An emergency medical service (or EMS) is a service providing out-of-hospital acute care and transport to definitive care, to patients with illnesses and injuries which the patient believes constitute a medical emergency.
EMS is an intricate system, and each component of this system has an essential role to perform as part of a coordinated and seamless system of emergency medical care. An EMS system comprises the following components:
- Agencies and organizations (both private and public)
- Communications and transportation networks
- Trauma systems, hospitals, trauma centers, and specialty care centers
- Rehabilitation facilities
- Highly trained professionals, including: volunteer and career pre-hospital personnel, physicians, nurses, therapists, administrators and government officials
- An informed public that knows what to do in a medical emergency
EMS does not exist in isolation, but is integrated with other services and systems intended to maintain and enhance the community’s health and safety. EMS operates at the crossroads between health care, public health and public safety. A combination of the principles and resources of each is employed in EMS systems. Since EMS providers work in the community, they are often the first to identify public health problems and issues. The emergence of significant health problems is often heralded by its arrival in the Emergency Department and it arrives via EMS. Since EMS providers respond to all kinds of emergencies and all kinds of hazards, they often work shoulder-to-shoulder with public safety colleagues in law enforcement and fire services. But their primary mission is emergency medical care.
Are There Different Types of EMS?
The most common and recognized EMS type is an ambulance organization. EMS can encompass services developed to move critically ill patients from one facility to another (also known as Inter-facility Transport), or they can respond to medical emergencies (known as 9-11 calls). The fire department plays a very active role in the EMS, as they are located throughout most neighborhoods in the United States. In a fire unit there are trained firefighters able to respond to medical emergencies. Here is a more comprehensive list of different EMS organizations:
Operating separately (although alongside) from the fire and police service of the area, these ambulances are funded by local or national government. In some countries, these tend to be found only in big cities, whereas in countries such as the United Kingdom, almost all emergency ambulances are part of the National Health Service
Fire or Police Linked Service
In many countries (USA, France, Germany, Japan), many ambulances are operated by the local fire or police service. This is particularly common in rural areas, where maintaining a separate service is not necessarily cost effective. This can lead, in some instances, to an illness or injury being responded to by a vehicle other than an ambulance, such as a fire truck. In some locales, firefighters are the first responders to calls for emergency medical aid, with separate ambulance services providing transportation to hospitals when necessary.
Some charities or non-profit companies operate ambulances, which provide emergency and patient transport function. This may be along similar lines to volunteer Fire companies and may be either community or privately owned. They may be linked to a voluntary fire service, with volunteers providing both services. There are also charities which focus on providing ambulances for the community, or coverage at private events (sports etc.). The Red Cross provides this service in many countries across the world on a volunteer basis (and in others as a Private Ambulance Service), as do some other smaller organizations such as St John Ambulance. In some countries, these volunteer ambulances may be seen providing support to the full-time ambulance crews during times of emergency.
Private Ambulance Service
These are normal commercial companies with paid employees, but often on contract to the local or national government. Many private companies provide only the patient transport element of ambulance care (i.e. non-urgent). However, in some places, they are also contracted to provide emergency care, or to form a 'second tier' response, where they only respond to emergencies when the full-time emergency ambulance crews are busy or they respond to non-emergency home calls, such as "pick up and put back" calls. This is when a person falls without injury but needs help getting up. Dependent on their contract they might also provide "first aid only" services, such as providing bandages (but not a trip to the hospital emergency room) to a child who skinned his/her knees at a playground. They may also be contracted by private clients to provide standby EMS for large events such as sports, conventions, or parades.
Combined Emergency Service
These are full-service emergency service agencies, which may be found in places such as airports or large colleges and universities. Their key feature is that all personnel are trained not only in ambulance (EMT) care, but as a firefighter and a peace officer (police function). They may also be found in some smaller towns and cities which do not have the resources or requirements for separate services. This multi-functionality allows the community to make the most of limited resources or budget by having a single team respond to any emergency.
Hospital Based Service
Some hospitals may provide their own ambulance service as a service to the community, or where ambulance care is unreliable or chargeable. Their use would be dependent on using the services of the providing hospital.
What are the Certifications in EMS?
