EMT or Paramedic:What's The Difference

So it’s a busy Saturday afternoon, you have the kids piled in the back of the SUV and a stack of errands to do before you get home to make dinner. The traffic on Boston Road is slow and tedious and nothing seems to be going well for you. All of a sudden you hear the wail of a siren and see a burst of bright lights in your mirror. You pull to the right side of the road and stop while the Wilbraham Fire Department Medic 2 flies by you. As you watch the white box with the red stripe go by you wonder to yourself, “What exactly do they do in the back of that thing?”

First off, thank you for pulling to the right and STOPPING. It’s dangerous and difficult enough to drive an emergency vehicle without having to jockey for position with every vehicle that fails to move to the right and stop. It’s very frustrating as you try to deal with vehicles that don’t see you, don’t hear you or just plain ignore you. Cars pull out of driveways and side streets without looking. People pull over but don’t stop, forcing you to drive along side them while you try to avoid oncoming traffic. That’s why everywhere but on a divided highway, traffic coming at an emergency vehicle is also required to pull over and STOP. Another good tip to keep in mind, if everyone in front of you is pulling to the right and stopping, it’s probably not so you can go by. Check your rearview mirror and make sure an emergency vehicle is not waiting to pass.

Now back to the original question, what exactly do they do in the back of that thing?

Wilbraham Fire Department is located at 2770 Boston Road. Not only do we provide fire prevention, suppression and education but also we, like many area fire departments, provide our citizens with emergency medical services (EMS). In other words, we run the ambulance. Some local cities and towns are provided EMS by privately owned and operated ambulance services. For instance, American Medical Response (AMR) covers Springfield and Holyoke. Private service providers offer very competent and timely coverage; however there is a certain personal touch that goes along with a fire based service in your own community.

Ambulances have a history that date back to Civil War times. We’ve come a very long way from creaky wagons and bumpy horse trails. Today’s EMS provider is not simply “an ambulance driver”. Many months and sometimes years of training go into making emergency medical technicians (EMT) and paramedics.

There are three levels of training for EMS personnel. Everybody begins as an EMT-Basic. EMT Basics attend a three-month program to be taught basic life support or BLS. Locally the program is available through Springfield College, STCC and Human Services Training Consultants out of West Springfield. The course is designed to make you proficient in CPR, use of the semi automatic heart defibrillator and airway training. You learn bleeding and shock management, splinting, oxygen and oxygen delivery devices, and cervical neck and spine immobilization. Newly introduced skills include use of epi-pens for allergic reactions, administering aspirin for chest pain, assisting a patient to use their own nitroglycerine or asthma inhalers and the paramedic assist program. While learning these skills, students also become familiar with basic anatomy, physiology and medical terminology so that the EMT is able to accurately and concisely give reports to nurses and doctors. Ten hours observation in the Emergency Room rounds out your training. Students not only must pass the classroom with a 70 average but also need to pass a written and practical exam administered by the Commonwealth. Students then become certified as emergency medical technicians

An option after becoming comfortable as a Basic is to go back to college to become an EMT-Intermediate. There are a couple of EMT-I courses offered locally, most notably at Springfield College and through Mary Lane Hospital.
Intermediates begin their training with a semester of classroom lecture and hands on skills training. More in depth training is provided on the anatomy and physiology of the airway and respiration. Students are trained to use a laryngoscope and endotracheal intubations (like on ER when they “tube” the patient) as an option for airway management. Much detail is focused on to understand the pathophysiology of shock and how to optimally manage it using oxygen and IV therapy. Intermediates are drilled to become proficient at patient assessment. Many times illnesses or injuries are identified in the field (our word for prehospital) but they’re out of the scope of our training to resolve. Then it becomes our job to accurately report to the receiving nurses and doctors what we’ve found. This can greatly decrease the time between the patient becoming sick or injured and receiving definitive care at the hospital. The second part to becoming an EMT Intermediate is to spend a set number of hours at Baystate or Mercy Hospital. Your time is spent in the ER assessing patients and starting IV’s under the watchful eyes of the nurses, PA’s and doctors. The rest of the time is extremely challenging as you head to the operating room to intubate surgical patients under the tutelage of experienced anesthesiologist.

Not everyone chooses to become an EMT Intermediate. Some folks stay at the Basic level and are quite comfortable at that level for their career. Some brave souls however, choose to move on to paramedic school and the challenges it presents. Locally, Springfield College offers a two-year program. Paramedic students are refreshed in their basic skills and taught IV, advanced airway and patient assessment techniques similar to those that are taught in Intermediate school. During the first semester students begin to become acquainted with pharmacology. Not only are medications learned but also their uses, contraindications and how they work with the physiology of the patient. Semester one flows right into the summer session. That’s when students begin learning Advanced Cardiac Life Support (ACLS). In depth study of the anatomy and physiology of the cardiac and respiratory systems goes hand in hand with learning how to use newly acquired pharmacology knowledge. By the end of the summer session, students’ ability to identify and treat cardiac, respiratory and stroke patients is second nature. Third semester is a continuous review of classroom and practical skills while learning new subjects such as, special needs of the geriatric and pediatric patient, overdoses and poisonings, psychology and many other necessary subjects that round out the professional paramedic.

A semester is spent at an approved facility, most likely Baystate Health Systems, doing a series of clinical rotations. ICU, CCU, psych, ER, Pedi ER, OR, Infants & Toddlers, OB/GYN all provide the student the opportunity to learn necessary skills while being monitored by experienced nurses, doctors and Physician Assistants. Another semester is spent riding with more experienced paramedics, to begin putting all the knowledge gathered to good use for patients.

So the next time you’re pulled to the side of the road, stopped, and one of our town’s ambulances cruises by you, think to yourself, “what’s going on in there?” Is a heart patient being monitored with 12 lead EKGs, being given medication to treat a heart attack? Is an accident patient being stabilized through splinting, airway management and pain control medications? Is a child receiving asthma treatments to not only help them breathe easier, but receiving one on one TLC from an EMT, EMT-I or Paramedic who is well trained and calmly reassuring both child and patient.

One thing is for sure, in Wilbraham, it isn’t just an ambulance driver whose only hope is to drive fast to the emergency room. In Wilbraham, it’s one of the well-trained, professional firefighters who are cross-trained to deal with any emergency.

As always, Acting Chief Fran Nothe and the members of the Wilbraham Fire Department are there for you in fire safety and good health.