# San Diego now has Advanced EMT.



## exodus (Mar 28, 2010)

> The Advanced EMT in San Diego County are allowed to perform the following skills (per B-327):
> 
> •	ETAD (Combitube) / Pharyngeal (King) Airways
> •	Blood Glucose Monitoring
> •	Administer the following medications: Nitroglycerin, Aspirin, Glucagon, Albuterol, Narcan, Epinephrine



Skill sign off sheet: http://www.sdcounty.ca.gov/hhsa/pro...MS_EMTOptionalSkillsVerificationForm_2009.pdf

SD EMS: http://www.sdcounty.ca.gov/hhsa/programs/phs/emergency_medical_services/prehospital_system.html


So time to figure out what good this will do.


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## TransportJockey (Mar 28, 2010)

Hmmm... almost like NM EMT-B with just a few (2) more meds.


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## exodus (Mar 28, 2010)

Just found out, our company will be utilizing this level by requiring any EMT working on our Critical Care/RN rigs to have this card.


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## MrBrown (Mar 28, 2010)

Sounds like a stripped down version of our Technician; ours have

- Ondansetron
- ASA
- GTN
- IM Glucagon
- Salbutamol nebules
- Acetamyophen
- Entonox 
- Methoxyflurane
- LMA


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## emt_irl (Mar 28, 2010)

emt's in ireland can give glucagon, epinephrine, salbutamol, gtn, asprin, glucose gel, entanox, and paracetamol. we can monitor blood glucose and 3 lead ecg's(no point listing the rest). we can only use opa's though but reckon lma's will come down the line


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## JPINFV (Mar 28, 2010)

It actually looks like San Diego is using two different optional skills packages than EMT-IIs or AEMTs. Specifically the medication skills package and the airway skills package. Similarly, California is looking to introduce the AEMT in July with the rest of the changes of the EMT 2010 project.


http://www.emsa.ca.gov/about/EMT2010_Overview.asp


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## Veneficus (Mar 28, 2010)

Maybe it is just me, but perhaps CA would have more money if they simplified their system considerably?


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## MrBrown (Mar 28, 2010)

Veneficus said:


> Maybe it is just me, but perhaps CA would have more money if they simplified their system considerably?



Why not just have Advanced EMT and Paramedic? Makes so much more sense

New Zealand has made moves to having only Paramedic and Intensive Care Paramedic although we are stuck with the Technician level for the vollies it seems, shame.


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## Veneficus (Mar 28, 2010)

MrBrown said:


> Why not just have Advanced EMT and Paramedic? Makes so much more sense
> 
> New Zealand has made moves to having only Paramedic and Intensive Care Paramedic although we are stuck with the Technician level for the vollies it seems, shame.



I like making our EMT-B level the "medical first responder" with a paid provider required to be a medic.


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## eveningsky339 (Mar 28, 2010)

Veneficus said:


> I like making our EMT-B level the "medical first responder" with a paid provider required to be a medic.



I tend to disagree; the creation of new "AEMT" or "EMT-A" levels in several states would seem to indicate the need for an intermediate level of EMS provider.

That said, my ambulance service utilizes EMT-I's as they would EMT-B's.  They do not replace medics.  I don't think a three-level system is unnecessarily complicated by witnessing how my own company operates.


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## Shishkabob (Mar 28, 2010)

eveningsky339 said:


> I tend to disagree; the creation of new "AEMT" or "EMT-A" levels in several states would seem to indicate the need for an intermediate level of EMS provider.



Except the AEMT isn't really "new". It's just an EMT-B with a couple more advanced skills and some drugs... like a stripped down I/85.  They are taking away the 'advanced' skills of the I/99 and making people become a Paramedic if they want that stuff.


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## MrBrown (Mar 28, 2010)

eveningsky339 said:


> I tend to disagree; the creation of new "AEMT" or "EMT-A" levels in several states would seem to indicate the need for an intermediate level of EMS provider.
> 
> That said, my ambulance service utilizes EMT-I's as they would EMT-B's.  They do not replace medics.  I don't think a three-level system is unnecessarily complicated by witnessing how my own company operates.



Most states in Australia have two levels (Paramedic/Intensive Care), Canada has two levels (PCP/ACP) as does the UK (ECA or Technician/Paramedic) and most of Europes ambulances are staffed with either RNs or very highly educated civilian Intensive Care Paramedics.

