# EMT Enhanced



## REMSI Medic 10 (May 29, 2008)

From where you guys are from, do you have EMT-J's(EMT Enhanced). And if you do, what can they do in ur state?


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## Jeremy89 (May 29, 2008)

Here in AZ we have EMT-Basic, Intermediate (85), Intermediate (99), and Paramedic.  Protocols are listed here:  http://www.azsos.gov/Public_Services/Title_09/9-25.htm

Also, here is our protocols for drugs: www.azdhs.gov/bems/rules-pdf/R9_25_503_010607.pdf

Hope that helps!

Edit:

Didn't see the second part of your question.  I believe 85 Intermediates can do IV's with limited drugs, some EKG interpretation, etc and 99 Intermediates can do nearly everything that medics can do, just not intubation.  I'm not 100% for sure though...


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## letsrun100 (May 29, 2008)

In Virginia, the first level of ALS is EMT-Enhanced, which is unique to Virginia. EMT-Enhanced can start IV lines, perform endotracheal intubation, perform chest decompressions, establish IO lines and administer some medications such as D50, glucagon, albuterol/atrovent, epinephrine and in some cases narcotics. EMT-Enhanced holds a 3 year certification.

Here's a link to the University of Virginia's program:
www.healthsystem.virginia.edu/internet/phe/Course.cfm

There are several other options available to receive instruction. I am currently enrolled in the Enhanced program thru Bedford County Virginia Fire and Rescue. I test on June 12, 2008.


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## Jon (May 29, 2008)

PA might be getting "enhanced" EMT's in the near future. It is part of the revisions to the EMS Act introduced during EMS Week.


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## zacdav89 (Jun 30, 2008)

i guess it depends were you are cuase i am a EMT-I 99 and i can intubate and we just have  some meds we can't give and some skills that we can't do that paramedics can. the EMT-J sounds kinda like what the NREMT is going to replace the EMT-I with in 2010. i am from colorado.


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## NomexMedic (Jul 2, 2008)

We don't have them in Missouri because our bureau is run by a bunch of nurses that can't agree on what Intermediates should be allowed to do.  They've been approved for 10 years but we still don't have the licensure level.


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## reaper (Jul 2, 2008)

That's because your state knows what is best! Two certs, EMT and Paramedic, that is all that is needed.


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## VentMedic (Jul 2, 2008)

NomexMedic said:


> We don't have them in Missouri because our bureau is run by a bunch of nurses that can't agree on what Intermediates should be allowed to do.



Anyone know why there are several RNs in many State EMS administrative positions overseeing Paramedics and EMTs?

Hint:  It has to do with education.

I agree with Reaper.  The U.S. has over 46 different certifications which has not helped the cause for establishing national standards and unity.


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## Ridryder911 (Jul 2, 2008)

Actually MO. has active Paramedics in their EMS Bureau. One of the few states that actually that tries to get their act together. Not only having only two levels as it should be, they also have EMS regions with funding so the state is >90% covered with ALS. 

Sorry, there in between levels is just an excuse not to have Paramedics. Remember, all levels are always in comparison of the gold standard.... the Paramedic. Any other is a substitute. 

R/r 911


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## NomexMedic (Jul 2, 2008)

Ridryder911 said:


> Actually MO. has active Paramedics in their EMS Bureau. One of the few states that actually that tries to get their act together. Not only having only two levels as it should be, they also have EMS regions with funding so the state is >90% covered with ALS.
> 
> Sorry, there in between levels is just an excuse not to have Paramedics. Remember, all levels are always in comparison of the gold standard.... the Paramedic. Any other is a substitute.
> 
> R/r 911


I'm not saying that Intermediates are the end all be all.  I didn't know, however that there were paramedics in the upper level positions.  I know of some regional coordinators that are medics, but what about the upper echelon?  

I also agree that it's about education and believe fully that paramedics should have atleast an associate's degree with the ability to continue their education and get a bachelor's and be considered an advanced paramedic with the ability to do more in the field.  Personal opinion only there.  In the end, I just wish we could get things straight and make it so paramedic is recognized as a professional degree/career instead of a technical job.

