The emergency medical service system in the U.S

In the U.S., pre-hospital emergency medical care is provided by emergency medical technicians (EMTs) with the medical oversight of an emergency medical doctor. In general, EMTs have three ranks: Basic (EMT-B), intermediate (EMT-I), and paramedic (EMT-P). After completing the required training hours, they are eligible for certificate examinations to obtain or renew (maintain) their certificate.

Basic EMTs (EMT-B) receive 121 hours of training, and the main focus of the training is on patient assessment and safe transportation of the patient. Education in medical knowledge is limited to the level necessary to improve the efficiency of on-site medical care. EMT-B is the same level as an ambulance worker in Korea. Intermediate EMTs (EMT-I) are an intermediate level between EMT-B and paramedics. Experienced EMTs receive more extensive training on specific emergency medical treatments

(tens to hundreds of hours for training) and are given specific tasks. The training procedure for EMT-I’s is a part of the training program for paramedics. Therefore, in addition to the emergency medical treatments that can be performed by EMT-B’s, EMT-I’s can perform additional tasks (e.g., securing IV path, utilizing MAST, and defibrillation). Paramedics (EMT-P) are a highly trained workforce who can perform advanced emergency medical treatments of patients under life-threatening conditions. In addition to emergency medical care, all emergency situations are reported to the single telephone number of 911. The EMD directs the call to the appropriate department based on the characteristic of the report (occurrence of patient, onset of fire, or occurrence of crime). The main advantage is that police, ambulance (medical team), and firefighters can be dispatched simultaneously in cases where all three are needed.

Since mediate response to every report made to 911 results in a massive waste of resources, larger cities have another emergency telephone number, 311, for less urgent cases where the reporting individual can self-identify the severity of the incident, which can report accordingly to separate the cases based on their severity. This allows for the accommodation of different types of demands for emergency medical care (medical consultation for self-diagnosis and onset of mild symptoms at night), on top of preventing emergency medical service resources being wasted or emergency rooms being filled with patients with mild symptoms due to a lack of communication. Although 911 and 311 are separate numbers, the EMD is the same individual. Based on the judgment of the EMD, an ambulance may be dispatched even if the report was made to 311 (Park KJ, 2014).

Although the affiliation, scope of tasks, and standards of EMTs vary among different states, there is a minimum standard level. While most EMTs receive direct medical oversight from physicians, EMTs can perform on-site treatments or tasks without medical oversight in special cases (e.g., short transportation periods in metropolitan cities). Since most EMTs are highly trained, there are no issues with on-site emergency medical treatment provided by EMTs. More specifically, paramedics (EMT-P) are very highly trained so that they can provide an expert level of emergency medical care.

The main agency responsible for the transportation of patients varies among states and regions, but fire departments, private ambulances, and departments of public health in the state government are the main examples.

The scope of on-site treatment, ranging from BLS to ACLS, also varies across regions but is often evaluated by higher-level monitoring organizations based on medical evidence. Identified problems or issues are reflected in the performance evaluation. While patients with moderate emergency conditions are transported to nearby emergency medical centers, patients with severe traumatic injuries are remotely transported to the nearby level 1 trauma center.

The main characteristics of general emergency medical service system in the U.S. are that, in addition to pre-hospital emergency medical services provided by public organizations (like the 119 emergency medical care team in Korea), the role of private or hospital-affiliated emergency medical care teams is highly significant for inter-facility transport. In the U.S., all emergency medical care teams regardless of their affiliation (for example, 911 ambulance teams from fire departments or private companies) receive partial financial support from the federal and state governments. In addition to financial support, they are under appropriate yet strict management and

regulation by these governments in terms of their operation and EMT management and training (Goldberg, 1990). The medical cost of the pre-hospital emergency medical service is billed to the patient (including the transport fee) and there are multiple health insurance plans available for the general population, allowing the patient to choose beforehand. Furthermore, the social security system for the elderly, infirm, or poor people ensures that no patient under life-threatening conditions is denied of emergency medical service because of medical cost.

In order to promote the participation of the general population in the emergency medical service system, Good Samaritan laws have been enacted to ensure that no legal charges will be filed against individuals who provide emergency medical care to a patient under life-threatening conditions, where the help was voluntary and not for monetary compensation. Moreover, there are other policies to promote the participation of people in the emergency medical service system, such as approving business permits only if a set portion of the employees have certificates of emergency medical training (for limited types of business).