In the US (per NY protocols) that’s how it works:
1st Level: CPR certified.
2nd Level (Certified First Responded) : Above plus some trauma training (2-3 months study time)
3rd Level (Emergency Medical Technician) : Same as above but with advanced airway management, suction, defibliration, full trauma training, extrication, immobilization, trained in giving and assisting with basic meds (O2, Charcoal, epinephrine, baby aspirin, nitroglycerin and inhalers) They are also called BLS units (Basic Life Support) (5-6 months study time)
4th Level (Paramedic) : EMT with advanced cardiac skills (EKGs), even more advanced airway management (intubation/treacha tubes/etc), starting lines, thy also have a lot of meds at their disposal. You are basically a field doc. They are also called ALS units (Advanced Life Support) (12 -24 months study time)
I know that outside of NY there is a level of training between 3 and 4. I think they are called EMT Intermediate. Those guys can start lines but don’t give meds and I think they work on intubations as well.
Now in NYC Paramedics are dispatched to cardiac calls, pregnancy (OB calls) and difficulty breathing. We have strictly paramedic units and strictly EMT units. Medics are very rarely dispatched to trauma calls because they like to play around when patient needs hot light and cold steel. They don’t mean bad but in NYC unless I’m stuck somewhere I’m never more than 10-15 minutes away from the hospital and delaying transport is always bad. In other places were hospital is 40-50 minutes away paramedics usually ride with EMT and provide their part of the trade en route to the hospital. BLS units love to work with ALS units because there is a lot we can learn and we see aspects of medicine we rarely come in contact with. ALS loves BLS because we take care of their dirty messy work. When Paramedic shows up on the scene they are in charge. I just passed my Paramedic qualification exams and I’m starting one year program this January.
Hope that helps,
Matt