Emergency Medical Technicians and Paramedics

People's lives often depend on the quick reaction and competent care of emergency medical technicians (EMTs) and paramedics. Incidents as varied as automobile accidents, heart attacks, slips and falls, childbirth, and gunshot wounds require immediate medical attention. EMTs and paramedics provide this vital service as they care for and transport the sick or injured to a medical facility.

In an emergency, EMTs and paramedics are typically dispatched by a 911 operator to the scene, where they often work with police and fire fighters. Once they arrive, EMTs and paramedics assess the nature of the patient's condition, while trying to determine whether the patient has any pre-existing medical conditions. Following protocols and guidelines, they provide emergency care and transport the patient to a medical facility. EMTs and paramedics operate in emergency medical services systems where a physician provides medical direction and oversight.

EMTs and paramedics 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. These workers generally work in teams. During the transport of a patient, one EMT or paramedic drives, while the other monitors the patient's vital signs and gives additional care, as needed. Some paramedics work as part of a helicopter's flight crew to quickly 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 department staff, and may provide additional emergency treatment. After each run, EMTs and paramedics document the trip, replace used supplies and check equipment. If a transported patient has a contagious disease, EMTs and paramedics decontaminate the interior of the ambulance and report cases to the proper authorities.

EMTs and paramedics also provide transportation for patients from one medical facility to another, particularly if they work for private ambulance services. Patients often need to be transferred to a hospital that specializes in treating their injury or illness or to facility that provides long-term care, like nursing homes.

Beyond these general duties, the specific responsibilities of EMTs and paramedics depend on their level of qualification and training. The National Registry of Emergency Medical Technicians (NREMT) certifies emergency medical service providers at five levels: First Responder; EMT-Basic; EMT-Intermediate (which has two levels called 1985 and 1999) and Paramedic. Some States, however, have their own certification programs and use distinct names and titles.

The EMT-Basic represents the first response of the emergency medical system. An EMT trained at this level is prepared to care for patients at the scene of an accident and while transporting patients by ambulance to the hospital under the direction of more highly trained medical personnel. The EMT-Basic has the emergency skills to assess a patient's condition and manage respiratory, cardiac, and trauma emergencies.

The EMT-Intermediate has more advanced training. However, the specific tasks that those certified at this level are allowed to perform varies greatly from State to State.

Paramedics provide more extensive pre-hospital care than do EMTs. In addition to carrying out the procedures of the other levels, paramedics administer medications orally and intravenously, interpret electrocardiograms (EKGs), perform endotracheal intubations, and use monitors and other complex equipment. However, like the EMT-Intermediate level, what paramedics are permitted to do varies by State.

Work Environment

EMTs and paramedics held about 261,300 jobs in 2020. The largest employers of EMTs and paramedics were as follows:

Ambulance services - 46%
Local government, excluding education and hospitals - 28%
Hospitals; state, local, and private - 19%

The above percentages exclude volunteer EMTs and paramedics who do not receive pay.

EMTs and paramedics work both indoors and outdoors, in all types of weather. Their work is physically strenuous and can be stressful, sometimes involving life-or-death situations.

Volunteer EMTs and paramedics share many of the same duties as paid EMTs and paramedics. They volunteer for fire departments, providers of emergency medical services, or hospitals. They may respond to only a few calls per month.

Injuries and Illnesses

EMTs and paramedics are required to do considerable kneeling, bending, and lifting while caring for and moving patients. They may be exposed to contagious diseases and viruses, such as hepatitis B and HIV. Sometimes they can be injured by combative patients. These risks can be reduced by following proper safety procedures, such as waiting for police to clear an area in violent situations or wearing gloves while working with a patient.

Work Schedules

Most paid EMTs and paramedics work full time. Some work more than 40 hours per week. Because EMTs and paramedics must be available to work in emergencies, they may work overnight and on weekends. Some EMTs and paramedics work shifts in 12- or 24-hour increments. Volunteer EMTs and paramedics have variable work schedules. For example, they may work only a few days per week.

Education & Training Required

A high school diploma is usually required to enter a formal emergency medical technician training program. Training is offered at progressive levels: EMT-Basic, EMT-Intermediate, and Paramedic.

At the EMT-Basic level, coursework emphasizes emergency skills, such as managing respiratory, trauma, and cardiac emergencies, and patient assessment. Formal courses are often combined with time in an emergency department or ambulance. The program 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 must pass a written and practical examination administered by the State licensing agency or the NREMT.

At the EMT-Intermediate level, training requirements vary by State. The nationally defined levels, EMT-Intermediate 1985 and EMT-Intermediate 1999, typically require 30 to 350 hours of training based on scope of practice. Students learn advanced skills such the use of advanced airway devices, intravenous fluids, and some medications.

The most advanced level of training for this occupation is Paramedic. At this level, the caregiver receives training in anatomy and physiology as well as advanced medical skills. Most commonly, the training is conducted in community colleges and technical schools and may result in an associate's degree. These programs may take up to one to two years. Such education prepares the graduate to take the NREMT examination to become certified as a Paramedic. Extensive related coursework and clinical and field experience is required. Refresher courses and continuing education are available for EMTs and paramedics at all levels.

Certifications Needed

All 50 States require EMTs and Paramedics to be licensed, but the levels and titles vary from State to State. In most States and the District of Columbia certification by the NREMT is required at some or all levels. Some States administer their own certification examination or provide the option of taking either the NREMT or State examination. In most States, licensure renewal is required every two to three years and generally, EMTs and Paramedics must take refresher training courses or complete continuing education requirements. Many States restrict licensure based on an individual’s criminal history.

Other Skills Required

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. Many employers require a criminal background check.

How to Advance

Paramedics can become supervisors, operations managers, administrative directors, or executive directors of emergency services. Some EMTs and paramedics become instructors, dispatchers, or physician assistants; others move into sales or marketing of emergency medical equipment. A number of people become EMTs and paramedics to test their interest in healthcare before training as registered nurses, physicians, or other health workers.

Job Outlook

Employment of EMTs and paramedics is projected to grow 11 percent from 2020 to 2030, faster than the average for all occupations.

About 20,700 openings for EMTs and paramedics are projected each year, on average, over the decade. Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire.

Employment

Emergencies, such as car crashes, natural disasters, and acts of violence, will continue to require the skills of EMTs and paramedics. The need for volunteer EMTs and paramedics in rural areas and smaller metropolitan areas will also continue.

Growth in the middle-aged and older population will lead to an increase in age-related health emergencies, such as heart attacks and strokes. This increase, in turn, will create greater demand for EMT and paramedic services. An increase in the number of specialized medical facilities will require more EMTs and paramedics to transfer patients with specific conditions to these facilities for treatment.

Earnings

The median annual wage for EMTs and paramedics was $36,930 in May 2021. The median wage is the wage at which half the workers in an occupation earned more than that amount and half earned less. The lowest 10 percent earned less than $28,320, and the highest 10 percent earned more than $60,000.

In May 2021, the median annual wages for EMTs and paramedics in the top industries in which they worked were as follows: