Emergency Medical Responder
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Emergency medical responders are people who are specially trained to provide out-of-hospital care in
medical emergencies A medical emergency is an acute injury or illness that poses an immediate risk to a person's life or long-term health, sometimes referred to as a situation risking "life or limb". These emergencies may require assistance from another, qualified p ...
. There are many different types of emergency medical responders, each with different levels of training, ranging from
first aid First aid is the first and immediate assistance given to any person with either a minor or serious illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery. It includes initial in ...
and
basic life support Basic life support (BLS) is a level of medical care which is used for patients with life-threatening illnesses or injuries until they can be given full medical care by advanced life support providers (paramedics, nurses, physicians). It can be pr ...
. Emergency medical responders have a very limited scope of practice and have the least amount of comprehensive education, clinical experience or clinical skills of
emergency medical services Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...
(EMS) personnel. The EMR program is not intended to replace the roles of
emergency medical technicians An emergency medical technician (EMT), also known as an ambulance technician, is a health professional that provides emergency medical services. EMTs are most commonly found working in ambulances. In English-speaking countries, paramedics are ...
or
paramedics A paramedic is a registered healthcare professional who works autonomously across a range of health and care settings and may specialise in clinical practice, as well as in education, leadership, and research. Not all ambulance personnel are p ...
and their wide range of specialties. Emergency medical responders typically assist in rural regions providing basic life support where pre-hospital health professionals are not available due to limited resources or infrastructure. "Emergency medical responder" is a broad term, used either to describe a certain EMS certification level, or generally to describe those who respond to
medical emergencies A medical emergency is an acute injury or illness that poses an immediate risk to a person's life or long-term health, sometimes referred to as a situation risking "life or limb". These emergencies may require assistance from another, qualified p ...
. Specifically used, an Emergency Medical Responder is an EMS certification level used to describe a level of EMS provider below that of an
emergency medical technician An emergency medical technician (EMT), also known as an ambulance technician, is a health professional that provides emergency medical services. EMTs are most commonly found working in ambulances. In English-speaking countries, paramedics are ...
and
paramedic A paramedic is a registered healthcare professional who works autonomously across a range of health and care settings and may specialise in clinical practice, as well as in education, leadership, and research. Not all ambulance personnel are p ...
. Broadly used, a
first responder A first responder is a person with specialized training who is among the first to arrive and provide assistance or incident resolution at the scene of an emergency, such as an accident, disaster, medical emergency, structure fire, crime, or terr ...
is the first medically trained personnel who comes in contact with a patient. This could be a passerby, citizen volunteer, or fire department, police, or
emergency medical services Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...
personnel.


In Canada

Emergency Medical Responder (EMR), Primary Care Paramedic (PCP), Advanced Care Paramedic (ACP) and Critical Care Paramedic (CCP) in Canada are the titles and levels of practitioners recognized by the National Occupational Competency Profile Paramedic Association of Canada. Generally speaking, Emergency Medical Responders (EMRs) require 80 to 120 hours of training. Primary Care Paramedic (PCP), depending on province, require generally a two-year diploma of paramedicine. Advanced Care Paramedics (ACP) require an additional year of training and clinical experience totaling three years of education, and Critical Care Paramedics (CCP) require a final year of education totaling four years of education. Under the new NOCP, most providers that work in ambulances are identified as 'paramedics'. However, in some cases, the most prevalent level of emergency prehospital care is that which is provided by the Emergency Medical Responder (EMR). Generally speaking, emergency medical responders (EMRs) require 80 to 120 hours of training. As a group, EMRs staff rural ambulance stations, community volunteer ambulance services, fire departments, police departments, industrial ambulances or mobile treatment centers. For many small communities, without this level of certification, the operation of a much-needed small community ambulance system might not be possible. EMRs across Canada contribute an important role in the chain of survival. It is a level of practice that is least comprehensive (clinically speaking), and is also generally not consistent with any medical acts beyond advanced first-aid and oxygen administration, with the possible exception of automated external defibrillation, which is still a regulated medical act in Canada, although one which is increasingly performed by members of the public under a legal exemption that allows members of the public to undertake some controlled medical acts in emergencies. This level of training is equivalent to an
Emergency Medical Technician An emergency medical technician (EMT), also known as an ambulance technician, is a health professional that provides emergency medical services. EMTs are most commonly found working in ambulances. In English-speaking countries, paramedics are ...
in the United States. Many paramedics in Canada at all levels from Emergency Medical Responder (EMR), Primary Care Paramedic (PCP), Advanced Care Paramedic (ACP) and Critical Care Paramedic (CCP), are combining their diplomas of paramedicine with a bachelor's degree of paramedicine which is heading towards the standard of educational requirements in Canada. Emergency Medical Responders would not be eligible for these educational advances due to their limited scope of practice and education.


