Ambulance Drivers
Written By Julie Holmes EMT-P/RN
Edited By Tracy Harris Staff Writer
The need for some kind of rapid emergency transport from point A to a place that could provide a higher level of medical care came about in 1865 in Cincinnati, Ohio. At that time, they used wagons to transport the injured/sick to a hospital but did not provide care on the wagon. This occurred after the Civil War showed the need to get the wounded soldiers off the battlefields to the behind-the-lines medical tents. EMS has continued to evolve throughout time. The local Ambulance services that we think of now were set up by rural areas/people who recognized this need and started off with two people dressed all in white (including their hats), whose only job was to get the patient on the cot, get the cot secured in the hearse, then drive them as fast as they could to the closest hospital. A lot has changed since the inception of an EMS service, gradually making EMS and its providers into what you see today.
EMS professionals are licensed and certified by the same Health Board, which licenses Dr.s, NPs, PAs, RNs, OTs, PTs, RTs, etc. There are four different levels of licensure within EMS.
EMT-Basic goes to college for a semester and learns Basic Life Support-CPR (compressions and breaths) and general splinting. They are taught to recognize A airway, B breathing, and C circulation (ABC’s) problems. The only medication they are licensed to administer is Oxygen.
Advanced EMT’s (AEMT) go to college for two semesters— the basic EMT semester and another semester, adding building blocks to what they are already allowed to do and learning more about disease processes. AEMTs can now give several more medications than they used to if their service does on-the-job training. They can administer nitro, aspirin, nebulized albuterol, Zofran (vomiting medication), Fentanyl (pain medicine), Epi, and Narcan (OD). They can also administer oxygen in several different treatment forms as well as start an IV or IO (drill a needle into the bone) to administer fluids or medications to patients.
A Paramedic EMT-P goes to school for five semesters (a semester longer than an associate’s education.) They build on the two semesters of the EMTB/AEMT. A paramedic can do everything for you in an emergent situation, which a Dr. and a room full of nurses can do for you, in the Emergency Room. Paramedics, however, are doing this alone (sometimes with another person in the back of the ambulance with them if they are available,) all while standing up and going down the road at 80 MPH at the risk of life and limb, all in the hopes of helping that one life. They can restart your heart, stop it, speed it up, slow it down. They can recognize different rhythms on a monitor, which can tell them multiple things, and then they can relay that to the ED so they are ready in a critical situation the minute they breach the door. They can use the shocky thingies and holler “clear,” which is a hit on many TV shows. They can put a tube down your windpipe to breathe for you – it also prevents vomit/blood/etc.… from going into your lungs. They can administer any medications in the ambulance, treating everything from cardiac arrest/allergic reactions/trauma/low blood pressure/high blood pressure/breathing issues/and so on.
Then there is a Critical Care Paramedic, who goes to school one more semester than the paramedic, learning ICU type of skills- running a ventilator/knowing what settings to put it on for your needs, carrying multiple drips running to keep you stable, more about lab values and how to treat the different ones reported with hospital transfers.
On top of this, all levels must attend classes all year long to learn updates, keep critical skills fresh in their minds, and keep up their licensures. All of these classes are taught by hospitals like Vanderbilt, which teaches about pediatric-specific needs; or teaches information on OB to be aware of complications in a pregnancy, as well as how to treat a newborn with emergent needs. The list goes on.
I know that I have missed things involved with each level of licensure, but this is a rough example of the roles each provider plays on YOUR ambulance. You do not think about these things until it is too late and it was your 911 call that deserved the full level of treatment that could have been provided. EVERY ambulance should be ALS (Advanced Life Support) capable, which means that a paramedic should be on there to perform advanced and critical skills and advanced medications for life-saving measures! Our EMTs are golden, but at the end of the day, they cannot provide the level of care that a paramedic can. A good paramedic/EMT team and an ambulance stocked to its full capabilities literally bring an ER on wheels to you and your particular emergency.
The general public has never recognized these providers because they haven’t been proactive in teaching others about their line of work, unlike the nurses you see every time you go to the hospital. Lay people have absolutely no clue what it is that EMS providers do, and it is our job as “Ambulance Drivers” to start educating them about why it is they HAVE to have an ALS response.
