Emergency Medical Responder
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Emergency medical responders (EMRs) are people who are specially trained to provide out-of-hospital care in medical emergencies, typically before the arrival of an ambulance. 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 (often, more simply, EMT) is a medical professional that provides emergency medical services. EMTs are most commonly found serving on ambulances and in fire departments in the US and Canada, as full-time and som ...
and
paramedic A paramedic is a healthcare professional trained in the medical model, whose main role has historically been to respond to emergency calls for medical help outside of a hospital. Paramedics work as part of the emergency medical services (EMS), ...
. However, the EMR is not intended to replace the roles of such providers and their wide range of specialties. EMRs have the knowledge and skills necessary to provide immediate lifesaving interventions while awaiting additional
emergency medical services Emergency medical services (EMS), also known as ambulance services, pre-hospital care or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to d ...
(EMS) resources to arrive, typically in rural communities or other remote environments. EMRs also provide assistance to higher-level personnel at the scene of emergencies and during ambulance transport, if needed. 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. First responders typically include Law enforcement, law enforcement officers (co ...
is the first medically trained personnel who comes in contact with a patient. This could be a passerby, citizen volunteer, or emergency services 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, EMRs require 80 to 120 hours of training. PCPs, depending on province, require generally a two-year diploma of paramedicine. ACPs require an additional year of training and clinical experience totaling three years of education, and CCPs 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 EMRs. 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. Many paramedics in Canada at all levels, are combining their diplomas of paramedicine with a bachelor's degree of paramedicine which is heading towards the standard of educational requirements in Canada. EMRs would not be eligible for these educational advances due to their limited scope of practice and education.


In the United States


Role

EMRs most commonly practice in rural communities as volunteers, serving with volunteer rescue squads and fire departments. EMRs can also serve as secondary providers or drivers on ambulances with volunteer EMS services. An EMR 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.


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 a ...
(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. 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 respo ...
s which do not have the resources or funds to conduct full EMT training. EMR training is intended to fill the gap between first aid and EMT. The
American Red Cross The American National Red Cross is a Nonprofit organization, nonprofit Humanitarianism, humanitarian organization that provides emergency assistance, disaster relief, and disaster preparedness education in the United States. Clara Barton founded ...
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 the year 2015, most states recognize the level of EMR.


Scope of practice

EMRs in the United States provide initial emergency care first on the scene (police, fire department, search and rescue) and support EMTs and paramedics when they arrive. The skills allowed at this level include taking vital signs, bleeding control,
positive pressure ventilation Positive airway pressure (PAP) is a mode of Modes of mechanical ventilation, respiratory ventilation used in the treatment of sleep apnea. PAP ventilation is also commonly used for those who are critically ill in hospital with respiratory failure ...
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 Modes of mechanical ventilation, positive pressure ventilation ...
, oropharyngeal airway, 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 naloxone. 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 airways. Skills that EMRs are commonly not allowed to perform (that EMTs are) include insertion of administration of certain medications, traction splinting, glucometry, CPAP, or insertion of supraglottic airways. However, certain regions and states (such as Wisconsin) or medical directors may allow them to assist in or perform these skills.


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, focused on automobile safety regulations. NHTSA is charged with writing and enforcing Feder ...
and endorsed by the
National Registry of Emergency Medical Technicians The National Registry of Emergency Medical Technicians (National Registry) is a US based, non-profit, non-governmental certification organization for pre-hospital emergency medical providers that exists to ensure that emergency medical services ( ...
. Each state, region, and agencies may add to or deduct from this list as they see medically fit.


Rescue

The
National Fire Protection Association The National Fire Protection Association (NFPA) is a U.S.-based international nonprofit organization devoted to eliminating death, injury, property damage, and economic loss due to fire, electrical, and related hazards. , the NFPA claims to have 5 ...
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, etc., are emergency medical responders, emergency medical technicians, or
paramedic A paramedic is a healthcare professional trained in the medical model, whose main role has historically been to respond to emergency calls for medical help outside of a hospital. Paramedics work as part of the emergency medical services (EMS), ...
s, as most every rescue has a patient involved.


