Look at 'dem Ambulance Drivers blazing down the road with lights blazing and sirens a screamin' . Many of us in the EMS profession joke about opinions that in the publics' eye we're all "Ambulance drivers" but in reality that is not the case. Truth be told, the public rarely knows the difference between one prehospital care provider and the other, nor do they realize the training and dedication it takes to graduate to each level.  So the following will briefly and (hopefully) concisely show the delineation between the different levels of prehospital care provider in the Town of Shandaken and what we have to offer you just in case we meet by accident.  

    As a preface, a division of the Department of Transportation, the National Highway Traffic and Safety Administration has set standards for three levels of Emergency Medical Technician. All States are free to adopt DOT standards, or they may adopt their own. New York has adopted four levels which are described below to the best of my abilities.

    All pre-hospital emergency services providers in New York start at the EMT- Basic level if employed by an Ambulance. An EMT-Basic course is approximately 140 hours in which the student is taught the basics of prehospital emergency care such as assessment skills, immobilization skills, basic lifesaving maneuvers and interventions, and some limited medication administration. New York has chosen not only to adopt the DOT recommended curriculum for EMT-Basics, but to add several additional expanded topics of study. All NYS EMTs are mandated to recertify every three years by the State by taking 40+ hours of continuing medical education credits (CMES) or taking a refresher class which can range from a few hours and a written/ practical exam to an entire curriculum which can take an additional two months depending on competency. Shandaken currently has nine NYS credentialized EMTs on staff.

   The next level of EMT is the EMT-Intermediate, which 41 states recognize in some form. In New York, an EMT-I course is approximately 80 hours of classroom time. In addition to EMT-Basic and after initial classroom study, students are required to do rotations in a hospital and depending on curriculum, ride in an ambulance. During this ride time, the EMT-I student must initiate certain emergency advanced procedures in the field under the guidance of another Intermediate or Paramedic before the student can take the exam. In New York, an Intermediate can initiate IV's, and employ advanced airway devices to deliver Oxygen to patients. In over 30 states, Intermediates are also given the training to administer some medications that the EMT-Basic cannot. Shandaken Ambulance currently has no EMT-I credentialized individuals employed.

    A few states have a level of EMT above the Intermediate but below Paramedic and New York is one of them. These Advanced EMT's are trained in the use of even more advanced lifesaving techniques as well as in the use of a limited number of cardiac-related medications. This curriculum is even longer than the EMT-I course and the individuals that graduate this course are credentialized as EMT-CCs or Critical Care Technicians. This course is 120+ hours in addition to EMT-Basic and requires an extensive clinical rotation and internship. Shandaken Ambulance does not employ any EMT-CCs either.

    The highest level of EMT which is recognized in all 50 states is the Emergency Medical Technician-Paramedic. The classroom time and clinical time required to become a Paramedic varies from state to state, but not by much: most programs run from 1,400 to 2,000 hours of study plus extensive clinical rotation and internship and sometimes are encompassed by an Associate's Degree program. To put things in perspective, it has been said that in the first ten minutes of a cardiac arrest, there is little difference between what an ER doctor can do and what an EMT-Paramedic can do. EMT-Paramedics are trained in the use of numerous emergency procedures that other levels of EMT are not such as needle decompression, emergency cricothyrotomy, manual defibrillation, and cardiac pacing. In addition, EMT-Paramedics are trained in the administration of scores of medications that lower levels of EMT are not authorized to administer including narcotics for sedation and pain suppression. As with all levels of EMT the Paramedic must recertify every three years however must complete a refresher course spanning 2+ months or over 120 hours of continuing medical education credits. Shandaken has 10 Paramedics on our roster as of January 2010.

If you are interested in becoming an EMT or Paramedic for Shandaken Ambulance please call (845) 688-5030 for more details. As always please stay safe out there and remember in an emergency dial 911!