# AEMT vs EMT-I



## Chef (Nov 6, 2016)

Now that I am full time in this world I am looking to add additional skill sets. Most of the FF's in our city are Intermediates; but while searching online for formalized education it seems that AEMT is replacing I's.... 

Is it the same?? Why was it changed??


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## NomadicMedic (Nov 6, 2016)

The new A certification is a mix of I85 and I99. Many states had wide and varied standards for intermediates. It was designed to standardize the skill set and testing.


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## EpiEMS (Nov 6, 2016)

Chef said:


> Now that I am full time in this world I am looking to add additional skill sets. Most of the FF's in our city are Intermediates; but while searching online for formalized education it seems that AEMT is replacing I's....
> 
> Is it the same?? Why was it changed??



My understanding is that the National Scope of Practice Model replaced EMT-I (1985) and EMT-I (1999) with AEMT. For NREMT purposes, EMT-I '85s are (were?) given the option to upgrade to AEMT or downgrade to EMT, and EMT-I'99s were given the option to downgrade to AEMT or upgrade to Paramedic. Historically speaking, EMT-I '85 was a slapdash standard - it took a couple of things from the paramedic educational standards but never really was cohesive. And EMT-I '99 is arguably just plain silly - giving paramedic skills to people who don't have the level of education even close to that.

The idea of AEMT is to have a national standard of intermediate provider linked in a clear fashion to the EMT and Paramedic levels - a limited ALS provider - to address the gap between EMT and Paramedic, in line with the available technologies and needs of areas that can't afford or otherwise do not have the ability to obtain paramedic level coverage.

This document gives you some history of the standards as they evolved. And here's the national scope model.


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## NysEms2117 (Nov 6, 2016)

EpiEMS said:


> This document gives you some history of the standards as they evolved. And here's the national scope model.


always coming up clutch with the cool articles !


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## Tigger (Nov 6, 2016)

It should also be noted that many states still have and certify EMT-Is (in additional to AEMTs too in some places). We still have I99s Colorado, though there are no more I99 classes as far as I can tell. The state will continue to recertify I99s indefinitely while also having an AEMT certification.


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## EpiEMS (Nov 6, 2016)

Tigger said:


> It should also be noted that many states still have and certify EMT-Is (in additional to AEMTs too in some places). We still have I99s Colorado, though there are no more I99 classes as far as I can tell. The state will continue to recertify I99s indefinitely while also having an AEMT certification.



That's a good point - many states do this (Virginia and Rhode Island [see page 28 for RI "AEMT-Cardiac" additions to the National AEMT scope] also come to mind).


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## NomadicMedic (Nov 6, 2016)

I think there is still one cardiac tech left in Georgia.


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## twistedMP (Nov 6, 2016)

DEmedic said:


> I think there is still one cardiac tech left in Georgia.



I didn't realize there was still a licensed CT here. When I went through Emt school 10 years ago there was only 12 still licensed in Georgia 


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## MonkeyArrow (Nov 6, 2016)

DEmedic said:


> I think there is still one cardiac tech left in Georgia.


Let's seek him out and find him!!!


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## LanceCorpsman (Nov 7, 2016)

In my state, to operate as a Paramedic you need an AAS degree in paramedicine. But since you can't expect a bunch of volunteer EMS providers (in my county there is only one paid department that operates two rigs, and they don't go out of their district) to have a two year degree just to volunteer. That is why they still have the EMT-I in Oregon. If the state decided to get rid of EMT-Is and downgraded everyone to the AEMT scope, rural Oregon will have nobody that can do ACLS, pain management...etc. That would be an absolute disaster.


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## EpiEMS (Nov 7, 2016)

I'm under the impression that Georgia has AEMT as the baseline staffing for a transporting ambulance?


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## MonkeyArrow (Nov 7, 2016)

EpiEMS said:


> I'm under the impression that Georgia has AEMT as the baseline staffing for a transporting ambulance?


Depends where you go system-by-system. Grady in City of Atlanta requires AEMT, neighboring Dekalb County AMR doesn't.


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## EpiEMS (Nov 7, 2016)

MonkeyArrow said:


> Depends where you go system-by-system. Grady in City of Atlanta requires AEMT, neighboring Dekalb County AMR doesn't.


Interesting -- thanks!


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## Summit (Nov 7, 2016)

LanceCorpsman said:


> In my state, to operate as a Paramedic you need an AAS degree in paramedicine.



Not really. Any associates degree or above is acceptable. You can have a BA in Interpretive Dance. Actually you can apply for equivalency via experience in leui of a degree. Even if you have none of those, you can get licensed and practice up to 2 years without a degree (under the assumption you will earn it by the end of the 2 years).