I do believe though that we should do EMT-IV and Paramedic only though.  In areas where you can't afford double medic units, it's nice to have someone else that can atleast start IV's on a serious pt. and draw up medications for things like RSI.  I really don't feel like starting IV's is a difficult task.  We spent one 8 hour class on it and then just relied on clinicals to obtain proficiency.


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## zacdav89 (Jul 2, 2008)

it would be great to have paramedics on every ambulance, every agancy full time paid w/ benifits, but its not possible,the inbetween levels of providers are there so rual places like were i live, were it take 40-50minites code3 to get to a level 4 trumma center just to stablize so we can then fly people 2 hours away to get the definitive care, will have some form of als care in route, not many medics are willing to go to 2years of school to then volunteer for agancies with a call volume of less then 400 a year, and those who do have trouble being able to re-cert,  EMS is about the people and giveing the best care possible for the cercimstances. but thank you for those medics that do.


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## reaper (Jul 2, 2008)

Dang, Here goes this argument again!!


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## Ridryder911 (Jul 2, 2008)

zacdav89 said:


> it would be great to have paramedics on every ambulance, every agancy full time paid w/ benifits, but its not possible,the inbetween levels of providers are there so rual places like were i live, were it take 40-50minites code3 to get to a level 4 trumma center just to stablize so we can then fly people 2 hours away to get the definitive care, will have some form of als care in route, not many medics are willing to go to 2years of school to then volunteer for agancies with a call volume of less then 400 a year, and those who do have trouble being able to re-cert,  EMS is about the people and giveing the best care possible for the cercimstances. but thank you for those medics that do.



Excuses, excuses.. do you have physicians or nurses at your hospital? ... There will be areas that will never have full capabilities of providing ALS care. That is to be expected and nothing can be done about it until socialized medicine occurs. 



NomexMedic said:


> In areas where you can't afford double medic units, it's nice to have someone else that can atleast start IV's on a serious pt. and draw up medications for things like RSI.  I really don't feel like starting IV's is a difficult task.  We spent one 8 hour class on it and then just relied on clinicals to obtain proficiency.



One cannot understand the philosophy of IV therapy in 8 hours. Yes, my trained Chimp could learn the procedure but not the reason, the change in homeostasis, and complications of the *therapy* of an intravenous fluid. Something we fail to remember, it is much more than a skill. 

In regards of "draw up" medications for RSI, * NO ONE* but * NO ONE* draws up my RSI med.'s except for myself.. If I administer it, I draw it up. In many states even RN's are not to administer RSI or degrees of sedation. Again, one does understand and realize how serious such matter medications and procedures are, they are *much more than a skill*.

R/r 911


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## mdkemt (Jul 2, 2008)

I'm staying out of this one this time!

Oh Canada!!!!

MDKEMT


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## zacdav89 (Jul 2, 2008)

we operate 10 ems system in a rual setting with only 1 being a full time paid servce, the rest reside in 6 counties were 4 of them are the poorest in the nation, so give me the solution to stock all these services with paramedics who whant to stay. then how to afforid to stock 18 ALS ambulance with equipment, untill then my stance is to utalize the in between levels untill someone can solve this problem. and yes we do have doctors and nurse just a verry short supply of them.


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## reaper (Jul 2, 2008)

If you have people that are dedicated enough to go to EMT-I school, then they are not dedicated enough to go to medic? I personally believe that EMT-I is a waste of time. If you went from EMT-B to Paramedic it would be what 6-8 months longer? Show me a reason to have an EMT-I position.

I have yet found one person that can give a good argument for having EMT-I.

Just my .02 worth.


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## Ridryder911 (Jul 2, 2008)

zacdav89 said:


> we operate 10 ems system in a rual setting with only 1 being a full time paid servce, the rest reside in 6 counties were 4 of them are the poorest in the nation, so give me the solution to stock all these services with paramedics who whant to stay. then how to afforid to stock 18 ALS ambulance with equipment, untill then my stance is to utalize the in between levels untill someone can solve this problem. and yes we do have doctors and nurse just a verry short supply of them.



