# Advanced EMT classes



## RunnerD1987 (Oct 1, 2011)

Hi, I noticed in our state a drop in the number of EMT I/Advanced EMT classes. Especially in the area of our state a lot of volunteer ambulances are only BLS providers. I volunteer 30 minutes away from where I live in a BLS service. I am find with that because a lot of friends and relatives live in the town I volunteer in. However, I was thinking of going back to college and going for a degree in the healthcare field. I work at a hospital right now stocking medicine and setting up machines. 

I wanted to do more with patient contact and was looking into advanced EMT, but I only found two in the state. However, they added a new paramedic class.

So summing this up any reason the drop in training more for Advanced EMT?


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## Fish (Oct 1, 2011)

WCSU1987 said:


> Hi, I noticed in our state a drop in the number of EMT I/Advanced EMT classes. Especially in the area of our state a lot of volunteer ambulances are only BLS providers. I volunteer 30 minutes away from where I live in a BLS service. I am find with that because a lot of friends and relatives live in the town I volunteer in. However, I was thinking of going back to college and going for a degree in the healthcare field. I work at a hospital right now stocking medicine and setting up machines.
> 
> I wanted to do more with patient contact and was looking into advanced EMT, but I only found two in the state. However, they added a new paramedic class.
> 
> So summing this up any reason the drop in training more for Advanced EMT?




I might be wrong, but it is my understanding that National Registry was going away from Advanced EMT and going to just Basic and Paramedic.


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## bstone (Oct 1, 2011)

> I might be wrong, but it is my understanding that National Registry was going away from Advanced EMT and going to just Basic and Paramedic.



Yes, you are wrong. 

They are retitling EMT-Intermediate 85 to Advanced EMT. The scope is slightly higher and they are requiring us to take a "bridge" course and then test us on knowledge we already have and skills we already know. And charge us for it.


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## Fish (Oct 2, 2011)

bstone said:


> Yes, you are wrong.
> 
> They are retitling EMT-Intermediate 85 to Advanced EMT. The scope is slightly higher and they are requiring us to take a "bridge" course and then test us on knowledge we already have and skills we already know. And charge us for it.




Copy


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## RunnerD1987 (Oct 2, 2011)

I figure with the restructuring of the level that it is catching up. Hopefully the hospital will again offer the class above EMT B again. For the moment looking to take a online introduction to the human body class,. Then ACLS, PALS, and Pediatric Life Support in Disaster Class in the meantime when the next AEMT class starts in the end of Summer.


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## Mavrande (Oct 5, 2011)

I figure this is probably related to the national changes - I'm being told that the New Jersey EMT certification levels are changing, that Basics are going to be just "EMT" now, and we're getting a few more skills like blood glucose testing and I think albuterol. I haven't been able to confirm any of this though - since I heard that the new curriculum is effective beginning in 2012, I expected to find something on the internet about it. Anyone know the details on how long the new course is and what additional skills we're getting?


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## wolfwyndd (Oct 5, 2011)

bstone said:


> Yes, you are wrong.
> 
> They are retitling EMT-Intermediate 85 to Advanced EMT. The scope is slightly higher and they are requiring us to take a "bridge" course and then test us on knowledge we already have and skills we already know. And charge us for it.


Close enough for government work, but it's SLIGHTLY more complicated.  There are a small handful of I/85 states out there (Ohio being one of them) so they are actually dropping the I/85 certification and going with the I/99 only certification.  That's what the 'bridge' class is for.  For that small handful of us that are I/85 certified we're going to be taught (essentially) the I/99 curriculum and renaming us all to AEMT.  I'm not too keen on the new name, but I'm completely ok with upping our skills / knowledge.  Kinda looking forward to it, actually.


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## bstone (Oct 5, 2011)

> Close enough for government work, but it's SLIGHTLY more complicated. There are a small handful of I/85 states out there (Ohio being one of them) so they are actually dropping the I/85 certification and going with the I/99 only certification. That's what the 'bridge' class is for. For that small handful of us that are I/85 certified we're going to be taught (essentially) the I/99 curriculum and renaming us all to AEMT. I'm not too keen on the new name, but I'm completely ok with upping our skills / knowledge. Kinda looking forward to it, actually.



Nope. The I/85 is not becoming the I/99. I/99s are being merged with Paramedic and I/85 is being "transitioned" to Advanced-EMT. The A-EMT level will not be at the level of I/99 in either scope of knowledge.

I am sending in my application to the NREMT for their at-large board position. If selected I am going to give them hell about this transition, which requires tests and money.