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## ExpatMedic0 (Nov 7, 2016)

Summit said:


> Not really. Any associates degree or above is acceptable. You can have a BA in Interpretive Dance. Actually you can apply for equivalency via experience in leui of a degree. Even if you have none of those, you can get licensed and practice up to 2 years without a degree (under the assumption you will earn it by the end of the 2 years).


This is mostly true (unless things have change since I lived there). Your AAS has to be the paramedic one. However, a BA or BS in any subject will qualify. If your an Oregon resident its pretty much impossible to become a paramedic without your AAS or BA/BS. However, outside residents who are filing reciprocity into Oregon may apply with no degree if they have 5 years experience and NREMT if certain conditions are met. Furthermore, you can be granted a probationary 2 year certificate while your completing your AAS but you need a medical director to evaluate that and approve it, in addition to proving to the state you are enrolled or are enrolling in the AAS program. If your already living in Oregon though, you either have to complete the degree or leave for 5 years and work as a paramedic with your NREMT somewhere and move back...


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## EpiEMS (Nov 7, 2016)

ExpatMedic0 said:


> This is mostly true (unless things have change since I lived there). Your AAS has to be the paramedic one. However, a BA or BS in any subject will qualify. If your an Oregon resident its pretty much impossible to become a paramedic without your AAS or BA/BS. However, outside residents who are filing reciprocity into Oregon may apply with no degree if they have 5 years experience and NREMT if certain conditions are met. Furthermore, you can be granted a probationary 2 year certificate while your completing your AAS but you need a medical director to evaluate that and approve it, in addition to proving to the state you are enrolled or are enrolling in the AAS program. If your already living in Oregon though, you either have to complete the degree or leave for 5 years and work as a paramedic with your NREMT somewhere and move back...



It's quite the regulatory framework...I guess the model makes sense, builds in some wiggle room when supply is tight.


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## ExpatMedic0 (Nov 7, 2016)

Ya if your from Oregon and want to start a career in EMS as a paramedic its definitely something you have to think about because return of investment on the degree is not as good as other's. The link to the  AAS can be found here for RN's at our largest community college http://catalog.pcc.edu/programsanddisciplines/nursing/ compared to AAS for paramedics here http://catalog.pcc.edu/programsanddisciplines/emergencymedicalservices/#degreestext You may notice striking similarities for the classes in the degrees are almost the same expect one takes a paramedic pathway and the other takes RN. As a medic though, you can expect to make about %30 less....


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## Summit (Nov 7, 2016)

ExpatMedic0 said:


> Ya if your from Oregon and want to start a career in EMS as a paramedic its definitely something you have to think about because return of investment on the degree is not as good as other's. The link to the  AAS can be found here for RN's at our largest community college http://catalog.pcc.edu/programsanddisciplines/nursing/ compared to AAS for paramedics here http://catalog.pcc.edu/programsanddisciplines/emergencymedicalservices/#degreestext You may notice striking similarities for the classes in the degrees are almost the same expect one takes a paramedic pathway and the other takes RN. As a medic though, you can expect to make about %30 less....



Indeed, but an AAS in Nursing doesn't get you very far outside of some rural Oregon. That AAS curriculum is pretty anemic for a associates RN curriculum, which is why it is AAS not an ASN/ADN. So when compring P vs RN AAS ROI factor in extended gap unemployment to first RN position, underemployment, undesirable employment, and a near mandatory BSN transition program with more extensive requirements due to the anemic initial curriculum.


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## NomadicMedic (Nov 7, 2016)

Slightly off topic, but if there was a single role paramedic opportunity in, say, the Bend area, I'd move back to Oregon in a heartbeat.


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## Summit (Nov 7, 2016)

Bend is nice. Mmmmmmmmmmmount Bachelor


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## NomadicMedic (Nov 7, 2016)

Summit said:


> Bend is nice. Mmmmmmmmmmmount Bachelor



Yessss! When I lived there I rode a ton at bachelor and XC at all the snoparks, rode my road bike almost every day it was nice and kayaked almost every weekend. Competed in Pole, Pedal, Paddle a couple of times. Camped in the middle of BLM wilderness and just had an amazing life. 

Damn EMS is all fire based though. 

What an amazing place to live.


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## LanceCorpsman (Nov 7, 2016)

DEmedic said:


> Yessss! When I lived there I rode a ton at bachelor and XC at all the snoparks, rode my road bike almost every day it was nice and kayaked almost every weekend. Competed in Pole, Pedal, Paddle a couple of times. Camped in the middle of BLM wilderness and just had an amazing life.
> 
> Damn EMS is all fire based though.
> 
> What an amazing place to live.