I appreciate your postings but please at least do spell check. Alike I described, there are going to be areas that will never have ALS until government funded. 

Just because a community cannot afford ALS care, does not mean one *should ever compromise patient care*. This is done by the way of excuses or substitutions. One would never replace a surgeon with a surgical technician, or even a RN with a nurse aide. Yes, one could always argue that they may be able perform some of the skills but again that is NOT having the knowledge or truly delivering care. We should NEVER allow substitutions for patient care, no matter what the bind maybe. If it does get critical enough, people will change it... it's called the disaster theory. 

Shame this has to occur and sacrifices will be made. Hopefully, it will not be many that have to make the difference....

R/r 911


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## zacdav89 (Jul 2, 2008)

http://www.dora.state.co.us/medical/rules/500.pdf
http://www.dora.state.co.us/medical/Rules/800.pdf
Here’s a link to Colorado rule 500 this is a side by side comparison of EMT and medics acts allowed by the state, we also have a rule 800 witch is added for medics. We are all trained but we ALL including medics have to fallow medical direction and have a medical advisor, we all are extensions of a M.D. license anyway. They are the Gold standard. Every EMT out there has to prove themselves to the docs before they can go out, I never heard of a medical director that didn't look at who he was putting out on the streets. Medic programs here run 2 years and require a minimum of a 2-3 hr drive to get to a college that offers the program, many people have families and other jobs. We would also have to travel to hospitals outside our area to do the 300 some odd hours of clinicals then the ride along with an agency that gets a large enough run volume. If you are concerned about the welfare of the patients of all the levels between EMT- basic or equivalent and paramedic, why not try and help out people in these levels by mentoring and not telling them that they are worthless under the paramedics, if we are endangering the life’s of our patients with use of a compacted ALS care were no other ALS care is available and needed, what is someone who has BLS certification going to do better, we are needed in our own unique areas of the world some training and certifications adapt better to the needs of different communities. We are all in for the same goal of helping the patients get the care they need. Not all calls are extreme ACLS or medical calls requiring medic’s full capabilities.


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## mikeylikesit (Jul 2, 2008)

reaper said:


> If you have people that are dedicated enough to go to EMT-I school, then they are not dedicated enough to go to medic? I personally believe that EMT-I is a waste of time. If you went from EMT-B to Paramedic it would be what 6-8 months longer? Show me a reason to have an EMT-I position.
> 
> I have yet found one person that can give a good argument for having EMT-I.
> 
> Just my .02 worth.


 i agree. it is only a...1000+ extra hour and after you draw the meds...you get to deliver them too. I better not hear one more person in my life say that emt-i and emt-p are the same.


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## Ridryder911 (Jul 2, 2008)

zacdav89 said:


> http://www.dora.state.co.us/medical/rules/500.pdf
> http://www.dora.state.co.us/medical/Rules/800.pdf
> Here’s a link to Colorado rule 500 this is a side by side comparison of EMT and medics acts allowed by the state, we also have a rule 800 witch is added for medics. We are all trained but we ALL including medics have to fallow medical direction and have a medical advisor, we all are extensions of a M.D. license anyway. They are the Gold standard. Every EMT out there has to prove themselves to the docs before they can go out, I never heard of a medical director that didn't look at who he was putting out on the streets. Medic programs here run 2 years and require a minimum of a 2-3 hr drive to get to a college that offers the program, many people have families and other jobs. We would also have to travel to hospitals outside our area to do the 300 some odd hours of clinicals then the ride along with an agency that gets a large enough run volume. If you are concerned about the welfare of the patients of all the levels between EMT- basic or equivalent and paramedic, why not try and help out people in these levels by mentoring and not telling them that they are worthless under the paramedics, if we are endangering the life’s of our patients with use of a compacted ALS care were no other ALS care is available and needed, what is someone who has BLS certification going to do better, we are needed in our own unique areas of the world some training and certifications adapt better to the needs of different communities. We are all in for the same goal of helping the patients get the care they need. Not all calls are extreme ACLS or medical calls requiring medic’s full capabilities.