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## terrible one (Oct 5, 2011)

Out of curiosity why is there not just EMT and Paramedic? I never understood the need for anything in between these two.


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## bstone (Oct 5, 2011)

> Out of curiosity why is there not just EMT and Paramedic? I never understood the need for anything in between these two.



Due to the huge chunk of the country where EMS is volunteer and getting paramedic-level ALS is often impossible. The question might actually be asked why there is an EMT-Basic level at all if becoming an Intermediate is only another semester-long course and allows the practitioner to work almost seemlessly with a paramedic. Why would you have one Basic who is partnered with a Medic, thus requiring the Medic to initiate and do all ALS interventions. Why not have an Intermediate and a Medic, so both can start IVs, insert endotracheal tubes, push meds, etc etc


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## terrible one (Oct 5, 2011)

Then why not make an Intermediate scope of practice at an EMT level? Increase the EMT curriculeam to one year length and paramedic to two years?
I think I might have bit off more than I can chew with that question.


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## bstone (Oct 5, 2011)

I agree. Do away with Basic, make Intermediate/Advanced the new beginning step, make the program a year long (shorter if you go full-time). But then we are back to the issue of the rural areas. They might only be equipped to train for the Basic level and maybe MAYBE the Intermediate level, but almost never for the medic level. As an Intermediate (and certified instructor) I can train people up to the Intermediate level, but I can't train them past that. A lot of the rural areas don't have paramedics and so there is not only no true full-ALS but there is no one to train to that level.

I would be very happy to see Basic being specific to the rural areas, with Intermediate/Advanced being the ALS providers, while having Intermediate and Medic being what you find in suburban and urban areas. Of course I'd love for medics to be on every bus, but that just doesn't exist.


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## wolfwyndd (Oct 6, 2011)

bstone said:


> Nope. The I/85 is not becoming the I/99. I/99s are being merged with Paramedic and I/85 is being "transitioned" to Advanced-EMT. The A-EMT level will not be at the level of I/99 in either scope of knowledge.


Really now?  You don't say.  

Ok then.  What, exactly, is the national curriculum going to be for the new AEMT?  IV, I assume?  More drugs then the basic (nitro, aspirin, D50, morphine, narcan, albuterol breathing treatments, diphenhydramine, etc, etc, etc.), chest decompression.  Any of the cardiac stuff like the I-99's get?  Honestly, that was pretty much my biggest issue with the I-85.  We skip almost the entire cardiac section.  Inquiring minds wanna know.


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## mcdonl (Oct 6, 2011)

This is going to sound bad, but I know a lot of EMT Basics who could never pass an I99 class. And, I know that most of those EMT Basics I referred to provide a very important service and we need them.

In Maine, we may be facing this situation in a few years.

I became an intermediate for two reasons... The number one reason is I can give NTG. EPI and Breathing Treatments with OLMC approval. We have a 40 minute transport, even longer on our many mutual aid calls. 

The second reason is IV. Our protocol has us doing a lot of IV's, and in cases of dehydration and hyperglycemia there is a marked improvement in the patients when administered fluids. Although, I would venture a guess that most of my IV's are done due to protocol and preperation for MEDIC or Hospital drug administration.

So, that is why **I** decided to step up to Intermediate. Now, if the EMT Advance protocol allows me to continue to provide these services then I will be content with that. My EMT-I class was an I99 class... If I were to lose any of those skills I would take the bridge to MEDIC.

Incidentally, in our new protocl going into effect 12/1 we lose ET's but maintain blind airways and I am cool with that.


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## LIT (Oct 6, 2011)

bstone said:


> Due to the huge chunk of the country where EMS is volunteer and getting paramedic-level ALS is often impossible. The question might actually be asked why there is an EMT-Basic level at all if becoming an Intermediate is only another semester-long course and allows the practitioner to work almost seemlessly with a paramedic. Why would you have one Basic who is partnered with a Medic, thus requiring the Medic to initiate and do all ALS interventions. Why not have an Intermediate and a Medic, so both can start IVs, insert endotracheal tubes, push meds, etc etc



I agree the basic and intermediate should be merged but it's not just one more semester, not in texas anyway. It's two semesters, a full year longer which totals up to $1550 in tuition and an additional $600+ in books.


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## 18G (Oct 6, 2011)

terrible one said:


> Then why not make an Intermediate scope of practice at an EMT level? Increase the EMT curriculeam to one year length and paramedic to two years?
> I think I might have bit off more than I can chew with that question.