Three levels, no not a problem

- Some sort of basic first responder (firefighter/rural first responders in thier jammie pants) who can do basic airway care, oxygen, AED, nebules 
- Paramedic (super ILS)
- Intensive Care Paramedic (ALS)


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## terrible one (Mar 28, 2010)

Out of curiosity what is the difference between a paramedic and ICP in australia? In other words what can a ICP do that a paramedic cannot? Thanks


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## triemal04 (Mar 28, 2010)

JPINFV said:


> It actually looks like San Diego is using two different optional skills packages than EMT-IIs or AEMTs. Specifically the medication skills package and the airway skills package. Similarly, California is looking to introduce the AEMT in July with the rest of the changes of the EMT 2010 project.
> 
> 
> http://www.emsa.ca.gov/about/EMT2010_Overview.asp


I couldn't tell from the link; are they looking to follow the standards laid out in the Scope of Practise Model, or will this be a cert that is still only specific to the state, or in the case of San Diego, the county?


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## JPINFV (Mar 28, 2010)

How California currently works is there are 3 levels. The EMT-1 (EMT-B), EMT-2 (EMT-intermediate, rare), and EMT-P. For the EMT-1 and EMT-2 levels, there are several "optional skill packages" that the counties can adopt. So if an EMT-1 goes through, say, the medication package in SD, I believe that he should be able to be signed off on the package without a new class if he moves to another county that *uses that package.* For example, if the EMT-B with the package moved to Orange or Los Angeles counties, then he wouldn't be able to provide those interventions since those areas don't use that package. 

I just went through the changes listed on the link. From what it looks like (I'm admitedly not that familiar with the scope of EMT-2s in California since they are extremely rare), the EMT-2 is somewhere between the current EMT-I/85 and EMT-I/99. Essentially the changes being made are bringing the EMT-2 down to the standardized AEMT level with the certification exam being moved to the NREMT in July 2013. From what I've read earlier, there may be a few interventions that the AEMT can provide that the current EMT-2s can't and they aren't looking at including those interventions at this time. 

Based on the fact that AEMTs are still going to be considered a "limited advanced life support (LALS)" provider and an impact study has to be done if an agency wants to decrease service from ALS to LALS. As such, I highly doubt that the changes are going to mean much since most urban areas probably aren't going to accredited AEMT providers, even if it is a little easier now per statute. What I can possible see happening is some services looking at this as an EMT+ than a limited paramedic. 

On an interesting side note, current EMT-2s in California will be able to keep their current scope of practice if the county allows them to work as one. So there's the possibility of California having a 4 tiered system, EMT, AEMT, grandfathered EMT-2s, and paramedics. If EMT-2s weren't limited to very rural areas (there are an entire 2 schools that produce EMT-2s in the entire state), then this could be confusing. However it is essentially a non-issue. 

Edit:

Going through the EMT-B changes, a lot of the changes here appear to be more house keeping than anything else, especially with standardizing terms (good bye EMT-1 and EMT-2 terms). That said, they are getting rid of the stupid supervised manual defibrillation optional skill. It also looks like the state is getting rid of the medication package currently used in San Diego. http://www.emsa.ca.gov/about/files/EMT2010/Ch2EMTRegsApprovedByEMSComm.pdf Bottom of page 17 to bottom of page 19.


Edit 2: It looks like California is also introducing a central registry for EMS providers
http://www.emsa.ca.gov/about/files/EMT2010/Ch10CentralRegisryApprovedByEMSComm.pdf


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## MrBrown (Mar 28, 2010)

Sounds awfully confusing.

To give you an idea of how we are working down here at the moment we are moving from five levels (first responder, BLS, IV/Cardiac, ILS and ALS) to three; essentially eliminating first responders and the IV/Cardiac level.

Nobody new is allowed to practice at the two old levels but people at those levels have till 2012 to either go up to Technician (BLS) or Paramedic (ILS) or they will be automatically moved down.  If you are an IV/Cardiac level Officer come 2012 and have not upskilled to Paramedic (ILS) you get moved to Technician (BLS) and if you are a First Responder you essentially become nothing.  In other words they cannot keep an old scope of practice beyond 2012.

If you want to become a Paramedic (ILS) after 2012 you must do the Bachelors Degree and if you wish to become an Intensive Care Paramedic, you must do the Post Graduate Certificate.

Paramedic in this part of the world means what you might call a super-Intermediate in the US and Intensive Care Paramedic is ALS.  Paramedics here can do 12 leads, cardiovert, all Technician drugs plus IV adrenaline, analgesia, anti-emetic, naloxone etc whereas Intensive Care has things like ketamine, midazolam, pacing, intubation, some have RSI etc.