There are several certifications available. In addition to the ones listed below, individual states may have their own specialty certifications (such as in West Virginia where one can become certified as an EMT-Miner. This certification is focused on the unique situations experienced in the mining industry).
Emergency Medical Responder (EMR)
Also known as a First Responder, these individuals are able to perform immediate life saving care until the ambulance or a higher trained provider arrives on the scene. This includes such skills as hemorrhage control, spinal stabilization, and CPR
Emergency Medical Technician (EMT)
Also known as Ambulance Technician in the UK and EMT-Basic in the United States. Technicians are usually able to perform a wide range of emergency care skills, such as defibrillation, spinal care and oxygen therapy.
Advanced Emergency Medical Technician (AEMT)
This is a new certification level that is being phased in under the new EMS Educational Guidelines published by the National Highway Traffic and Safety Administration. The AEMT has the ability to start IVs, administer some medications and performed some advanced airway procedures that can be beneficial to a wide variety of patients. It is intended to replace the EMT-Intermediate certification described below.
Emergency Medical Technician - Intermediate (EMT-I)
This is the next level of Emergency Medical Certification in the National Registry and in most US states. It places the provision of emergency medical care at a level between that of ALS and BLS, allowing the EMT to perform such duties as IV and IO cannulation, administration of a limited number of drugs, more advanced airway procedures, CPAP, Analgesic Administration, and limited cardiac monitoring and manual defibrilation capabilities. Some states still allow intermediates to practice, but do not issue new intermediate licenses, instead choosing to focus on efforts to go from the Basic to Paramedic route. Some states utilize a modified Intermediate curriculum for training basic EMTs, like the Tennessee EMT-Intravenous Therapy program. In a few other US states, the level of Paramedic is actually an Intermediate-level curriculum. This is strictly an American level of licensure. This certification is schedule to be phased out over the next few years.
This is a high level of prehospital medical training and usually involves key skills not performed by technicians, including cannulation (and with it the ability to use a range of drugs such as morphine), cardiac monitoring, intubation and other skills such as performing a cricothyrotomy. In many countries, this is a protected title, and use of it without the relevant qualification may result in criminal prosecution. In the United States, paramedics represent the highest licensure level of prehospital emergency care in most states. In addition, several certifications exist for Paramedics such as Wilderness ALS Care, Flight Paramedic Certification, and Critical Care EMT-Paramedic.
How Do I Become An EMT?
Almost all community colleges and some state colleges and hospitals offer training for Emergency Medical Technicians. This is typically a 3 to 4-month course that can be completed as part of other curriculum at a college. Once the course has been completed, you must pass a computer-based test to become nationally registered. This test is known as the National Registry Exam. To obtain a license or certification to work in your area, you must file an application with the local EMS authority along with your national registry card and a certificate of course completion, which will be valid for two years. You must be 18+ years old and agree to have a background check on past criminal activities.
What Is BLS and ALS?
Basic Life Support (or BLS) is a specific level of prehospital medical care provided by trained responders. Basic Life Support consists of a number of life-saving techniques focused on the "ABC"s of pre-hospital emergency care:
The protection and maintenance of patient airway including the use of airway adjuncts such as an oral or nasal airway
The actual flow of air through respiration, natural or artificial respiration, often assisted by emergency oxygen
The movement of blood through the beating of the heart or the emergency measure of CPR
BLS may also include considerations of patient transport such as the protection of the cervical spine and avoiding additional injuries through splinting and immobilization and the use of CPR and AED (automated external defibrillator). BLS generally does not include the use of drugs or invasive skills.
ALS (Advance Life Support) provider may perform advanced procedures and skills on a patient involving invasive and non-invasive procedures including:
- Cardiac Monitoring
- Cardiac Defibrillation
- Transcutaneous pacing
- Intravenous cannulation (IV)
- Interosseous (IO) access and Intraosseous infusion
- Surgical Cricothyrotomy
- Needle Cricothyrotoy
- Needle decompression of Tension Pneumothorax
- Advanced medication administration through parental and enteral routes (IV, IO, PO, PR, ET, SL, topical, and transdermal)
- Following protocols as set forth by AHA Advanced Cardiac Life Support (ACLS)
- Following protocols as set forth by AHA Pediatric Advanced Life Support (PALS)
- Following protocols as set forth by Pre-Hospital Trauma Life Support (PHTLS)