While EMS education can be offered five days a week, the majority of First Responder and EMT-Basic courses in the Baldwin area are offered once or twice a week, often in the evening, to accommodate volunteers who often have full-time jobs. Day classes are ocassionally available to accommodate second and third shift workers. In addition to the typical EMT or First Responder training courses, there are several schools in Wisconsin that offer either a two year or a four year degree in Emergency Medical Services. These schools run these programs just like any other college degree course. These courses are intended for those students hoping to obtain a career in EMS. However, there is no requirement whatsoever to obtain a two or four year degree in order to operate as an EMT or Emergency Medical Responder.

The requirements and length of the educational course depends on the level of training being taught. All students must start out by completing either an Emergency Medical Responder or an EMT-Basic course. After becoming an EMT, students are then eligible to enroll in any of the advanced levels of training from Intermediate Technician through Paramedic.

In addition to the formal EMT or EMR training courses, there are a large variety of additional courses that an EMT may take. These include dealing with hazardous materials, bloodborne pathogens and bio terrorism; Basic Trauma Life Support (BTLS); Specialized pediatric and geriatric training, incident management training, and much more. EMTs also often spend time attending local, regional and state EMS conferences and training events. There are multiple EMS magazines, web sites and continuing educational opportunities to also take advance of. While the initial training is often the longest and most important, like all forms of medical care, EMS is constantly changing and evolving. This requires EMTs of all levels to stay informed and essentially continue their education throughout their volunteer of full-time EMS career.

It does not matter whether the EMT or EMR will operate as a volunteer or a paid, full-time provider. The training and certification is the same for all EMTs regardless of the work they will perform. There are not separate licenses for volunteers and for full-time providers. Every First Responder, EMT and Paramedic in Wisconsin and across the United States is trained to the same standards and must pass the exact same examination to become licensed.

EMERGENCY MEDICAL RESPONDER  Most EMR courses now require 60 hours of education, although there are some programs in Wisconsin that provide a more generic First Responder course in 40 hours. Emergency Medical Responders are taught the basics of emergency medical care and are able to treat life threatening problems prior to the arrival of the ambulance. Their skills include operating a cardiac defibrillator, inserting simple and advanced airways and using an epinephrine auto injector. Bleeding control, CPR, cervical spinal immobilization, taking vital signs, and oxygen administration are also part of the course. A First Responder is only able to treat patients at the scene. While they may assist in the back of an ambulance, an EMR is not able to function as a licensed member of the ambulance crew. Following initial certification, every EMR must complete a 16-18 hours refresher course every two years to retain that certification.

EMT  The backbone of EMS in Wisconsin and across the nation is the Emergency Medical Technician. These EMS providers actually receive a sizable amount of training. EMT'ss undergo 160 hours of instruction including classroom, practical and emergency room education. The training includes basic anatomy and physiology, understanding of various body systems, illnesses, injuries and their associated treatments. Besides administering oxygen, Wisconsin EMT's are trained and authorized to administer aspirin, albuteral, atrovent, epinephrine, and glucagon. They are able to give patient's injections as well as test their blood sugar. Because the EMT is the only level of care required in Wisconsin, an EMT must learn and become familiar with a wide variety of patient conditions and treatments. Following their initial licensure, an EMT must complete a 30 hour refresher course every two years or obtain training at one of the higher levels of EMS in order to retain their license.

ADVANCED EMT After becoming licensed as an EMT some EMTs go on to obtain training and certification as an Advanced EMT. This requires an additional 70 hours of training beyond the initial 140 hours to complete the EMT-Basic course. Approximately 60 of these hours are spent in the classroom with the remaining 40 hours spent in the emergency room practicing their skills. EMT-Intermediate Technicians are able to start IVs and administer IV fluids. They carry and administer several additional medications including nitroglycerine for chest pain, Narcan to treat narcotic overdose, and 50% Dextrose to treat diabetics. Following course completion, the EMT must again pass a written and practical exam to become licensed as an Advanced EMT. In addition, they must be licensed and volunteering or working with an ambulance services licensed at this level. There are currently 130 ambulance services that operate at the Advanced EMT. The A-EMT would not be able to use their advanced skills if they were operating with one of Wisconsin's approximately 180 EMT-Basic services. In this case, they would be restricted to the EMT-Basic level of care regardless of their certification. An A-EMT must complete a 42 hour refresher course every two years or obtain training at one of the higher levels of EMS in order to retain their license.

EMT-Intermediate  The next level of care is the EMT-Intermediate. This level of provider must undergo at least 335 hours of additional training. About two-thirds of this training is completed in the classroom with the remaining time spent in various departments of the hospital, and in the back of an ambulance with an instructor or preceptor, performing their skills. EMT-Intermediates receive a much more detailed education in the various systems of the body and in the pathophysiology of the various emergency conditions they will treat. They are trained to interpret ECGs as well as perform a much more advanced and detailed patient assessment. They carry and administer over 20 different medications including cardiac drugs and narcotic medications to treat pain as well as seizures. They are able to perform a variety of advanced procedures including endotracheal intubation, placing a special needle into the leg bone or sternum, placing a catheter through the chest wall to treat a collapsed lung, and starting IVs in the external jugular vein of the neck. EMS providers at this level may operate either as volunteers or as part of a paid ambulance service or fire department. EMT-Is may only use their advanced skills while operating with an ambulance service licensed at this level of care. Currently there are approximately 25 ambulance services in Wisconsin, located in mid-sized communities, who operate at this level of care. Along with these, however, are several very small communities who have this level of care because of very dedicated volunteers. An EMT-I must complete a 48 hour refresher course and complete an Advanced Cardiac Life Support (ACLS) refresher course every two years to retain their license or complete the additional training required to become a paramedic.

EMT-Paramedic  The highest level of training is the EMT-Paramedic. Paramedics must complete at least 1,000 hours of education to obtain their license. Typically about half of this time is spent in the classroom with the remaining hours being spent in a large number of hospital departments and in the ambulance working with licensed paramedics. Paramedics receive a very detailed education in anatomy, physiology, pathophysiology, pharmacology, critical thinking and advanced medical procedures. The EMT-Paramedic is allowed to carry and administer as many as 40 or more different medications. In addition to all of the procedures of the EMT-Intermediate, a Paramedic can perform a chricothyrotomy, place a needle into the sac that surrounds the heart to remove blood and even completely sedate and paralyze a patient in order to facilitate the insertion of a breathing tube. Paramedics often operate as part of a full-time paid ambulance service or fire department and make their living in EMS. However, there are areas of Wisconsin that have volunteer paramedics as well as those who only work in EMS part-time while they maintain their regular career in a completely unrelated field. Typically Wisconsin's larger cities have paramedic ambulance services and fire departments. Still, several very small communities also have this level of care because of very dedicated volunteers. Like the Intermediate, the EMT-Paramedic must complete a 48 hour refresher every two years and complete an Advanced Cardiac Life Support (ACLS) refresher course to retain their license.

Information provided by Don Hunjadi and the Wisconsin EMS Association.