The Difference Between a Paramedic and EMT

EMT vs Paramedic
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Posted By: admin January 9, 2019

You’ve probably heard ambulance personnel called many things, including: First Responders, Ambulance Drivers, EMTs, and Paramedics. Many news organizations frequently refer to ambulance crews as “The Paramedics” or “The EMTs”, but there is a difference between the two. Most States require that an Ambulance crew consists at least 2 EMTs, but may also consist of Advanced EMTs (AEMTs) and/or Paramedics. Paramedics and EMTs both train for Emergency situations, and to provide help to sick and injured people, but there are some of the differences between EMTs and Paramedics:

The main difference between a Paramedic and EMT is the amount of training they receive. EMT training takes approximately 140-200 hours (3-6 months) to complete, and a Paramedic school takes approximately 1400-1800 hours (1-2 years) to complete. Both EMTs and Paramedics work on an ambulance, but an Emergency Medical Technician (EMT) provides Basic Life Support (BLS), and a Paramedic provides Advanced Life Support (ALS). A Paramedic will first need to be certified as an EMT before starting Paramedic school.

EMT vs Paramedic

Until recently, many States and the NREMT categorized EMTs as EMT-B (Basic), EMT-I (Intermediate), and EMT-P (Paramedic). Now the NREMT, and most States, have 3 levels of EMTs: 1. EMT 2. Advanced EMT (AEMT) 3. Paramedic.

The former EMT-Basic, is now classified as EMT, and an Intermediate EMT (EMT-I) is now classified as an Advanced EMT (AEMT), in most States. Paramedics are not typically refereed to as an EMT-P anymore, they are just called a “Paramedic”. So, referring to someone licensed as a Paramedic as an “EMT” may still technically be correct, but referring to someone licensed as an EMT as a “Paramedic”, is not correct.

There are a few States that still recognize EMT-Intermediate licenses, or I-99. If you are planning on becoming an EMT, it is important to check your State’s requirements for becoming licensed. Most States also have a certification for an EMR (emergency medical responder), but you cannot be responsible for patient care on an ambulance with only an EMR license.

EMT vs Paramedic- Salary

Paramedics require more training than EMTs, and therefore earn a higher salary on average than EMTs. It is difficult to know exactly how much more Paramedics earn than EMTs on average, because the Bureau of Labor Statistics does not make a distinction between EMTS and Paramedics when they are compiling their statistics (see my page regarding EMT and Paramedic Wages).

According to the Bureau of Labor Statistics, the estimated median wage for Emergency Medical Technicians (EMTs) and Paramedics in 2017 was $33,380/year, and the estimated median hourly wage was $16.05/hour. 

From my personal experience, I have found that Paramedics make approximately 20% more per hour than an EMT does. For example, I currently worked for an employer that payed Paramedics $19/hour, and EMTs $15/hour (I know this is anecdotal).

EMT vs Paramedic
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EMT vs Paramedic -Scope of Practice

Paramedics are required to train more, and are allowed to perform more invasive procedures than an EMT. Your scope of practice may differ in each state, and also may differ depending on the organization you work for, and your Medical Director/protocols.

A Paramedic will learn about many more medications, cardiology, cardiac monitoring, advanced airway management, pathophysiology, and medication administration.

Here are a list of some different skills a Paramedic and EMT may be able to perform.

EMT vs. Paramedic- Medications

What medications an EMT and Paramedic can give is always defined by their State, and by their organization’s protocols/Medical Director. Here is an example of what medications an EMT and Paramedic may be able to administer, if their protocols allow for it.

EMT- Medications

An EMT may be able to assist a patient with a few medications. Some protocols will only allow the EMT to give these medications to the patient if the patient already has them prescribed, and has that medication readily available. For example, an EMT may only be able to assist a patient with their inhaler only if the patient already has a prescription for the inhaler, and has their own inhaler readily available.

Some of the medications an EMT may assist a patient with are:

  • Albuterol
  • Nitroglycerin
  • Epinephrine
  • Activated Charcoal
  • Aspirin
  • Oral Glucose
  • Oxygen

An EMT will go through training on each of the medications that they are allowed to assist with, and should know the indications and contraindications.

Paramedic Medications-

A Paramedic will have knowledge of many more medications (40+) than an EMT, and will be able to provide some of these medications even if the patient is not prescribed the medication.

For example, a Paramedic may be able to give medications for:

  • Bradycardia (low heart rate)
  • Tachycardia (high heart rate)
  • SVT (supra-ventricular tachycardia)
  • Cardiac arrhythmias
  • Hypotension (low blood pressure)
  • Hypertension (high blood pressure)
  • Seizures
  • Cardiac Arrest
  • Low Blood Sugar
  • Chest Pain
  • Difficulty Breathing
  • Nausea/Vomiting

A Paramedic will be able give medications for a variety of issues, and be able to give those medications through different routes, including: Intravenously, Inramuscular, IntraNasal, Intraosseous, and oral medications.

Intravenous (I.V.)/Intraosseous (I.O)/IntraMuscular (I.M.) Medications

In general, a Paramedic can give medications or fluids with a needle, and an EMT cannot. However, Advanced EMTs (AEMT) may be able to start an I.V. and give certain medications, depending on the State and their protocols. The scope of practice for AEMTs (or Intermediates) vary greatly by State.