Sadly, now it is plagued by a bunch of rich people moving in from California


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## ExpatMedic0 (Nov 7, 2016)

LanceCorpsman said:


> Sadly, now it is plagued by a bunch of rich people moving in from California


Same with Portland unfortunately. Rental prices have skyrocketed but not wages. I miss the Pacific Northwest but if I move back I think it will be to Washington state and I've lived in Oregon most of my life


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## ExpatMedic0 (Nov 7, 2016)

But before this thread goes side ways, I was an Oregon intermediate for several years. seemed like a big help in the rural areas, especially for pain management and ACLS.


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## EpiEMS (Nov 7, 2016)

ExpatMedic0 said:


> But before this thread goes side ways, I was an Oregon intermediate for several years. seemed like a big help in the rural areas, especially for pain management and ACLS.


Did the service not have paramedics available?


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## ExpatMedic0 (Nov 7, 2016)

EpiEMS said:


> Did the service not have paramedics available?


A lot of volunteer areas or areas that are mixed with paid and volunteer staff don't have many medics. I'm not sure about now, this was over 10 years ago. Oregon is full of fire engine tier response systems where in engine responds to most Ems calls and in theory arrives before the ambulance. In the big cities most have 1 paramedic on board, but not always the case in rural areas. At my fire academy out of 100 or so guys I was the only intermediate I know of and 1 guy was a paramedic. in Portland though all 911 ambulances are double paramedic and most engines have at least 1 paramedic on board.


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## VentMonkey (Nov 7, 2016)

EpiEMS said:


> Did the service not have paramedics available?


There was an old EMT who moved to Oregon once on of our AMR ops closed several years ago. From the sound of things the service he ended working for covered large areas of rural Oregon, and would have hours long (or several) transports weather permitting, perhaps this was a factor?

Fun fact: this service was also featured on the movie "Kindergarten Cop".


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## LanceCorpsman (Nov 7, 2016)

In my county, besides the one paid agency with two medic units (that do respond out of dist) we maybe have 5 medics spread across 12-15 ambulances. And those medics are spread in between two volunteer departments. Like my department, we have three intermediates and that is it. Our most reliable  ALS support is from the HEMS agencies. But most of the time, if I do require a medic, I just treat with diesel.


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## Tigger (Nov 7, 2016)

LanceCorpsman said:


> In my county, besides the one paid agency with two medic units (that do respond out of dist) we maybe have 5 medics spread across 12-15 ambulances. And those medics are spread in between two volunteer departments. Like my department, we have three intermediates and that is it. Our most reliable  ALS support is from the HEMS agencies. But most of the time, if I do require a medic, I just treat with diesel.


How long are your transports?


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## LanceCorpsman (Nov 7, 2016)

Tigger said:


> How long are your transports?



It all depends, for my department usually between 10-15 mins to the closest level III trauma hospital. But in some of the more rural/remote locations, it can take more than an hour going code 3. 
Some departments have a 30 min minimum transport time (with no ALS) and I know a few departments that can be three hours away from the closest hospital.


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## Tigger (Nov 7, 2016)

LanceCorpsman said:


> It all depends, for my department usually between 10-15 mins to the closest level III trauma hospital. But in some of the more rural/remote locations, it can take more than an hour going code 3.
> Some departments have a 30 min minimum transport time (with no ALS) and I know a few departments that can be three hours away from the closest hospital.


That is a drag.

I feel fortunate that we can provide paramedics to our area. 5 paramedic ambulances for 1000+ square miles and 35k people.


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## LanceCorpsman (Nov 7, 2016)

Tigger said:


> That is a drag.
> 
> I feel fortunate that we can provide paramedics to our area. 5 paramedic ambulances for 1000+ square miles and 35k people.



There definitely has to be a change.


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## EpiEMS (Nov 7, 2016)

LanceCorpsman said:


> It all depends, for my department usually between 10-15 mins to the closest level III trauma hospital. But in some of the more rural/remote locations, it can take more than an hour going code 3.
> Some departments have a 30 min minimum transport time (with no ALS) and I know a few departments that can be three hours away from the closest hospital.



Oof. Are these mostly volley EMS or are we talking volley fire running one or two ambulances?


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## LanceCorpsman (Nov 8, 2016)

EpiEMS said:


> Oof. Are these mostly volley EMS or are we talking volley fire running one or two ambulances?