In the United States


History

The
U.S. Department of Transportation The United States Department of Transportation (USDOT or DOT) is one of the executive departments of the U.S. federal government. It is headed by the secretary of transportation, who reports directly to the President of the United States and ...
(DOT) recognized a gap between the typical eight hours training required for providing basic first aid (as taught by the Red Cross) and the 180 hours typical of an EMT-Basic program. Also, some rural communities could not afford the comprehensive training and highly experienced instructors required for a full EMT course. The First Responder training program began in 1979 as an outgrowth of the "Crash Injury Management" course. In 1995 the DOT issued a manual for an intermediate level of training called "First Responder." This training can be completed in twenty-four to sixty hours. Importantly, this training can be conducted by an EMT-Basic with some field experience, which is a resource available in-house for many
volunteer fire department A volunteer fire department (VFD) is a fire department of volunteers who perform fire suppression and other related emergency services for a local jurisdiction. Volunteer and retained (on-call) firefighters are expected to be on call to respond ...
s which do not have the resources or funds to conduct full EMT training. The first responder training is intended to fill the gap between first aid and Emergency Medical Technician. The
American Red Cross The American Red Cross (ARC), also known as the American National Red Cross, is a non-profit humanitarian organization that provides emergency assistance, disaster relief, and disaster preparedness education in the United States. It is the desi ...
conducts a course titled "Emergency Medical Response" that fits this definition. In the US the term "Emergency Medical Responder" has largely replaced the term "Certified First Responder" or "Medical First Responder" beginning in 2012. "Emergency Medical Responder" or "EMR" is an EMS certification level recognized by the National Registry of Emergency Medical Technicians. The term "emergency medical responder" is used loosely in many states, with "first responder" and "medical first responder" still being common terms. By 2015, most states recognized the level of Emergency Medical Responder.


Scope of practice

Emergency Medical Responders (EMR) in the United States provide initial emergency care first on the scene (police/fire department/search and rescue) and support Emergency Medical Technicians and Paramedics when they arrive. The skills allowed at this level include taking vital signs, bleeding control,
positive pressure ventilation Modes of mechanical ventilation are one of the most important aspects of the usage of mechanical ventilation. The mode refers to the method of inspiratory support. In general, mode selection is based on clinician familiarity and institutional pref ...
with a
bag valve mask A bag valve mask (BVM), sometimes known by the proprietary name Ambu bag or generically as a manual resuscitator or "self-inflating bag", is a hand-held device commonly used to provide positive pressure ventilation to patients who are not breathi ...
,
oropharyngeal airway An oropharyngeal airway (also known as an oral airway, OPA or Guedel pattern airway) is a medical device called an ''airway adjunct'' used in airway management to maintain or open a patient's airway. It does this by preventing the tongue from cov ...
, supplemental oxygen administration, oral suctioning, cardio-pulmonary resuscitation (CPR), use of an automated external defibrillator (AED), splinting, and assisting in the administration of basic medications such as epinephrine auto-injectors and oral glucose. They are also trained in packaging, moving and transporting patients. Due to the opioid epidemic, EMRs in certain states or regions are also trained and allowed to give Naloxone and utilize
supraglottic airway Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either cl ...
s.


Procedures by certification level

These are the ''minimum'' skills recommendations put forth by the
National Highway Traffic Safety Administration The National Highway Traffic Safety Administration (NHTSA ) is an agency of the U.S. federal government, part of the Department of Transportation. It describes its mission as "Save lives, prevent injuries, reduce vehicle-related crashes" rela ...
and endorsed by the
National Registry of Emergency Medical Technicians The National Registry of Emergency Medical Technicians is a US certification agency covering prehospital medical providers. History The NREMT was established in 1970 in response to a recommendation from President Lyndon Johnson's Committee on ...
. Each State, region, and agencies may add to or deduct from this list as they see medically fit.


First responder skills and limitations

First responders can serve as secondary providers with some volunteer EMS services. An Emergency Medical Responder can be seen either as an advanced first aid provider, or as a limited provider of emergency medical care when more advanced providers have not yet arrived or are not available. Skills that Emergency Medical Responders are commonly not allowed to perform (that EMTs are) include insertion of traction splinting, administration of nebulized albuterol, administration of ASA, pulse oximetry, glucometry, or insertion of supraglottic airways. However, certain regions and states (such as Wisconsin) or medical directors may allow them to assist in or actually perform these skills.


