In August of 2020, at the height of the pandemic, I began my paramedicine journey at Malcolm X College in Chicago after being accepted into their paramedic program. In order to apply, I needed a valid EMT-B and CPR license, certain prerequisite classes such as Biology, Anatomy & Physiology, and English, and I had to pass an entrance exam. It was strongly recommended that applicants have a minimum of 500 hours of EMT-B experience and preference was given to applicants that had an associate’s or bachelor’s degree, although these things were not required. 

What are the levels of EMT certification?

In medicine there are in-hospital workers, such as doctors and nurses, and there are prehospital workers, such as firefighters and paramedics. Most prehospital workers have an emergency medical technician license (EMT). 

Emergency Medical Technicians can be licensed at a number of different levels. The lowest level is an EMT-B. The B stands for “basic” and only requires a high school diploma and a minimum age requirement of 18. After that comes an EMT-I (intermediate), an EMT-A (advanced), and finally an EMT-P (paramedic). Some states, such as Illinois, allow you to skip over the EMT-I and EMT-A levels and go straight to EMT-P. Other states require you to complete EMT-I and/or EMT-A before you can pursue an EMT-P license. 

What’s the Difference Between an EMT-B and a Paramedic?

EMT basics are trained to provide BLS (basic life support) care including skills such as administering CPR, applying neck and limb braces, stopping external bleeding, and providing oxygen support.  

On the other hand, a paramedic is trained to provide ALS (advanced life support) care. This means they can do everything an EMT basic can do as well as perform IV’s, administer medications, provide breathing support using tubes and ventilation devices, interpret EKGs, etc. 

Schooling and Training Requirements for Earning a Paramedic License

As I mentioned earlier, in order to become a paramedic, you need to start at the EMT-B level. EMT-B schooling can range from 8 to 12 weeks or about one semester. I completed the required 120 hours of training in 12 weeks in a class that met twice a week for 5 hours each time. After that comes paramedic schooling which can take 1 to 2 years depending on the pace of the program and requires a minimum of 1200 hours of training.   

The paramedic curriculum is split into two parts: the didactic portion and the hands-on skills known as the psychomotor portion

In the didactic section, we covered major topics such as trauma, pharmacology, cardiac, pediatrics, geriatrics, neurologic, endocrine, and pregnancy emergencies. We also covered smaller topics such as the importance of having cultural/religious awareness, the history of EMS (emergency medical services), and how to navigate mass casualty incidents.

In the psychomotor section, we learned how to do a complete patient assessment, how to customize this assessment to each patient, and the appropriate interventions. For example, a patient in a car accident needs a trauma assessment to identify all possible life threats. If the patient is found to have a collapsed lung, they might need a needle decompression, a skill that we learn as part of our psychomotor training. 

To tie all of our training together, Malcolm X College sends their paramedic students on a 3-month internship with the Chicago Fire Department (CFD) at the end of two semesters. Paramedics that work for CFD work 24 hour shifts out of a firehouse with 72 hour rest periods. While on shift, we respond to 911 calls under the supervision of two preceptors who guide us as we make decisions about the patient’s care. It is up to us to properly evaluate patients, treat them, and make appropriate transport decisions. The preceptors observe and grade us throughout the internship which is then factored into our cumulative grade. Passing the internship is the final step to qualify for graduation.

Certification Exam

After successfully graduating from an accredited paramedic program, you are qualified to take your certification exam. You will have two years to pass it and a maximum of three tries. You have the choice of taking a state level exam or a national level exam. If you choose to take the state level exam, you can only work in the state that you took the exam in. If you take the national exam, you are technically qualified to work in all 50 states, however, you will need to apply for reciprocity in each state.

Both the state and the national certification exam has two components, a written portion and a psychomotor portion. You need to pass both in order to apply for your license. To apply for your license you can submit an electronic application to the Department of Public Health in your state. You always apply for the license in the state that you plan to work in. If you are nationally certified, you can apply for a new license in any state you move to (process of reciprocity). 

Why does each state require you to apply for a new license?

The reason you need to apply for a new license in each state is because each state is comprised of regions called “systems”. Each system is run by a physician who specializes in emergency medicine and they are known as that system’s medical director. Every paramedic that works in a particular system is operating under the license of that medical director. What this means is, the medical director is responsible for establishing rules and policies that apply to that particular system that the paramedic must follow. For example, a medical director that is in charge of a system in Florida might need to establish policies relating to specific types of snake bites whereas a medical director in charge of a system in Montana might need to establish policies relating to frostbite. According to the state you live in, you will need to test into one of these systems. You can also test into multiple systems in one state. 

All the Places Paramedics can Work

After you test into a system, you can finally begin to work as a paramedic. Paramedics work in a number of different places: 

Many work for private ambulance companies. These paramedics may respond to 911 calls, however, they will also provide non-emergent patient transport services. This can include transporting discharged patients back to their residence, interfacility transport and transporting from state facilities such as prisons and morgues. These transports can be long distance and sometimes require these paramedics to transport across state lines. 

There are also different types of paramedics. On-location paramedics work at private events such as school fairs, sporting events and concerts. Some paramedics are firefighter paramedics and as such are considered state or county employees. Benefits and pay tend to be better for these paramedics and their primary job is to respond to 911 calls. They tend to stay local to the firehouse they are stationed at. 

There are also critical care paramedics, flight paramedics, and shipboard paramedics. These specializations require additional training and certifications. Some paramedics work exclusively with other paramedics, whereas others work with different healthcare professionals such as doctors, nurses, and EMT-B’s. Some paramedics such as S.W.A.T. paramedics are even cross trained as both a paramedic and a police officer. 

A small percentage of paramedics also work in the hospital, mainly in the emergency department.

Working as a Paramedic

My experience as a paramedic is limited to the 3 months I spent working for the Chicago Fire Department during my internship. I was stationed at two different fire houses and worked 24 hour shifts with 72 hour rest periods. 

Paramedics that work for fire departments usually work in pairs each having a specific role: The paramedic who drives the ambulance and performs all the skills for the patient is known as the FPM, the fire paramedic. The paramedic who evaluates the scene, stays with the patient, and types up the report of everything that happened is known as the PIC, the paramedic in chief. Even though there are two separate roles, paramedics work together to care for the patient and can perform each other’s roles if they need to. I have worked in both of these roles. 

Despite my relatively short stint as a paramedic, I was exposed to many different types of patients. People call 911 for all sorts of reasons and we need to be prepared to help every single one of them whether it is a gunshot victim, a drug overdose, an incident of abuse, a car accident, a heart attack, a woman in labor, a psychiatric emergency, or even just a broken finger. Our main goal is to keep ourselves and the patient safe while providing physical as well as emotional support and care. This care can be as complicated as trying to resuscitate someone’s heart or as simple as holding someone’s hand.   

For me, being a paramedic has been an eye opening experience. Working in the field allowed me to learn about my community in a unique way. Patients come from all walks of life and we are present for a very small, yet vulnerable part of their lives. I learned that patients always remember how they were treated in those critical moments. As such, it is very important to treat all patients with respect and dignity. My paramedic instructors always told us that the mark of a good paramedic is their ability to maintain good bedside manner at the peak of their exhaustion. This means that no matter how tired or challenged we might be, we maintain the same level of care no matter what situation we find ourselves in. Being a paramedic brought me to new levels of patience, compassion, and spirituality as I always reminded myself that I serve people in order to serve Allah (s.w.t.). 

Esma Arslan

May 2023