EMT training typically involves mastering basic medical techniques and implementing a procedure manual which specifies in detail the exact procedures to be undertaken given a certain situation. The goal of EMT training is to maximize speed and response and minimize the necessity for deep and complex judgement.
More and more, EMTs are utilized for duties involving home health care as well as non-emergency transportation of in-hospital patients. Many ambulance services provide transport for patients not experiencing an emergency, but nonetheless require medically supervised transportation. Such patients may include those being transferred between hospitals, bedridden patients being discharged to nursing homes or patients who are to undergo specialized treatment or diagnostic procedures, such as hemodialysis, physical therapy or MRIs.
In the United States, EMTs are licensed according to their level of training. Although the National Registry of EMTs is one such licensing entity, individual states may set their own standards of licensure. All EMTs must meet the minimum requirements as set forth in the Department of Transportation's standards for EMT curriculum. National Registry recognizes three levels of EMT: EMT-B (Basic), EMT-I (Intermediate) and EMT-P (Paramedic). An ambulance with only EMT-Bs is considered a BLS or Basic Life Support[?] unit whereas an ambulance with EMT-Ps is dubbed an ALS[?] or Advanced Life Support[?] unit.
EMT-B skills include CPR, first aid, airway management, oxygen administration, spinal immobilization, bleeding control and traction splinting. EMT-I skills add IV therapy, endotracheal intubation and initial cardiac drug therapy. Both EMT-I and EMT-P actually require something like a residency to attain; an EMT-B is the highest level of training one can receive without being employed as an EMT and sponsored by one's employer or a hospital.
Regardless of the level of an EMT, what they are allowed to do in the field is governed by an "Acts Allowed" list that is unique for each county (in the USA) and is set forth by the supervising physician. This individual, a doctor and usually a trauma surgeon, is responsible for all of the EMTs of a given county and they all answer to him. EMTs in the field are usually in contact with the supervising physician while they are on a call and as such can be ordered to perform acts that they normally would not (though they must still be trained for in the correct procedure). There is a training class (at least in Colorado) lasting a few hours that will enable an EMT-B to become IV-certified. Once the EMT-B becomes IV-certified they can administer an IV but cannot administer any drugs with it. This is the only invasive procedure that an EMT-B is allowed to perform. The invasiveness of the acts increases as the training does. An EMT-P, usually called a paramedic, can actually stick a needle directly into the chest in certain cases: if the pericardium, the sac surrounding the heart, starts filling with blood (a pericardial tamponade), then that blood must be drained for the heart to have room to beat; if the lungs start filling with fluid they must be drained to allow air to reach the alveoli[?] so that oxygen can enter the bloodstream; people without a heart-beat must have adrenaline injected directly into the heart.
When nursing shortages occur, EMTs are being increasingly used in the Emergency Rooms and Intensive Care Units of hospitals.
Currently, in the United States of America, the busiest EMS service per ambulance is New Orleans' Health Department EMS, which responds to approximately 4,000 "911" calls per month, utilizing six ambulances for the entire city of about 500,000 people.