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## eveningsky339 (Mar 29, 2010)

:wacko:

How about this:

EMR (current EMT-B)
EMT (current EMT-I/85)
Paramedic (current EMT-P)


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## EMSLaw (Mar 29, 2010)

This has all been worked out in the new scope of practice model, no?  Why reinvent the wheel - again.


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## LucidResq (Mar 29, 2010)

This level of care sounds a lot like the EMT-B with IV approval in CO. 

EMT-Bs can use Kings and Combitubes, the caveat in the Colorado Board of Examiners Rules that define authorized medical acts for EMTs define these as "Medical skills and acts not specifically addressed in the National Standard EMT Curricula and additional local training is recommended. As such, medical directors shall ensure that individuals performing these skills and acts obtain appropriate additional training." However, these are now commonly taught in the initial EMT-B program. 

Nitro (patient assisted), aspirin, albuterol MDIs (patient assisted), and epinephrine autoinjectors are all allowed for EMT-Bs and taught in EMT class. 

With a simple class of a minimum of 24 class hours, plus 10 successful sticks, 8 of which acquired on actual patients through clinical time, an EMT-B gains IV approval. Allowed medications are crystalloids, IV dextrose and intranasal or IV naloxone.


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## JPINFV (Mar 29, 2010)

EMSLaw said:


> This has all been worked out in the new scope of practice model, no?  Why reinvent the wheel - again.



...because they can?


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## MrBrown (Mar 29, 2010)

EMSLaw said:


> This has all been worked out in the new scope of practice model, no?  Why reinvent the wheel - again.



Because that wheel has a bunch of patches, is as bald as a babys bum and gonna fall apart sometime soon.


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## karaya (Mar 29, 2010)

EMSLaw said:


> This has all been worked out in the new scope of practice model, no? Why reinvent the wheel - again.


 
It won't be reinvented. The new standards, scope of practice, etc. has been an undertaking for over ten years and has involved participation from every state, industry stake holders, EMS publishers, etc. One of the keys to keep this standardized was to get all of the publishers on board in which they participated as a stake holder.

This unified publishing participation pretty well forces educators to teach within the National Scope of Practice Model which only recognizes four levels of licensure - EMR, EMT, AEMT, and Paramedic. Every EMS textbook publisher is on-board with the new scope and currently many books that just came out last year are already working on new editions for the new standards. I've worked on several books since last year and I'm currently involved in several re-editions for this year. 

However, states can certainly mandate that only paramedic certification will be accepted to work on an ambulance. Something to think about?


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## EMSLaw (Mar 29, 2010)

MrBrown said:


> Because that wheel has a bunch of patches, is as bald as a babys bum and gonna fall apart sometime soon.



Considering it's brand new and hasn't been road tested yet, I think that's a bit unfair, and probably part of your reflexive need to belittle the US EMS system at every opportunity.  Generally, I tend to agree with your sentiments, but in this case, I think what's coming will be a marked improvement over what we have, and I don't think there will be another set of drastic changes immediately.


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## triemal04 (Mar 29, 2010)

karaya said:


> It won't be reinvented. The new standards, scope of practice, etc. has been an undertaking for over ten years and *has involved participation from every state, industry stake holders, EMS publishers, etc.* One of the keys to keep this standardized was to get all of the publishers on board in which they participated as a stake holder.
> 
> *This unified publishing participation pretty well forces educators to teach within the National Scope of Practice Model *which only recognizes four levels of licensure - EMR, EMT, AEMT, and Paramedic. Every EMS textbook publisher is on-board with the new scope and currently many books that just came out last year are already working on new editions for the new standards. I've worked on several books since last year and I'm currently involved in several re-editions for this year.
> 
> However, states can certainly mandate that only paramedic certification will be accepted to work on an ambulance. Something to think about?


Please, stop saying that, or be sure to explicitly limit that type of comment to textbook publishers, which I don't even know is accurate.  Nothing in the Scope of Practice Model forces any state to accept the new levels.  Nothing forces any teacher, or school to teach to the new levels, or, if using a redesigned textbook, to teach all the material inside.  If Joe Schmo the EMT Instructor wants to teach an EMT course that is no different than todays, as long as the state he teaches in has no issue with that, it's not a problem.

Nothing in the Scope of Practice Model is mandatory.  If a state opts out of it, or decides to keep some of their own levels, they damn well can.

Part of why this is only a very, very small step in the right direction.


