An EMT (formerly called EMT-Basic) can perform a wide range of emergency medical skills, from controlling severe bleeding and managing airways to administering specific medications and using an automated defibrillator. The national scope of practice covers more ground than most people expect, though it stops short of the advanced interventions reserved for paramedics. Here’s a detailed breakdown of what EMTs are trained and authorized to do.
Airway and Breathing Support
Keeping a patient breathing is the single most critical skill set for an EMT. At the most basic level, this includes manual techniques like the head tilt-chin lift and jaw thrust to open a blocked airway, along with physically clearing obstructions from the throat. EMTs insert oral airways (for unconscious patients without a gag reflex) and nasal airways (for patients who are still somewhat responsive but need help keeping their tongue from blocking airflow).
When a patient can’t breathe adequately on their own, EMTs ventilate using a bag-valve-mask, ideally with two rescuers so one can maintain a tight seal while the other squeezes the bag. They also use mouth-to-mask devices and, in some systems, CPAP machines that deliver continuous positive pressure to help patients with conditions like congestive heart failure or severe asthma breathe more easily.
Oxygen delivery is a core EMT skill. The preferred prehospital method is a nonrebreather mask, which can deliver up to 90% oxygen at 15 liters per minute. When patients won’t tolerate a mask, EMTs switch to a nasal cannula. They also monitor blood oxygen levels using a pulse oximeter, giving them real-time data on whether their interventions are working.
Suctioning the upper airway is another essential tool. When gurgling sounds indicate fluid in the airway during ventilation, EMTs suction immediately, keeping each attempt to 15 seconds or less to avoid depriving the patient of oxygen.
Cardiac Arrest and Heart Emergencies
EMTs perform CPR and use automated external defibrillators (AEDs) to shock patients in cardiac arrest. The key distinction from paramedics is that EMTs use semi-automatic devices that analyze the heart rhythm and determine whether a shock is appropriate. They do not interpret cardiac rhythms manually or use manual defibrillators. They can also operate mechanical CPR devices, which deliver consistent chest compressions during transport.
For patients with chest pain that may signal a heart attack, EMTs give oral aspirin and can assist with the patient’s own prescribed nitroglycerin (placed under the tongue). They’re also authorized to acquire and transmit a 12-lead ECG to the hospital, giving emergency physicians an early look at the heart’s electrical activity before the patient arrives. This can shave critical minutes off the time to treatment for a heart attack.
Bleeding Control and Wound Care
Hemorrhage control has expanded significantly for EMTs in recent years. They apply direct pressure, pack wounds with hemostatic or plain gauze, and apply tourniquets to extremities with life-threatening bleeding. For large open neck wounds, they use occlusive dressings to prevent air from entering blood vessels.
The general approach follows a clear sequence: expose the wound, control bleeding, prevent further contamination, then apply a sterile dressing and bandage it securely. EMTs reassess frequently to make sure bleeding stays controlled during transport.
Fractures, Spinal Injuries, and Splinting
EMTs stabilize broken bones and suspected spinal injuries using a variety of tools. For fractures, they immobilize the joint above and below the injury site, check for a pulse and sensation beyond the break both before and after splinting, and pad splints to prevent pressure injuries. If a limb is severely deformed or has lost its pulse, they gently realign it with traction before splinting. Traction splints are used specifically for femur (thigh bone) fractures.
For potential spinal injuries, EMTs apply cervical collars, use long spine boards, and perform seated spinal motion restriction with devices like the KED (a vest-like brace used to carefully extract patients from car seats). The guiding rule is straightforward: when in doubt, splint it.
Medications EMTs Can Give
The medication list for EMTs is limited but covers several life-threatening emergencies. EMTs directly administer three medications on their own: aspirin (for suspected heart attack), oral glucose (for low blood sugar), and oxygen. They also assist patients with their own prescribed medications, including inhaled bronchodilators for asthma or COPD and nitroglycerin for chest pain.
Beyond those basics, EMTs carry and use epinephrine auto-injectors for severe allergic reactions and opioid antagonists (available as a nasal spray or auto-injector) for suspected overdoses. Some systems also authorize inhaled bronchodilators delivered by nebulizer, auto-injector antidotes for chemical exposures, over-the-counter pain relievers, and nitrous oxide for pain management. These additional medications require approval from the system’s medical director.
EMTs administer medications through several routes: by mouth, under the tongue, inhaled or nebulized, intramuscular injection via auto-injector, and intranasal spray. They do not start IV medication drips, though they are authorized to maintain a non-medicated IV line that’s already running.
Childbirth and Other Emergency Skills
EMTs are trained to assist with both normal and complicated field deliveries. This includes managing the delivery itself, caring for the newborn, and handling complications like breech presentation or a prolapsed umbilical cord until the patient reaches a hospital.
Additional skills include taking automated blood pressure readings, using telemetric monitoring devices to transmit patient data (including video) to receiving hospitals, and performing emergency moves to relocate patients from dangerous environments. EMTs can also apply mechanical restraints when patients pose a danger to themselves or others.
What EMTs Cannot Do
The clearest way to understand EMT limitations is by comparison with paramedics. EMTs do not start IV lines (they only maintain existing ones), do not administer IV medications, and do not perform advanced airway procedures like intubation, where a tube is placed directly into the windpipe. They don’t interpret EKG rhythms, perform needle decompression for collapsed lungs, or administer the broad range of cardiac and emergency drugs available to paramedics.
Paramedic training builds directly on the EMT foundation and typically requires 1,200 to 1,800 additional hours of education. The EMT level focuses on assessment, stabilization, and rapid transport, while paramedics provide more definitive field treatment.
Training and Certification Requirements
Becoming a nationally certified EMT requires completing a state-approved EMT course that meets the National EMS Education Standards. Programs typically run 120 to 180 hours of classroom and clinical instruction. After finishing the course, candidates must pass the National Registry of Emergency Medical Technicians (NREMT) cognitive exam and a state-approved skills competency evaluation. The course must have been completed within the past two years to be eligible for the certification exam.
It’s worth noting that the national scope of practice sets a baseline. Individual states and local medical directors can expand or restrict what EMTs do in their specific systems. An EMT working in a rural area with long transport times may be authorized to perform additional skills that wouldn’t be part of the standard scope in an urban system with short hospital distances. Always check your state’s specific protocols for the most accurate picture.