Rescue

The
National Fire Protection Association The National Fire Protection Association (NFPA) is an international nonprofit organization devoted to eliminating death, injury, property and economic loss due to fire, electrical and related hazards. As of 2018, the NFPA claims to have 50,000 mem ...
standards 1006 and 1670 state that all "rescuers" must have medical training to perform any technical rescue operation, including cutting the vehicle itself during an extrication. Therefore, in most all rescue environments, whether it is an EMS or fire department that runs the rescue, the actual rescuers who cut the vehicle and run the extrication scene or perform any rescue such as rope rescues or
swift water rescue Swift water rescue (also called "white water rescue") is a subset of technical rescue dealing in white water river conditions. Due to the added pressure of moving water, swift water rescue involves the use of specially trained personnel, ropes an ...
, etc., are Emergency Medical Responders, Emergency Medical Technicians, or
Paramedic A paramedic is a registered healthcare professional who works autonomously across a range of health and care settings and may specialise in clinical practice, as well as in education, leadership, and research. Not all ambulance personnel are p ...
s, as most every rescue has a patient involved.


Traditional Emergency Medical Responders

Emergency Medical Responder training is considered a bare minimum for emergency service workers who may be sent out in response to an
emergency call Most public switched telephone networks have a single emergency telephone number (sometimes known as the universal emergency telephone number or the emergency services number) that allows a caller to contact local emergency services for assista ...
. It is typically required for
firefighters A firefighter is a first responder and rescuer extensively trained in firefighting, primarily to extinguish hazardous fires that threaten life, property, and the environment as well as to rescue people and in some cases or jurisdictions also ...
. The Emergency Medical Responder level of medical training is also often required for
police officers A police officer (also called a policeman and, less commonly, a policewoman) is a warranted law employee of a police force. In most countries, "police officer" is a generic term not specifying a particular rank. In some, the use of the ...
and
search and rescue Search and rescue (SAR) is the search for and provision of aid to people who are in distress or imminent danger. The general field of search and rescue includes many specialty sub-fields, typically determined by the type of terrain the search ...
personnel. Many Emergency Medical Responders have location specific training such as water rescue or mountain rescue and must take advanced courses to be certified (i.e. lifeguard, ski patrol).


Other types of Emergency Medical Responders

Many people who do not fall into the earlier mentioned categories seek out or receive this type of training because they are likely to be first on the scene of a medical emergency, or because they work far from medical help. Some of these other Emergency Medical Responders include: *
Firefighters A firefighter is a first responder and rescuer extensively trained in firefighting, primarily to extinguish hazardous fires that threaten life, property, and the environment as well as to rescue people and in some cases or jurisdictions also ...
*
campus police Campus police or university police in the United States and Canada are sworn police or peace officers employed by a college or university to protect that private property of the campus and surrounding areas and the people who live, work, and v ...
*
Lifeguard A lifeguard is a rescuer who supervises the safety and rescue of swimmers, surfers, and other water sports participants such as in a swimming pool, water park, beach, spa, river and lake. Lifeguards are trained in swimming and CPR/ AED first a ...
s *
Ski patrol Ski patrols are organizations that provide medical, rescue, and hazard prevention services to the injured in ski area boundaries, or sometimes beyond into backcountry settings. Many have technical-medical certifications, such as Outdoor Emergen ...
lers *
Park ranger A ranger, park ranger, park warden, or forest ranger is a law enforcement person entrusted with protecting and preserving parklands – national, state, provincial, or local parks. Description "Parks" may be broadly defined by some systems in thi ...
s * Event first aid staff *
Security guard A security guard (also known as a security inspector, security officer, or protective agent) is a person employed by a government or private party to protect the employing party's assets (property, people, equipment, money, etc.) from a variety ...
s *
Emergency management Emergency management or disaster management is the managerial function charged with creating the framework within which communities reduce vulnerability to hazards and cope with disasters. Emergency management, despite its name, does not actuall ...
personnel *
HAZMAT Dangerous goods, abbreviated DG, are substances that when transported are a risk to health, safety, property or the environment. Certain dangerous goods that pose risks even when not being transported are known as hazardous materials ( syllabi ...
personnel * Community Emergency Response Team (CERT) members * Disaster relief personnel *
Street medic Street medics, or action medics, are volunteers with a minimum of first aid medical training supplemented by specific protest-related training, who attend protests and demonstrations as support or mutual aid roles to provide medical and wellness ...
s *
Athletic trainer Athletic training is an allied health care profession recognized by the American Medical Association (AMA)"What is an Athletic Trainer?". The Board of Certification Website. 2003. Athletic training is also recognized by the Health Resources Serv ...
s *
SCUBA Scuba may refer to: * Scuba diving ** Scuba set, the equipment used for scuba (Self-Contained Underwater Breathing Apparatus) diving * Scuba, an in-memory database developed by Facebook * Submillimetre Common-User Bolometer Array, either of two in ...
divers *
Bodyguard A bodyguard (or close protection officer/operative) is a type of security guard, government law enforcement officer, or servicemember who protects a person or a group of people — usually witnesses, high-ranking public officials or officers, w ...
s * Designated industrial or corporate workers in a large facility (industrial plant or large office building) or at a remote site (oil rig, fish-packing plant, commercial vessel) (i.e. "Medical Emergency Response Team (MERT) Scheme) * General aviation
pilots An aircraft pilot or aviator is a person who controls the flight of an aircraft by operating its directional flight controls. Some other aircrew members, such as navigators or flight engineers, are also considered aviators, because they a ...
and commercial
flight attendant A flight attendant, also known as steward/stewardess or air host/air hostess, is a member of the aircrew aboard commercial flights, many business jets and some government aircraft. Collectively called cabin crew, flight attendants are prima ...
s