How about some paragraphs?

Sorry, I know its rough in the rural and frontier areas... as well in the metro and urban too, that's life. 

As well, Physician level is NOT the gold standard for EMS care! All levels (EMT) is evaluated and compared to what?... The Paramedic. Period. 

Again, I realize the difficulty and again and again, you may *never* be able to have ALS capability. Sorry, one does not get to skip through medical school because they want to work in the Rockies.. they still have to attend and finish, just alike anyone else. The same should be true for in EMS. Cutting corners NEVER saves lives! Something is sacrificed! 

You want mentoring, but want someone else to do it for you. Sorry, it is your choice to live and reside where you do. Unfortunately, this is the risks and compromise of living in rural, and frontier areas. 

At one time, there was an exchange program that placed metro medics for a couple of weeks in the rural areas, and the rural medics in the metro. A learning experience for all. As one soon finds out, the rural areas require more knowledge and more in-depth education. You maybe with the patient for several hours, instead a few minutes, as well as assisting the ED staff member (yes, single member). 

Again, there is NO reason to be less educated, less skilled. It is a horrible myth that those from the rural areas have to be provide less and poor care. Something I despise to see and hear as an excuse. Don't want to be good at what you do, then get out! Allow someone else to attempt it. 

R/r 911


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## WuLabsWuTecH (Jul 2, 2008)

In Missouri, according to the guy in the EMS office who I talked to a few weeks ago, they should have an EMT-I level by the end of August.  He said something about legislature passing it and now it was just implementing it.

I think its very relavant to have EMT-I's  For me, it wouldn't make sense to go to Medic school.  I'll have my MD in hopefully 7 more years from now so the addition years of work put into it (I'm a full time student so paramedic classes would have to be done over summer vacation or other off school times, possibly nights) and I'd be very close to having my MD.  For my friend who is a Senior in college it makes even less sense since he is also premed and will have his MD in 4 years.  Yet both of us can still contribute to prehospital emegency care at a higher level before that and in places that can't have medics all the time and I level allows for some ALS care.  Best case scenario?  No.  But better than nothing or BLS only?  Yes!


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## mikeylikesit (Jul 2, 2008)

WuLabsWuTecH said:


> In Missouri, according to the guy in the EMS office who I talked to a few weeks ago, they should have an EMT-I level by the end of August. He said something about legislature passing it and now it was just implementing it.
> 
> I think its very relavant to have EMT-I's For me, it wouldn't make sense to go to Medic school. I'll have my MD in hopefully 7 more years from now so the addition years of work put into it (I'm a full time student so paramedic classes would have to be done over summer vacation or other off school times, possibly nights) and I'd be very close to having my MD. For my friend who is a Senior in college it makes even less sense since he is also premed and will have his MD in 4 years. Yet both of us can still contribute to prehospital emegency care at a higher level before that and in places that can't have medics all the time and I level allows for some ALS care. Best case scenario? No. But better than nothing or BLS only? Yes!


 well....your circumstance is special. you are continuing to something that most of us here will never reach. go with the I to get some more experience in IV and ekg interp. by the time your done with residency you will be the best EMT alive until your in practice.


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## triemal04 (Jul 7, 2008)

zacdav89 said:


> it would be great to have paramedics on every ambulance, every agancy full time paid w/ benifits, but its not possible,the inbetween levels of providers are there so rual places like were i live, were it take 40-50minites code3 to get to a level 4 trumma center just to stablize so we can then fly people 2 hours away to get the definitive care, will have some form of als care in route, not many medics are willing to go to 2years of school to then volunteer for agancies with a call volume of less then 400 a year, and those who do have trouble being able to re-cert,  EMS is about the people and giveing the best care possible for the cercimstances. but thank you for those medics that do.


Actually, this is the best arguement for having paramedics in your service.  If it takes you that long to get to a po'dunk community hospital, then you damn sure need someone who is capable of doing more than slapping on a non-rebreather and calling it good.  Longer transports=longer for the disease/illness/injury to manifest itself=greater need for a higher level of care.

