EMS Operations Study Guide for the EMT Test

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General Information

It is the overall operation of the emergency medical services (EMS) system to provide emergency care and transport to the sick and injured. Within that system are a multitude of procedural guidelines that contribute to lifesaving efforts, and each one has its role in delivering exceptional results. Be sure you know all of the guidelines and understand how they function in a well-run EMS system. You need to consult your textbook for complete details on all of the following concepts.

EMS Systems

Emergency medical services are a system of response for the care of the sick and injured. An EMS system includes many components, including personnel, training, and equipment to report and respond to emergencies. The system includes ambulances, other first responders, emergency dispatching, and medical oversight. The Americans with Disabilities Act (ADA) provides provisions for EMTs with disabilities to pursue a career in EMS when possible.

Terms/Concepts to Know: Emergency Medical Services, certification, licensure, Americans with Disabilities Act of 1990, National EMS Scope of Practice

Four Training and Licensure Levels

Most states typically follow national guidelines developed by the National Highway Traffic Safety Administration (NHTSA) in the National EMS Scope of Practice Model. The latest model went into effect in 2005 and made changes to the levels of certification and skills practiced.

Emergency Medical Responder

EMRs have very basic training and provide care prior to the arrival of EMTs. Training includes familiarity with some EMT procedures and equipment, but not competency in those procedures or in ambulance operations.

Emergency Medical Technician

EMTs are trained to provide basic life support (BLS) to ill and injured patients. This training includes the use of airway adjuncts, automated external defibrillation, and assisting patients with certain medications. EMT training is the foundation for the next levels of certification, and EMTs are often considered the backbone of EMS systems. Training is typically 150 hours, depending on the state. This is what you are training for.

Advanced Emergency Medical Technician

AEMT builds on the EMT training to include limited advanced life support (ALS) care such as IV therapy, use of advanced airway adjuncts, and the administration of certain emergency medications. Training is typically 200-400 hours.


Paramedic is the highest level of pre-hospital training. It includes comprehensive training in basic and advanced life support knowledge and skills, including endotracheal intubation, emergency pharmacology, and cardiac monitoring. Training ranges from 1,000 to 1,300 hours, and it is becoming common for it to be included as part of a college degree.

Terms/Concepts to Know: Advanced Life Support (ALS), Automated External Defibrillator (AED), Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced EMT (AEMT), Paramedic

History of EMS

In the past, civilian EMS was not organized and varied widely by location. It was commonly provided by funeral homes, with minimal care beyond the ability to transport someone on a stretcher. A few urban areas had better equipped ambulance services, but the focus was still on transport. Modern EMS systems are considered to have had their start with the passage of federal legislation in the 1960s and 70s that provided guidance and funding for development.

Terms/Concepts to Know: The White Paper, National Highway Transportation Safety Administration (NHTSA), Highway Safety Act of 1966, EMS Agenda for the Future

Important Components of the EMS System

The EMS Agenda for the Future defines 14 components of EMS systems that interact with each other. An EMS system cannot function without all of them, and it is important to understand and know each of them.

Public Access

A system to request help is vital. In most areas, this is provided by dialing 9-1-1 and being connected to an emergency communication center. Dispatchers can assess information and send ambulances and other responders, and provide first aid and CPR instructions.

Communication Systems

Radio and other communication links are essential for sending resources. GPS can be used to track the locations of responders. Wireless communications can be used to transmit important information such as response maps and updated information to computers in the ambulance.

Clinical Care

EMTs are trained to use a variety of emergency equipment. Clinical care describes the various pieces of equipment and when the equipment is indicated or contraindicated for use. Also, familiarity with the primary service area, checking equipment, and being able to operate all the features in the ambulance are necessary.

Human Resources

How people are recruited, compensated, and retained are important functions of human resources. The goal is to create systems that attract and retain talented people. Interstate mobility, career ladders, and protection of employee well-being are vital to achieving these goals.

Medical Direction

Each EMS system has a set of protocols written by a physician who authorizes the care provided by EMTs. These protocols constitute the EMT’s scope of practice. Modifications or further treatments may be directed by online medical control. Training and continuing education requirements are also determined by the medical director.

Legislation and Regulation

EMS systems are governed by individual state laws and regulations. State EMS offices administer these laws and provide oversight, often with input from an advisory committee. Locally, EMS systems have individual policies and procedures regarding daily operations.

Integration of Health Services

EMS care is only the start of the patient’s medical journey. The care started must be integrated with the receiving hospitals to assure proper coordination. Many EMS systems have developed special alert procedures for certain time-sensitive conditions, such as stroke and heart attacks.


Continuous quality improvement is a circular process of reviewing and improving the processes of patient care and reducing error. Errors can be rule, knowledge, or skill-based and are inevitable in systems run by humans. EMTs have an obligation to recognize and reduce errors.

Information Systems

Computer technology has become an integral part of EMS systems. Data can be used for a wide variety of purposes, including staffing, equipment justification, and identifying training needs. Federal data reporting provides a snapshot of EMS that can be used to improve planning.

System Finance

Regardless of the type of EMS system, funding is needed for continued operations. Funding may come from many sources, including patient fees, taxes, donations, and grants. EMTs play a critical role by properly documenting care and obtaining patient billing signatures.

Education Systems

Education systems are critical for producing EMS providers and offering continuing education. Accreditation is common and some states require special certification for EMS educators. EMTs have a professional duty to maintain knowledge and obtain the required continuing education hours.


EMS can be considered part of the public health system. The goal of public health is to prevent health problems, which can then reduce the costs of healthcare. EMTs’ knowledge about the causes of injury and illness in their community can be used for prevention efforts.

Public Education

EMTs can play important roles in educating the public about healthy behaviors and injury prevention. CPR and first aid education of the public can minimize the effects of events when they occur. Public education efforts also increase the standing of EMTs in the community.


EMS treatments were often adopted from other healthcare providers. Evidence-based medicine is now being used to guide EMS treatment. Good documentation may be vital to gathering research information. Research must be read carefully to understand the results.

Terms/Concepts to Know: EMS Agenda for the Future, public safety access point, emergency medical dispatch (EMD), primary service area (PSA), medical director, medical control, mobile integrated healthcare (MIH), continuous quality improvement (CQI), National EMS Information System (NEMSIS), public health, primary prevention, secondary prevention

Roles of the EMT

EMTs have many roles and responsibilities, from knowing their equipment to protecting patient privacy under HIPAA. EMTs must also display professional attributes, including appearance, integrity, empathy, and respect.

Terms/Concepts to Know: Health Insurance and Portability and Accountability Act (HIPAA)


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