Emergency Medical Services (EMS) personnel treat nearly 20 million patients a year in the United States. Many of these patients have complicated medical or traumatic conditions that require considerable knowledge, skill, and judgment to be treated effectively in the out-of-hospital setting. Some are critically ill or injured, and the proper care can literally make the difference between life and death. For most patients, their crisis may not be a matter of life or death, but it is no less significant to them and their family. High quality out-of-hospital emergency care is an important part of the United States health care system.

The National EMS Scope of Practice Model defines the practice of EMS personnel. EMS personnel are unique health care professionals in that they provide medical care and transportation in an out-of-hospital setting with medical oversight. EMS personnel are not independent practitioners. While the practice is not independent, it is relatively unsupervised and often has little backup. Therefore, EMS personnel must be able to exercise considerable judgment, problem-solving, and decision-making skills.

Most EMS personnel work in emergency medical organizations that respond to emergency calls. Emergency response is typically a local government function (or contracted by local government to a private entity). In most communities, citizens call 9-1-1 when they need emergency medical care, and the appropriate EMS resources are dispatched. EMS personnel respond and provide care to the patient in the setting in which the patient became ill or injured, including the home, field, work, industrial, and recreational settings. In the case of emergency calls, EMS personnel are unique in that they typically have a “duty to act.”

Many EMS personnel provide medical transportation services for patients requiring medically supervised transportation, either exclusively or in addition to emergency response. These “medical transports” generally do not fall under the “duty to act” responsibility of emergency response. Some EMS personnel provide interfacility transfers of very high acuity patients.

In some cases, EMS personnel “stand by” at mass gatherings (for example, concerts, sporting events, etc.) and high-risk activities (for example, fire ground operations, etc.). EMS personnel occasionally serve a combined emergency response and occupational/primary care role in remote areas (for example, off-shore oil rigs, wildland fires, etc.) Increasing numbers of EMS personnel are working in more traditional health care settings in the hospital (especially emergency departments), urgent care centers, doctor’s offices and long-term care facilities. Finally, EMS personnel are becoming involved in numerous public health initiatives (immunizations, illness and injury prevention programs, etc.).

Emergency Medical Services are a local function and organized in a variety of ways. Common models are municipal government (fire-based or third-service) or a contracted service with a private (profit or nonprofit) entity. EMS personnel also can be categorized in a variety of ways. Those trained to higher levels tend to be paid (either full- or part-time) while those trained to lower levels tend to be volunteers or partially paid.

EMS provides out-of-hospital medical care to those with perceived urgent needs. It is a component of the overall health care system. EMS delivers care as part of a system intended to attenuate the morbidity and mortality associated with sudden illnesses and injury. The positive effects of EMS care are enhanced by linkages with other community health resources and integration within the health care system.

There are four licensure levels in the field of EMS. Each licensure level is substantially different from other licensure levels in skills, practice environment, knowledge, qualifications, services provided, risk, level of supervisory responsibility, amount of autonomy, and judgment/critical thinking/decision making. The Emergency Medical Responder (EMR) is the most basic level. The Emergency Medical Technician builds upon the EMR level education and training to include an expanded scope of practice and responsibilities. In other parts of the country, the Advanced Emergency Medical Technician (AEMT) is utilized with an increased scope of practice incorporating items from both EMR and EMT level with additional skills, knowledge, and responsibilities. The Paramedic further builds upon the scope of practice of the preceding levels (EMR, EMT, and AEMT) and is the most advanced level of licensure. One of the requirements to enter into a Paramedic level training course is current certification as an EMT or AEMT.