Advanced Emergency Medical Technician? The NHTSA says so.

[NREMT-Basic]

In its Scope of Practice Model 4.0 (and previous editions) the NHTSA has introduced what appears to be a replacement of the unwieldy old EMT-I classification that a lot of states have seemed not to know what to do with for so long. They are calling it the Advanced EMT. If you read the Scope of Practice which you can find at ems.gov, you will see that this level is the standard EMT-B with the following additions:

1. IV access

2. IV Narcan

3. IV D50

4. Inhaled Nitrous Oxide for relief of pain/discomfort

5. I/O access

6. Glucagon

These are in addition to what the NHTSA standards already include for Basics. I'm not putting this here as a source of argument and I refuse to engage in argument over it because it is more simple to say that I disagree with those that say that EMTs have no business pushing meds, starting lines, etc. I will say that the standard argument, largely made by paramedics, has been that BASICS shouldnt be performing these interventions but that the NHTSA has beaten those medics to the punch by eliminating the EMT-I level and replacing it with AEMT. I know some states already use this level, but the NHTSA states that it is attempting to streamline and increase standards of training and education. Yes, education. So the new levels would be, in the states that adopt the new Scope whole-cloth would be: MFR, EMT, AEMT, Paramedic. I guess the new level would end the element f the argument which says that Basics shouldnt push drugs since these providers would not be Basics.

[mrmeaner]

The AEMT level proposed is essentially the same as the EMT - Intermediate Technician level used by Wisconsin. This level requires additional training beyond EMT - Basic training. Although they do not specifically address training requirements in the report, I would have to belive that training for AEMT would above the training for the EMT level. Therefore, I do not understand the sumation tha EMT's will be starting IV's. If anything, the EMT (EMT-Basic) level is becoming more restricted in their skill set by this report.

As far as "streamlining" goes, I don't think this will be the end. My guess is that by the end of 10 years, there will be two levels: EMT and Paramedic. That doesn't mean that each state won't pu their own personal spin on it though.

[spenac]

So basically there is no change other than title. Basics still can do nothing. EMT-I or AEMT can do just very little extra just like now. So what is all the excitement about?

[fiznat]

We've had this discussion a million times before in a million different ways, but my prejudice as a paramedic aside (if you will allow me that), I don't think any expansion in scope below the paramedic level is a step forward for EMS. Personally I feel we should be working towards higher standards, not blurring the lines between the already low standards we've got.

[spenac]

We've had this discussion a million times before in a million different ways, but my prejudice as a paramedic aside (if you will allow me that), I don't think any expansion in scope below the paramedic level is a step forward for EMS. Personally I feel we should be working towards higher standards, not blurring the lines between the already low standards we've got.

But this is not an expansion of scope it is just renaming the EMT-I.

[NREMT-Basic]

The AEMT level proposed is essentially the same as the EMT - Intermediate Technician level used by Wisconsin. This level requires additional training beyond EMT - Basic training. Although they do not specifically address training requirements in the report, I would have to belive that training for AEMT would above the training for the EMT level. Therefore, I do not understand the sumation tha EMT's will be starting IV's. If anything, the EMT (EMT-Basic) level is becoming more restricted in their skill set by this report.

As far as "streamlining" goes, I don't think this will be the end. My guess is that by the end of 10 years, there will be two levels: EMT and Paramedic. That doesn't mean that each state won't pu their own personal spin on it though.

If you read the report, in its 42 pages, it does not in fact indicate that EMT-Basics will become more constricted in their scope. What the report does say is that AEMTs will be required to prove proficiency in all skills required by EMT-Bs in addition to the additions. While the AEMT is essentially a Basic with additional skills and protocols, the NHSTA considers the EMT-B and the AEMT to be different animals. As I say, the new classifications will be MFR, EMT, AEMT and Paramedic. If you read the 4.0 NHSTA report carefully, what they are recommending is a fundamental change in title and a specific change in scope. What they are hoping to accomplish here is a rather large step toward a national scope which would be the best thing to happen to EMS since we stopped using hearses for ambulances. There would no longer be, under the NHSTA classification, any such animal as an EMT-B. The one thing those of us that are now Basics would lose is the ability to say "yeah, but a Paramedic is an EMT too" because under the new system, which I am all for and am working very hard at the grass roots level to see go as national as possible, Paramedics are no longer EMTs (ie EMT-P) and an EMT is not an EMT Basic...but rather simply an Emergency Medical Technician.

I live 20 minutes from the Wisconsin border and since the department I am now training with can be called under MABAS to assist with calls with medical aspects in Wisconsin, I how hold EMT-B certification in IL and WI. I have to say that once you get past EMT-B in WI, their classification system is a mess and confusing even to those who work solely in that state.

In any case, Ive read the NHSTAs report several times this morning and there is no discernible truncation of the scope of what would be called simply an EMT, formerly known as an EMT-B. I even read it again after reading your thoughtful post and I simply dont see any removal of protocols from EMTs under the new system. I think phasing out the EMT-I classification at the national level is an extremely good idea. I know that my home state of IL is considering the AEMT level and I will be first in line to train for it. I know there is the argument that if you want to push drugs, become a medic, but there is also the equally legitimate argument that not all providers wish to become medics.

Thanks for keeping the first response to this new thread civil.

[p3medic]

I'm a bit confused, you say that not all providers want to become medics, but you want them to perform LIKE medics, by administering medication and performing invasive procedures? So, they want to use the toys, but don't want the hassle of going to school? Sounds good to me. :roll: You might get to respond to a disaster yet! Sorry, couldn't help myself....back on topic.

[AZCEP]

All that happened was a change in the title.

Basics are still allowed to help with "self-administration" of several meds. The new "Advanced" EMT is identical to the current basic with all of the add on skills. No education increase beyond a few clock hours.

[NREMT-Basic]

All that happened was a change in the title.

Basics are still allowed to help with "self-administration" of several meds. The new "Advanced" EMT is identical to the current basic with all of the add on skills. No education increase beyond a few clock hours.

I agree except that I would want more than an increase of a "few clock hours" if I am going to be giving narcan and d50. I'm always curious as to why some people are never satisfied with advances. People have been saying (and you know who you are) that EMTs need more training than 120 hours. I myself spent 280 hours on my EMT-B, which still isnt excessive by any standard, but more than double what is usually quoted by Basic detractors. You say no change but a few more clock hours, but what do you think those clock hours would be spent doing? As for the point which is sure to come up that EMTs dont have enough chemistry, pharmacology, etc I think if we are going to start giving drugs like D50 and narcan, that could very well be true. However, with very few exceptions, I know very few medics who can explain and "diagram" the complete pharmaco-kinetics of every single drug they push. They know its basic and essential actions, its indications, contraindications and complications. Heck, probably more than 50% of the drugs on the market today say in the accompanying monograph that "exact mechanism of action is unknown." If the MDs and other scientists that create a drug and get it on the market doesnt know how it works, I have my doubts that a street-level EMS provider of any level has has the training and spent the research time and cash to figure it out. Every level of provider has its limitations. Some are just dont acknowledge it.

[AZCEP]

It's a good idea, but the implementation of it will not get the result that is needed.

I've been pretty vocal about the need to increase everything in EMS education. I've gone so far as to outline how I think it should be accomplished. Looking at the new recommendations, the only significant change is one of title. If this is approved as it is written, you will have undereducated providers at the advanced level doing things that the current basic level is performing now.

Changing a title does not endow those providers with what they will need.