Traditional EMRs

EMR training is considered a bare minimum for emergency service workers who may be sent out in response to an
emergency call An emergency telephone number is a number that allows a caller to contact local emergency services for assistance. The emergency number differs from country to country; it is typically a three-digit number so that it can be easily remembered and ...
. It is typically required as a bare minimum of medical training for firefighters,
police officers A police officer (also called policeman or policewoman, cop, officer or constable) 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 ...
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 EMRs 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

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 EMRs include: * Firefighters *
Campus police Campus police or university police in the United States and Canada are Police officer, sworn police or peace officers employed by a college or university to protect the private or public property of the campus and surrounding areas and the peo ...
*
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 Cardiopulmonary ...
s * Ski patrollers *
Park ranger A ranger, park ranger, park warden, field ranger, or forest ranger is a person entrusted with protecting and preserving parklands and Protected area, protected areas – private, national, state, provincial, or local parks. Their duties include ( ...
s * Event first aid staff *
Security guard A security guard (also known as a security inspector, security officer, factory guard, 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.) ...
s *
Emergency management Emergency management (also Disaster management) is a science and a system charged with creating the framework within which communities reduce vulnerability to hazards and cope with disasters. Emergency management, despite its name, does not actu ...
personnel *
HAZMAT Hazmat, HazMat or HAZMAT may refer to: * Dangerous goods, hazardous materials and items * Hazmat suit * Hazmat diving * Hazmat (comics) is a Marvel Comics character * ''HazMat'' (film), a 2013 horror film See also * Hazmat Modine Hazmat Mo ...
personnel *
Community emergency response team In the United States, Community Emergency Response Team (CERT) can refer to * an implementation of Federal Emergency Management Agency, FEMA's National CERT Program, administered by a local sponsoring agency, which provides a standardized training ...
(CERT) members * Disaster relief personnel * Street medics *
Athletic trainer An athletic trainer is a certified and licensed health care provider who practices in the field of sports medicine. Athletic training has been recognized by the American Medical Association The American Medical Association (AMA) is an American ...
s * SCUBA divers *
Bodyguard A bodyguard (or close protection officer/operative) is a type of security guard, government law enforcement officer, or servicemember who protects an very important person, important person or group of people, such as high-ranking public offic ...
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 and commercial
flight attendant A flight attendant is a member of the aircrew whose primary responsibility is ensure the safety of passengers in the cabin of an aircraft across all stages of flight. Their secondary duty is to see to the comfort of passengers. Flight attenda ...
s


Levels of training

EMRs are generally trained to provide advanced
first aid First aid is the first and immediate assistance given to any person with a medical emergency, with care provided to preserve life, prevent the condition from worsening, or to promote recovery until medical services arrive. First aid is gener ...
and
basic life support Basic life support (BLS) is a level of medical care which is used for patients with life-threatening condition of cardiac arrest until they can be given full medical care by advanced life support providers (paramedics, nurses, physicians or any ...
. These responders may be laypeople, employees, or volunteers associated with an emergency service. Generally speaking, EMRs in the United States require 24 to 60 hours of training. EMTs are the next level of providers. Within the United States, there are three common levels of EMS personnel, each with an increased scope of practice: EMT, advanced EMT, paramedic, and critical care paramedic. Critical care paramedics have the most training of these levels. Paramedics and critical care paramedics 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 Key aspects of ALS level care ...
(ALS). Advanced EMTs perform intermediate life support (ILS) or limited
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 Key aspects of ALS level care ...
(LALS). 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 condition of cardiac arrest until they can be given full medical care by advanced life support providers (paramedics, nurses, physicians or any ...
(BLS).


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 ...
, medical providers receive additional training relating to wilderness medicine. There are several levels of certification that parallel the aforementioned levels, which include wilderness first responder and wilderness emergency medical technician.


See also

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


References

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