A Paramedic will be able to start an I.V. and give medications or fluids intravenously. If I.V. access is not available in critical patients, a Paramedic may be able to start an I.O. by drilling through a bone and accessing systemic circulation that way, and give medications and/or fluids through the I.O.. An EMT will not be able to perform these skills.

A Paramedic may be able to give some medications intramuscularly or subcutaneously. An example of this is giving epinephrine for an allergic reaction. A paramedic will be able to calculate the dose, draw the epinephrine from a vile, and give the medication with an injection. An EMT may be able to assist a patient with an epinephrine auto-injector, if the patient already has the medication prescribed.

EMT vs Paramedic- Cardiac Monitoring

An EMT will be able to use an AED (automated external defibrillator) during a cardiac arrest, but will not be able to perform any cardiac monitoring or rhythm analysis.

A Paramedic can use a cardiac monitor (example: LifePak, Zoll) connect a 4 or 12 lead, look for ST-elevation or depression (to indicate a heart attack, or STEMI), and monitor for other arrhythmias.

Examples arrhythmias a Paramedic looks for are: A-Fib, A-Flutter, SVT (supra-ventricular tachycardia), V-Tach, PVCs (premature ventricular contractions), and PACs (premature atrial contractions). A Paramedic will be able to treat some arrhythmias with medication and/or electricity (synchronized cardioversion, defibrillation).

EMT vs Paramedic- Airway Management

Another key difference between EMTs and Paramedics is the training they receive to manage a patient’s airway.

An EMT can use basic airway management tools, including:

  • Suctioning
  • Oropharyngeal Airway (OPA)
  • Nasopharyngeal Airway (NPA)

In some States, an EMT may be able to use supraglottic airway devices (King Airway, LMA, Combitube) that help protect a patient’s airway.

A Paramedic can use the basic airway tools to manage an airway, but can also intubate a patient with an endotracheal tube, providing the most protection to the patient’s airway from aspiration. A paramedic will also know how to use capnography to help confirm the E.T. tube is in the trachea.

How Long does it Take to become an EMT? Paramedic?

If you are considering becoming an EMT and/or Paramedic, you probably want to know how long this is going to take you to achieve. If you want to be a Paramedic someday, you will first need to become licensed as a EMT. In most States, you will first need to become certified by the NREMT (National Registry of Emergency Medical Technicians) as an EMT before you can apply for a State license as an EMT.

An Emergency Medical Technician (EMT) class will typically take between 3-6 months to complete the approximate 140-200 hours of training, depending on the hours/week of the class. There are accelerated classes that can be completed more quickly. Check with your local ambulance services and/or colleges about EMT classes available in your area. Make sure you check with your State’s EMT licensing office prior to taking a class, some States require taking a class that is accredited in order to apply for a State License.

EMT classes can range in price from from approximately $750-$1800, or more. Paramedic School can range in price from approximately $3000-$10,000 or more. The NREMT requires that Paramedic applicants complete a CAAHEP-accredited Paramedic program prior to applying for certification, so make sure whatever program you take is accredited.

As an example, when I attended an EMT class taught by my local ambulance service, I attended 2 nights a week (5 hours/night) for approximately 4 months. You may be able to take an accelerated class at your local ambulance service or college, and be done quicker than I was.

In order to pass my EMT class, I had to pass the final exam, and all practical stations, and then I was able to take the NREMT written test and practical exam. After receiving my NREMT certification, I was then able to apply for my State License as an EMT. You will need to renew your NREMT certificate every 2 years, and your state license every 2-4 years, respectively.

My Paramedic class was an accelerated class, and took approximately 8 months to complete (not including the EMT class), but most classes take 1-2 years. You may complete a Paramedic course for a certificate or possibly an associates degree (I personally do not have an associates degree) through a college (some States may require this), but like I said above, make sure it is accredited so you can get a Paramedic certificate through NREMT (although some states may not require NREMT for a State License).

EMT vs Paramedic Jobs

You can read my page about EMT and Paramedic Jobs and Wages here to find out about some potential EMT and Paramedic Jobs. Here is an example of jobs you may find as an EMT:

  • Ambulance
  • Fire Department
  • Wild-Land Firefighter/EMT
  • Hospital/Emergency Room
  • EMT/Security
  • Cruise Ship/EMT
  • Ski Resort EMT

A Paramedic will be able to apply for the jobs above as well, but will be eligible for a few positions that require a Paramedic License. For example, a to be eligible to work on as a medical Flight Crew member (fixed wing, or helicopter), you will likely need a Paramedic License (or be an RN). You will have more opportunities as a Paramedic than an EMT; there are many fire departments and ambulance services across the nation that are in need of Paramedics.

Conclusion

EMTs and Paramedics both provide life-saving care, and are valuable members of their communities, but they are not the same thing. If you are thinking about becoming an EMT or Paramedic, know that it is a very rewarding career, but it can also be stressful and it is not for everyone. Thank you for reading my article, and I hope you found it helpful!