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## karaya (Mar 29, 2010)

triemal04 said:


> Please, stop saying that, or be sure to explicitly limit that type of comment to textbook publishers, which I don't even know is accurate. Nothing in the Scope of Practice Model forces any state to accept the new levels. Nothing forces any teacher, or school to teach to the new levels, or, if using a redesigned textbook, to teach all the material inside. If Joe Schmo the EMT Instructor wants to teach an EMT course that is no different than todays, as long as the state he teaches in has no issue with that, it's not a problem.
> 
> Nothing in the Scope of Practice Model is mandatory. If a state opts out of it, or decides to keep some of their own levels, they damn well can.
> 
> Part of why this is only a very, very small step in the right direction.


 

No, I will not stop saying what I said. I currently work for 4 major EMS text book publishers and I've been very involved with the standards committees for several years. As a matter of fact, several members of the committees are close working associates of mine, so don't haul in here hiding behind your moniker and challenge my credentials. That is why I use my real name in signature.

I was not trying to imply that states are forced to do anything, including educators. You are correct in that states can teach what ever they want in lieu of the new scope; however, they will have to pay to have an author and publisher to produce their textbook material since all of the major EMS publishers have agreed as stakeholders that they will not deviate from the new scope of practice. That was the whole point of having the publisher participate as stakeholders during the development of the new scope.


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## triemal04 (Mar 29, 2010)

karaya said:


> No, I will not stop saying what I said. I currently work for 4 major EMS text book publishers and I've been very involved with the standards committees for several years. As a matter of fact, several members of the committees are close working associates of mine, so don't haul in here hiding behind your moniker and challenge my credentials. That is why I use my real name in signature.
> 
> I was not trying to imply that states are forced to do anything, including educators. You are correct in that states can teach what ever they want in lieu of the new scope; however, they will have to pay to have an author and publisher to produce their textbook material since all of the major EMS publishers have agreed as stakeholders that they will not deviate from the new scope of practice. That was the whole point of having the publisher participate as stakeholders during the development of the new scope.


Untwist your panties.  I could really care less what you do, in this case who you are, or who you send pictures to.  If you are right and some publishers are incorporating the new standards, then that's good.  If you have real knowledge of that, then it's also good that you aren't just spouting rumors, so as I said, keep saying what you want.  (Seriosuly, I do mean that.)  Be really good if ALL publishers do what you've said.  But, what you implied in the bolded portions of your initial comment was wrong.  Sorry, but get over it.

And once again...it doesn't matter what someone prints in a textbook; just the fact that something is there does not mean that it will be taught.  Again, you were wrong.  And you don't actually think that every cert out there has it's own textbook do you?  I'm sorry to be rude, but that's just laughable.  Look at all the cert's Washington has (or had since they're apparently going away from that); you really think there was a text for EMT-IV/AIRWAY/MEDS?  Please.

That's the problem with forums like this; anything can be said without any type of thought, proof, or accuracy.  Annoying really.


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## MrBrown (Mar 29, 2010)

Nothing in the Agenda or new standards is mandatory.

Those who do not wish to progress from Intermediate/99 to Paramedic will be downgraded to "Advanced EMT" which means they loose part of thier scope of practice.

Some states are choosing to implement the whole Agenda, others only part of it, others may choose to implement none of it.

I think it is a positive step which should eliminate the 50 gazillion levels some states have and bring about uniform terminology however the scopes of practice for EMT and A-EMT are still very limited, much below what is allowed here, in the UK/Ireland, Canada and Australia.

We'll see how things fare in 3-5 years.


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## triemal04 (Mar 29, 2010)

MrBrown said:


> Nothing in the Agenda or new standards is mandatory.  Correct.
> 
> Those who do not wish to progress from Intermediate/99 to Paramedic will be downgraded to "Advanced EMT" which means they loose part of thier scope of practice.  Unless their state decides to keep that level, in which case nothing will change for them, except that they won't be able to be certified by the NREMT.
> 
> ...


Yep.  I'll give a bit of an apology to karaya for my responces, but on this site it has been implied, or flat out said, that the Scope of Practice is the end all fix-it for EMS so many times that it is thoroughly aggravating to hear anything like that.  It's a small step in the right direction, but overall...won't come anywhere close to solving anything, and, unless it's immediately followed up on...won't do anything in the long run.

And most publishers always follow whatever the DOT/NHTSA set's as it's standards, so that's not exactly a huge revolution for EMS.


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## CAOX3 (Mar 29, 2010)

We dont even operate under the national registry.  It isnt needed to be certifed here and no changes they are introducing are being adopted here.


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