And, as has been said, there are paid services out there that have full-time paramedics as part of system that runs maybe 300 calls a year.  It can, and has been done, and should be done in more places.


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## rhan101277 (Jul 8, 2008)

triemal04 said:


> Actually, this is the best arguement for having paramedics in your service.  If it takes you that long to get to a po'dunk community hospital, then you damn sure need someone who is capable of doing more than slapping on a non-rebreather and calling it good.  Longer transports=longer for the disease/illness/injury to manifest itself=greater need for a higher level of care.
> 
> And, as has been said, there are paid services out there that have full-time paramedics as part of system that runs maybe 300 calls a year.  It can, and has been done, and should be done in more places.



Our po-dunk hospital is really po-dunk.  The X-ray machines looks like they were on of the first few invented, I even think they have some bone density scanners to go with them.  I am sure the service would love to have more medics, thats why after I do my EMT, I hope to be able to do medic to provide a better service to the community.


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## alex71 (Jul 11, 2008)

ya communities without als are pretty screwed when it comes to people dieing of heart attacks and suchj


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## Ridryder911 (Jul 11, 2008)

alex71 said:


> ya communities without als are pretty screwed when it comes to people dieing of heart attacks and suchj



??????  ?????? ??????


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## Jon (Jul 12, 2008)

alex71 said:


> ya communities without als are pretty screwed when it comes to people dieing of heart attacks and suchj



Alex,

What exactly do you mean? Most every community has SOME sort of access to ALS.


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## upstateemt (Jul 15, 2008)

reaper said:


> If you have people that are dedicated enough to go to EMT-I school, then they are not dedicated enough to go to medic? I personally believe that EMT-I is a waste of time. If you went from EMT-B to Paramedic it would be what 6-8 months longer? Show me a reason to have an EMT-I position.
> 
> I have yet found one person that can give a good argument for having EMT-I.
> 
> Just my .02 worth.



In NYS we have: Emt-B; Emt I; EMT-CC and Paramedic. 

I am an EMT-CC as well as an RN (with a BS).  My CC took me a year, 16 credits and hundreds of hours of clinical (despite my 20+ years as an RN).    I have no intention of going on for my Paramedic, WHY?  I am a volunteer and in my "paid" life make more as an RN than a Paramedic.  A Paramedic cert would bne another 18 months (full time) of school and who knows how many clinical hours. 

My (Volunteer)  Ambulance is full ALS for EVERY call, given the remote and rural nature of our community it makes no sense to send a BLS unit and have to call for ALS.  EMT-I's and EMT-CC's are key to providing that level of care.  

Paid Agencies may be able to fully staff with Paramedics bu a Volunteer agency simply cannot.


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## greenmountains (May 2, 2015)

reaper said:


> That's because your state knows what is best! Two certs, EMT and Paramedic, that is all that is needed.


It is?
My state knows what is best?
It does?
I can think of dozens of reasons for intermediate steps between EMT B and EMT P, not the least of which is location, cost of education, cost of a EMT P and so on.
Me? I am an EMT B and as soon as my state gets its act together for a curriculum I am going to EMT A, (advanced) which, functionally is a Paramedic without perhaps four or five drugs and multi lumen airway rights.
I cannot afford time or money to spend another two years on education which will grant me maybe another $6000 in optimal conditions...there are none of those on my world.  I have eight years of university training, three degrees and I do not choose to drive two hours each way and spend time better spent in working getting the right to deliver five drugs which are rarely used (not to mention multi lumen airways, which have not been used in the field at least in recorded history).


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## NomadicMedic (May 2, 2015)

greenmountains said:


> It is?
> My state knows what is best?
> It does?
> I can think of dozens of reasons for intermediate steps between EMT B and EMT P, not the least of which is location, cost of education, cost of a EMT P and so on.
> ...




Yeah! More skills, less education!







(...The SVT patient will appreciate that you didn't think adenosine was important.)

Half assed ALS is a disservice to all; The patients who think they're getting a paramedic, and the "advanced EMT" who thinks they're just as good.