Mostly volley fire. Im only aware of two volley EMS agencies in my county.


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## ExpatMedic0 (Nov 8, 2016)

My "career" in the fire service lasted about 4 weeks... Was not for me. It's a shame if you want to make any money as a paramedic in Oregon you have to be a fireman.


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## gotbeerz001 (Nov 8, 2016)

LanceCorpsman said:


> Sadly, now it is plagued by a bunch of rich people moving in from California



I'm from CA... We have considered packing up and moving to Bend. 


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## EpiEMS (Nov 8, 2016)

LanceCorpsman said:


> Mostly volley fire. Im only aware of two volley EMS agencies in my county.



Gotcha -- and most are BLS or limited ALS (AEMT)?



ExpatMedic0 said:


> My "career" in the fire service lasted about 4 weeks... Was not for me. It's a shame if you want to make any money as a paramedic in Oregon you have to be a fireman.



So there's no solid third-service, hospital-based, or privates to make a career at? That's a shame.


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## ExpatMedic0 (Nov 8, 2016)

EpiEMS said:


> Gotcha -- and most are BLS or limited ALS (AEMT)?
> 
> 
> 
> So there's no solid third-service, hospital-based, or privates to make a career at? That's a shame.



From my experience as a paramedic in Oregon, working for a private ambulance company will pay between 35-50k a year before any overtime, a crappy 401k and mediocre to bad health insurance. No stations, all system status management living your 12 hour shift in a parking lot somewhere. Some private ambulances have unions(AMR portland) but most don't. Oregon is an at will employer so you can be fired for any reason, your employer does not have to give a reason. Firefighter paramedic on the other hand, can range from 50-100k+, you get an actual public pension, top of the line health benefits, an incredibly powerful union and a station to hang out in during your shift. You respond on every EMS call in the engine and do patient care for 1-5 minutes before the ambulance arrives or cancel yourself because the ambulance is already on scene.TVFR and Portland Fire are 2 good examples. Obviously, this varies by region and location and I have not lived there in years...


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## ExpatMedic0 (Nov 8, 2016)

However, I guess its worth noting that in the very rural areas, what I said above does not always apply. That is where they rely more on EMT-I's and volunteers. I am only familiar with Portland area


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## VentMonkey (Nov 8, 2016)

ExpatMedic0 said:


> However, I guess its worth noting that in the very rural areas, what I said above does not always apply. That is where they rely more on EMT-I's and volunteers. I am only familiar with Portland area


Metropolitan Oregon sounds a lot like metropolitan California (yaaay west coast).

Just out of curiosity what is (was) the relationship like with the AMR Multnomah County paramedics and Portland Fire. I was under the impression that the AMR paramedics had scene control on the 911's. I could be completely mistaken BTW. 

Also does Astoria have an ALS fire department? I've always been fascinated with that part of the PNW, thanks.


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## ExpatMedic0 (Nov 8, 2016)

Not sure. I was affiliated with Metro West Ambulance in a suburb of Portland and I was a volunteer with TVFR for 4 weeks. I worked inside metro portland for 6 years, but only doing event stand by with another agency, so I am not 100% sure.


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## EpiEMS (Nov 8, 2016)

ExpatMedic0 said:


> . You respond on every EMS call in the engine and do patient care for 1-5 minutes before the ambulance arrives or cancel yourself because the ambulance is already on scene.TVFR and Portland Fire are 2 good examples.



Yeah, but then you have to fight fires (maybe...on ~20% of calls)...doesn't really appeal to me


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## ExpatMedic0 (Nov 8, 2016)

Ya i found out the same after about 4 weeks.


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## LanceCorpsman (Nov 9, 2016)

EpiEMS said:


> Gotcha -- and most are BLS or limited ALS (AEMT)?



The majority of agencies have EMT-Is, very few AEMTs. So there is a good chance you get what we call "Intermediate Life Support"


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## EpiEMS (Nov 9, 2016)

LanceCorpsman said:


> The majority of agencies have EMT-Is, very few AEMTs. So there is a good chance you get what we call "Intermediate Life Support"



Gotcha - thanks. Sounds like your EMT-Is are performing ACLS-type cardiac care (minus cardioversion and transcutaneous pacing), correct? I only know what I've seen from the state regs.


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## LanceCorpsman (Nov 9, 2016)

EpiEMS said:


> Gotcha - thanks. Sounds like your EMT-Is are performing ACLS-type cardiac care (minus cardioversion and transcutaneous pacing), correct? I only know what I've seen from the state regs.



Correct, basically ACLS minus a few drugs like adenosine or mag.


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