Great idea! I have often said that current EMT-Basic's really shouldn't be able to function as a primary care provider on an ambulance. The new Advanced-EMT level being rolled out will hopefully start to replace EMT-Basic's as the primary care provider. 

In PA we have never had an intermediate level so the AEMT will be something totally new for us.


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## mcdonl (Oct 6, 2011)

18G said:


> In PA we have never had an intermediate level so the AEMT will be something totally new for us.



I think you will find it pretty useful. We (AEMT/I) can work well in a system with medics... this is even more true in rural areas where medics are not as plentiful.


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## emt11 (Oct 6, 2011)

Honestly, I kinda like the way GA has put the scope of practice for AEMTs. Here's the full scope for every level in GA. At the top is a key for the colors.

http://ems.ga.gov/programs/ems/Proc... - Updated 7-1-2011 - ALL LEVELS (no EMR).pdf


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## bstone (Oct 6, 2011)

GA has four EMT levels. Whoa.


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## Handsome Robb (Oct 6, 2011)

We run I/P. I work as an I now until I finish school. I love the medics I work with and they love the fact that I can actually take patients with more of a complaint than toe pain, no offense to the basics on here. 

I don't understand how you guys weren't taught cardiac meds in school for I/85? I have a pretty solid scope as an Intermediate here.


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## bstone (Oct 6, 2011)

> I don't understand how you guys weren't taught cardiac meds in school for I/85? I have a pretty solid scope as an Intermediate here.



Because the 1985 national scope for Intermediate didn't include anything related to cariology that wasn't included in the basic curriculum. 99 fixed that, however. Many Intermediate, such as myself, were educated to a state level that FAR exceeded the 85 standard but yet fell a bit short of 99, so we tested as 85s. The NREMT would have us take a transition course that teaches us info we already know, test us on a scope that is below what we already do and allow us to pay for this.


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## Handsome Robb (Oct 6, 2011)

I see. Glad I won't have to deal with those shenanigans


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## bstone (Oct 6, 2011)

I'm hoping to put an end to the shenanigans. I sent in my application the NREMT to be selected for their at-large position on the Board of Directors. If I am selected then I will zealously fight for the common EMT.


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## 18G (Oct 6, 2011)

The National Scope of Practice for Advanced EMT's does not include ECG monitoring. Although each state can add to that.


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## Handsome Robb (Oct 6, 2011)

I/85 included monitoring if I am not mistaken.


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## jjesusfreak01 (Oct 8, 2011)

NVRob said:


> We run I/P. I work as an I now until I finish school. I love the medics I work with and they love the fact that I can actually take patients with more of a complaint than toe pain, no offense to the basics on here.
> 
> I don't understand how you guys weren't taught cardiac meds in school for I/85? I have a pretty solid scope as an Intermediate here.



IMO, there are two ways to properly utilize an EMT-I in the US. They can either be an advanced EMT and advanced paramedic assistant (IE, attend on basic and intermediate calls, pretty much do anything onscene with the paramedic on other calls) and as an independent practitioner (IE, work in an intermediate level system, have an I99 level scope and call for orders). There are benefits to both of these. In an intermediate level system, an I-99 can act at nearly a paramedic level while in contact with medical control, allowing a higher level of care with lower certification (and its cheaper for the system). Likewise, in a paramedic system, an I85 or higher teamed up with a paramedic gives you two providers who can essentially act as two paramedics (the medic can give orders and the intermediate can administer them with only a few exceptions). 

As a future intermediate, I would like to think that my scope of medications is limited by the danger they pose to my patients if misused weighed against their possible benefits. Whereas I would be perfectly comfortable giving narcan, glucagon, and morphine (which regrettably I cannot give), I am also happy to leave Cardizem and Amiodarone in the hands of the paramedics, as administration of these drugs requires both proper diagnosis of the patient as well as careful administration to prevent severe harm. I would also be happy to learn about the cardiac medications we carry (and I take the time to do so on my own), however it does make sense to me that my scope is limited by the danger each skill or medication poses to my patient, and that use of more advanced skills and medications deserves a greater level of education.


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## emt11 (Oct 8, 2011)

bstone said:


> GA has four EMT levels. Whoa.



Yes, we do. However, basics(except for some places on the far south side of GA) can not work on a truck, as per the state. I'99 numbers are not and have not been able to get numbers for several years. Meaning, if you have it you can renew it but no new numbers. I'85 is obviously being replaced by the A's. We also recognize the FR level but you'll never see one on a truck. Some FD's use them while others require I'85. The state still recognizes B but like I sAid theirs not a whole lot you can do with it.


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