I got an email from a high school student asking questions about the different EMS levels of care. I thought I would include some of my answers for her here on the MedicCast blog for EMTs and paramedics.


What are the different levels of EMS care in the U.S.?

There are four officially recognized levels of emergency medical response training recognized by the EMS community.  I say “officially” in quotes because they are not required standards nationwide.  Every state and local jurisdiction has the responsibility to determine what the requirements are for those four standards.  Many states recognize the National Registry for EMTs (NREMT) standard for the highest three (EMT-B, EMT-I, and EMT-P) but they are not required to do so.

What is a First Responder?

First responder is a certification that basically means that a person has basic first aid skills, CPR for healthcare providers (a little more involved version than the standard CPR), and some training in avoiding and treating patients in a professional emergency capacity.  It is often a designation used for specially trained personnel at industrial sites where these employees would act as the initial emergency personnel (i.e. first responders) until the professionally trained fire, rescue, and medical providers arrived.

What is the difference between EMT-B and First Responder?

The difference between EMT-Basic and first responder is two fold:


EMT-Bs take about 140 hours of training plus clinical time on an ambulance or in a hospital (versus about 30 to 40 hours for a first responder course).  EMT-B is the lowest level of training allowed to transport a patient by themselves in the back of an ambulance in most areas.  They have training in patient assessment, recognition and treatment of life threats, determination of medical priority and to which hospital to transport, and a short list of allowed medications they may administer on their own.


EMT-Bs are associated with local emergency services and private ambulance transport companies.  First responders may be either part of a corporate or industrial initial response plan or they may be a low level of training in a local fire department (although most paid fire departments are moving to requiring their fire fighters to be EMT-Bs as well).

Time line of EMS patient care

  • Let’s look into the time line around a patient’s injury. first a patient gets ill or injured and a first responder or a bystander with first aid training offers immediate assistance.  This helps the patient in the first 5 to 10 minutes of their injury.
  • The fire dept. or ambulance arrives with an EMT-B who is there to assess the severity of the injury, determine how bad it is, stabilize any basic life threats, determine if higher help is needed (EMT-I or EMT-P depending on region), and transport the patient to the emergency department.  This helps the patient during the first 10 to 60 minutes of their injury.
  • The hospital takes over after that for the first 60 minutes to days or weeks.


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