramedic,
or EMT-4. EMT-Basic coursework typically emphasizes emergency
skills, such as managing respiratory, trauma, and cardiac emergencies,
and patient assessment. Formal courses are often combined with
time in an emergency room or ambulance. The program also provides
instruction and practice in dealing with bleeding, fractures,
airway obstruction, cardiac arrest, and emergency childbirth.
Students learn how to use and maintain common emergency equipment,
such as backboards, suction devices, splints, oxygen delivery
systems, and stretchers. Graduates of approved EMT basic training
programs who pass a written and practical examination administered
by the State certifying agency or the NREMT earn the title “Registered
EMT-Basic.” The course also is a prerequisite for EMT-Intermediate
and EMT-Paramedic training.
EMT-Intermediate training requirements vary from State to State.
Applicants can opt to receive training in EMT-Shock Trauma, wherein
the caregiver learns to start intravenous fluids and give certain
medications, or in EMT-Cardiac, which includes learning heart
rhythms and administering advanced medications. Training commonly
includes 35 to 55 hours of additional instruction beyond EMT-Basic
coursework, and covers patient assessment as well as the use of
advanced airway devices and intravenous fluids. Prerequisites
for taking the EMT-Intermediate examination include registration
as an EMT-Basic, required classroom work, and a specified amount
of clinical experience.
The most advanced level of training for this occupation is EMT-Paramedic.
At this level, the caregiver receives additional training in body
function and learns more advanced skills. The Technology program
usually lasts up to 2 years and results in an associate degree
in applied science. Such education prepares the graduate to take
the NREMT examination and become certified as an EMT-Paramedic.
Extensive related coursework and clinical and field experience
is required. Because of the longer training requirement, almost
all EMT-Paramedics are in paid positions, rather than being volunteers.
Refresher courses and continuing education are available for EMTs
and paramedics at all levels.
EMTs and paramedics should be emotionally stable, have good dexterity,
agility, and physical coordination, and be able to lift and carry
heavy loads. They also need good eyesight (corrective lenses may
be used) with accurate color vision.
Advancement beyond the EMT-Paramedic level usually means leaving
fieldwork. An EMT-Paramedic can become a supervisor, operations
manager, administrative director, or executive director of emergency
services. Some EMTs and paramedics become instructors, dispatchers,
or physician assistants, while others move into sales or marketing
of emergency medical equipment. A number of people become EMTs
and paramedics to assess their interest in health care, and then
decide to return to school and become registered nurses, physicians,
or other health workers.
EMTs and paramedics held about 192,000 jobs in 2004. Most career
EMTs and paramedics work in metropolitan areas. Volunteer EMTs
and paramedics are more common in small cities, towns, and rural
areas. These individuals volunteer for fire departments, emergency
medical services (EMS), or hospitals, and may respond to only
a few calls for service per month or may answer the majority of
calls, especially in smaller communities. EMTs and paramedics
work closely with firefighters, who often are certified as EMTs
as well and act as first responders. A large number of EMTs or
paramedics belong to a union.
Full-time and part-time paid EMTs and paramedics were employed
in a number of industries. About 4 out of 10 worked as employees
of private ambulance services. About 3 out of 10 worked in local
government for fire departments, public ambulance services, and
EMS. Another 2 out of 10 were found in hospitals, working full
time within the medical facility or responding to calls in ambulances
or helicopters to transport critically ill or injured patients.
The remainder worked in various industries providing emergency
Employment of emergency medical technicians and paramedics is
expected to grow much faster than the average for all occupations
through 2014, as full-time paid EMTs and paramedics replace unpaid
volunteers. As population and urbanization increase, and as a
large segment of the population—aging baby boomers—becomes more
likely to have medical emergencies, demand will increase for EMTs
and paramedics. There will still be demand for part-time, volunteer
EMTs and paramedics in rural areas and smaller metropolitan areas.
In addition to jobs arising from growth, openings will occur because
of replacement needs; turnover is relatively high in this occupation
because of the limited potential for advancement and the modest
pay and benefits in private-sector jobs.
Job opportunities should be best in private ambulance services.
Competition will be greater for jobs in local government, including
fire, police, and independent third-service rescue squad departments,
in which salaries and benefits tend to be slightly better. EMTs
and paramedics who have advanced certifications, such as EMT-Intermediate
and EMT-Paramedic, should enjoy the most favorable job prospects
as clients and patients demand higher levels of care before arriving
at the hospital.
Earnings of EMTs and paramedics depend on the employment setting
and geographic location as well as the individual’s training and
experience. Median annual earnings of EMTs and paramedics were
$25,310 in May 2004. The middle 50 percent earned between $19,970
and $33,210. The lowest 10 percent earned less than $16,090, and
the highest 10 percent earned more than $43,240. Median annual
earnings in the industries employing the largest numbers of EMTs
and paramedics in May 2004 were:
General medical and surgical hospitals
Other ambulatory health care services
Those in emergency medical services who are part of fire or police
departments receive the same benefits as firefighters or police
officers. For example, many are covered by pension plans that
provide retirement at half pay after 20 or 25 years of service
or if the worker is disabled in the line of duty.
Other workers in occupations that require quick and level-headed
reactions to life-or-death situations are air traffic controllers,
firefighting occupations, physician assistants, police and detectives,
and registered nurses.
>Sources of Additional Information
General information about emergency medical technicians and paramedics
is available from:
National Association of Emergency Medical Technicians, P.O.
Box 1400, Clinton, MS 39060-1400. Internet: http://www.naemt.org/
National Registry of Emergency Medical Technicians, Rocco
V. Morando Bldg., 6610 Busch Blv d., P.O. Box 29233, Columbus,
OH 43229. Internet: http://www.nremt.org/