Virginia EMS Certifications: From First Responders to Paramedics

What's a First Responder? What's a paramedic? What's the difference between an EMT-B and an EMT-I? And what in the world is and EMT-Enhanced? I'm glad you asked, because I have your answers. There are five different EMS certifications in Virginia: First Responder, EMT-Basic, EMT-Enhanced, EMT-Intermediate and EMT-Paramedic. First Responder and EMT-B are the entry-level certifications and they provide Basic Life Support (BLS). EMT-Enhanced, EMT-Intermediate and EMT-Paramedic are the Advanced Life Support (ALS) certifications.

As you could probably guess by the name, a First Responder is often the first provider on the scene of an emergency. Firefighters and police officers are often certified First Responders. With advanced first aid training of at least 40 hours, the First Responders are able to identify and treat life threatening injuries. After an EMT of any level arrives on the scene, the First Responder transfers care of the patient to them. First Responders cannot administer any medications, not even oxygen, but they do splint, control hemorrhaging, and initiate spinal immobilization. The First Responder certification lasts for four years.

EMT-Basic is the next level of EMS provider. The class is a minimum of 111 hours of classroom instruction and 10 hours of clinical rotations. In addition to the first aid skills a First Responder has, EMT-Bs also receive training in recognizing and treating medical emergencies such as chest pain or difficulty breathing. They are better able to stabilize patients than a First Responder. EMT-Bs can administer oxygen, and can assist patients with taking their own nitroglycerin, inhalers and Epi-pens, and they can administer oral glucose in diabetic emergencies. Depending on where they practice, EMT-Bs may also be able to administer aspirin to chest pain patients. They are trained in CPR and AED use (automatic external defibrillators, you've probably seen them in airports or grocery stores), they can give artificial respirations (no, not mouth-to-mouth, don't worry!), and insert non-invasive airway devices in unconscious patients or those in cardiac arrest. The EMT-B certification lasts for four years.

Virginia has a unique certification, the EMT-Enhanced. You can think of the EMT-E as the stepping stone between the EMT-B and EMT-Intermediate levels. EMT-E's receive a minimum of 80 hours of classroom instruction and must do at least 48 hours of clinical rotations in a variety of settings including ERs, labor and delivery units and critical care units. EMT-E's are to ALS as First Responders are to BLS. EMT-E's can start IVs and intubate (place breathing tubes) in patients in cardiac arrest. They are able to administer some medications, such as Benadryl in allergic reactions, Albuterol nebulizer treatments for asthma patients and dextrose in diabetic emergencies. The EMT-E certification is good for three years.

As the name implies, the EMT-Intermediate is the intermediate level of ALS provider in between the EMT-E and the EMT-Paramedic. The EMT-I curriculum is 272 hours of classroom instruction and 68 hours of clinical rotations. In addition to the classroom and clinicals, the EMT-I student must have at least 10 patient contact calls where they act as the team leader on an ALS ambulance. They receive training in heart rhythm monitoring (EKG's) and treatment of cardiac emergencies like heart attacks. The EMT-I's scope of practice (what they are allowed to do) varies from council to council, but generally they are allowed to intubate unconscious patients in addition to those in cardiac arrest and children. EMT-I's are also able to perform manual defibrillation, which means that they can decide how many joules to deliver if a patient requires electrical interventions. They can administer the same medications as the EMT-E and they are allowed to administer cardiac medications, such as those to treat irregular heartbeats. After completing the EMT-I class, students are able to sit for the National Registry of EMT's test. The Virginia EMT-I certification is good for three years.

The EMT-Paramedic is the highest certification in Virginia. Paramedic classes are only offered at community colleges and at some medical schools such as the Medical College of Virginia. Many of the programs are two years long and the student graduates with an Associate's degree. The class consists of an average of 800 to 1200 hours of classroom instruction and a minimum of 168 hours of clinical rotations. In addition to the clinical hours, the paramedic student must perform certain skills such as intubation, starting IVs, and administering medications. They must also act as the ALS leader on an ambulance. The curriculum is much more in-depth than the EMT-I and EMT-P's are not only able to diagnose and treat medical emergencies like the EMT-I, but they have a greater understanding of the pathophysiology behind conditions. Their knowledge allows them to act more independently while treating patients. The EMT-P can perform all of the skills that the EMT-I can, as well as more invasive skills like placing a tube in the nose and down into the stomach (nasogastric tube). After completing the class, the student must sit for the National Registry of EMT's paramedic exam and pass (of course!) in order to obtain their Virginia EMT-P. The Virginia EMT-P certification is a three year certification and the NREMT-P is good for two years.

In order to recertify, the EMS provider must have a certain number of continuing education hours which vary from level to level. First Responders need 18 hours while the EMT-Paramedic needs 72 hours. All providers must have in-date CPR cards and EMT-P's need the Advanced Cardiac Life Support (ACLS) certification as well.

Virginia's five EMS certifications allow people to obtain a wide variety of training, from the most basic of skills of the First Responder to the highest level of EMT-Paramedic. With five levels, a person is sure to find the right fit for them.