What is an EMT?

I often worry at the idea of glorified first aiders dressing in green. Everyone asks ‘What is a tech?’ or What is an ECA? or Advanced first aider? And what is a Paramedic?

The answer is that it could be a number of things. ECA stands for emergency care assistant, EMT stands for emergency medical technician and a Paramedic is a protected term for a registered health care professional.

If you call 999 you might have a paramedic or 2 come to your assistance, you might have a paramedic with an ECA or technician and you might be sent a combination of the latter.

The worrying thing is that companies sometimes describe first aiders as an ECA, or tech when they have done little more than a first aid course. In fact officially, the First Person On Scene Intermediate course has often been referred to as an EMT or Emergency Medical technician course, as such some first aider who might have completed a course just a couple of days long might consider themselves EMT’s.

Confusion often occurs because the technician who might turn up from working for an NHS trust will have completed a much more in depth course. The technician course the NHS has previously used was run by the IHCD and was approximately 6-8 weeks with a further 750 hours of supervised clinical time. The EMT FPOS course is 5 days.

The voluntary sector has generally provided a lot of first aider. The average first aid course being approximately 2 days and covering things such as basic life support or CPR and how to stop bleeding. The ‘advanced’ skills tend to be the administration of oxygen, the use of an automated defibrillator and the administration of gas and air.

The ECA course which some trusts use is somewhere between the FPOS intermediate and the technician. Usually around 6 weeks long but to include 3 weeks of emergency driving. These courses are aimed at teaching the basics as well as how to assist a paramedic.

The College of Paramedics recently announced that they believed members of the public who called 999 have the right to a paramedic either in person or on the end of the phone. To clarify a paramedic is someone who has completed an approved HCPC program usually with a university. This is currently 3 years and includes a substantial number of clinical hours.

To confuse the public even further the IHCD program has been discontinued. It has been replaced by a new program called FREC (First Response Emergency Care). The Level 5 qualification is on par with the previous IHCD tech course.

The question I ask myself, is if my mother became ill, perhaps she had sudden abdominal pain. Would I want someone who had been given 5 days training in basic first aid giving her medical advice. The answer is of course not, which then as an event organiser brings up the next question. If that person with 5 days training in not able to give the correct medical advice how can they reduce the impact of the event on the NHS?

A change to the purple guide came in to force in the latter part of last year stating,

“Except for small low-risk events, organisers should not rely on NHS ambulances to convey patients from site to hospital. Plans should cater for conveyance of all casualties from the scene to the hospital as part of the medical provider’s service.”

In order to transport patients to hospital the provider must be registered with the Care Quality Commission and for emergency transport this must be for the activities of both ‘transport and triage’ and ‘treatment of disease and disorder’.

This has now closed the gap meaning that unregulated providers should no longer be covering all but small low-risk events and the first question should be, can the provider transport to hospital and if so what happens when the ambulance becomes stuck at hospital due to delays handing over.

The NHS ambulance services and hospital emergency departments have been pushed to breaking point with little or no capacity. This will no doubt result in the growth of the private sector to assist and will surely change the responsibility for event organisers, private schools, universities and even care homes to have their own provision rather than completely rely on the statutory services to deliver a safe provision to their services users. Waiting 4 hours for an ambulance and 6 hours to see a doctor in A&E has become closer to the norm that one would like.

Going back to the original question MET has decided to do things a little differently to everyone else. In addition to our team of A&E nurses and paramedics, we work with ambulance personnel who are on a university HCPC approved paramedic program at a number of paramedic training universities. Our minimum requirements are 6 months training at university and 150 hours working on a frontline 999 ambulance. At this stage staff are still closely supervised by a health care professional or paired with a more experienced member of staff. Our student paramedics have a vast knowledge and exposure to real emergencies which give them confidence after all the program is training to be the lead clinician at a scene. I would have no issues whatsoever in letting any of our teams look after my own family and I think that’s why we have become one of the leading providers in the UK.


College of Paramedic
The Purple Guide
Care Quality Commission

Dave Hawkins