Levels of training

First responders are generally trained to provide advanced
first aid First aid is the first and immediate assistance given to any person with either a minor or serious illness or injury, with care provided to preserve life, prevent the condition from worsening, or to promote recovery. It includes initial in ...
and
basic life support Basic life support (BLS) is a level of medical care which is used for patients with life-threatening illnesses or injuries until they can be given full medical care by advanced life support providers (paramedics, nurses, physicians). It can be pr ...
. These responders may be laypeople, employees, or volunteers associated with an emergency service. In the US, the term "Emergency Medical Responder" largely replaced the term "Certified First Responder" beginning in 2012.
Emergency medical technician An emergency medical technician (EMT), also known as an ambulance technician, is a health professional that provides emergency medical services. EMTs are most commonly found working in ambulances. In English-speaking countries, paramedics are ...
s (EMT) are the next level of providers. Within the United States, there are three common levels of EMTs, each with an increased
scope of practice Scope of practice describes the procedures, actions, and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional license. The scope of practice is limited to that which the law allows for ...
: EMT,
Advanced Emergency Medical Technician Advanced emergency medical technicians (AEMT) are providers of prehospital emergency medical services in the United States. A transition to this level of training from the ''emergency medical technician-intermediate'' (''EMT-I''), which have somewh ...
(AEMT), and
Paramedic A paramedic is a registered healthcare professional who works autonomously across a range of health and care settings and may specialise in clinical practice, as well as in education, leadership, and research. Not all ambulance personnel are p ...
. Paramedics have the most training of these levels. Paramedics and AEMTs perform
advanced life support Advanced Life Support (ALS) is a set of life saving protocols and skills that extend basic life support to further support the circulation and provide an open airway and adequate ventilation (breathing). Components These include: * Tracheal in ...
. EMTs and EMRs perform
basic life support Basic life support (BLS) is a level of medical care which is used for patients with life-threatening illnesses or injuries until they can be given full medical care by advanced life support providers (paramedics, nurses, physicians). It can be pr ...
.


Remote areas

In the field of
wilderness first aid A wilderness medical emergency is a medical emergency that takes place in a wilderness or remote setting affinitive care (hospital, clinic, etc.). Such an emergency can require specialized skills, treatment techniques, and knowledge in order to m ...
, medical providers receive additional training relating to
wilderness medicine Wilderness medicine is a rapidly evolving field and is of increasing importance as more people engage in hiking, climbing, kayaking, and other potentially hazardous activities in the backcountry. The modern definition of wilderness medicine is "m ...
. There are several levels of certification that parallel the aforementioned levels, which include
Wilderness First Responder Wilderness first responders are individuals who are trained to respond to emergency situations in remote locations. They are part of a wide variety of wilderness medical providers who deal with medical emergencies that occur in wilderness settings ...
and Wilderness Emergency Medical Technician.


See also

*
Emergency medical services Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...
* Emergency medical responder levels by U.S. state


References

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