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## Ewok Jerky (May 2, 2015)

greenmountains said:


> I can think of dozens of reasons for intermediate steps between EMT B and EMT P, not the least of which is location, cost of education, cost of a EMT P and so on.



Holy necropost Batman!

So your reasons for the existence of AEMT all include YOUR inability to obtain a higher cert level and nothing to do with providing adequate patient care?


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## greenmountains (May 3, 2015)

Ewok Jerky said:


> Holy necropost Batman!
> 
> So your reasons for the existence of AEMT all include YOUR inability to obtain a higher cert level and nothing to do with providing adequate patient care?



Then logically, anything less than a physician board certified in emergency medicine should be on an ambulance, right?
I agree.  Paramedics provide inadequate patient care.
Your inability to go to medical school is just an excuse for your inability to provide adequate medical care.
To all who share this attitude, I encourage them petition their state legislature to eliminate anything short of Paramedic (or for that matter M.D) and have nothing else licensed or providing care pre-hospital.
After all, in the late 1800's physicians staffed ambulances.  There is no reason they could not do so again, right?
Yes, all the god-like paramedics need to go to medical school and stop giving inadequate care to your patients.  They deserve better than a professional certificate.
I further encourage all ambulance services to fire anyone who is not a paramedic and employ only paramedics.


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## NomadicMedic (May 3, 2015)

greenmountains said:


> Then logically, anything less than a physician board certified in emergency medicine should be on an ambulance, right?
> I agree.  Paramedics provide inadequate patient care.



You're either a troll or clueless. Based on the statements you made above, I'm leaning toward clueless...


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## greenmountains (May 3, 2015)

DEmedic said:


> You're either a troll or clueless. Based on the statements you made above, I'm leaning toward clueless...


Or logical perhaps.
I see no other option given the reasoning I have seen.
Hire only M.Ds or you are giving inadequate care.
(Alternatively, I am right.)


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## WildlandEMT89 (May 3, 2015)




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## PotatoMedic (May 3, 2015)

greenmountains said:


> Or logical perhaps.
> I see no other option given the reasoning I have seen.
> Hire only M.Ds or you are giving inadequate care.
> (Alternatively, I am right.)


I would love to have an MD or DO come to my door if I call 911!  You should start the trend and go to med school.


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## triemal04 (May 3, 2015)

I'm sorry, but when you feel the need to trumpet how you have 3 degrees and 8 whole years of "university training," and then follow it up with the nonsense you been spouting...doesn't say anything good about you.

I would strongly urge you to look into what an AEMT in Vermont (that is where you are, right?) can do compared to what a paramedic in Vermont can do.  Because right now it's clear that you haven't done that, or lack the requisite knowledge to understand what the differences between the two are, and why it matters.


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## Smitty213 (May 4, 2015)

As somebody who is currently certified and actively practicing at the AEMT level, I would greatly appreciate it if you could stop spouting some of the nonsense that gives us a bad rep in many systems to begin with, BEFORE you have even reached certification at the Advanced level. While I will say that in a highly rural system with long transports and limited access to Paramedic care, the AEMT can provide lifesaving "basic ALS" measures beyond the scope of most BLS providers _while transporting to intercept with a Paramedic, _we are NOT "...functionally [a] Paramedic without perhaps four or five drugs and multi lumen airway rights.". For starters, the education pales in comparison to that of most Medic programs (by close to 1000 hours of difference), I completed mine _in addition to_ an undergrad semester because my EMT card was up for recert and I figured it would help me when I entered PA school that fall; it is a stepping stone, not a stopping place. The medications most commonly found in an AEMT medication protocols are ASA, NTG, DuoNeb's, D50, D25, Glucagon, Narcan and Epinephrine's 1:1 & 1:10; this is approximately one pocket of most Paramedic drug bags. In the majority of states and EMS regions, the AEMT has no ability to very limited abilities to perform cardiac monitoring, and the corresponding amount of training in it; therefore we cannot pace or cardiovert, but those are just silly things that never get used right? As for airway management, my state/region allow me to do needle decompressions and intubate, however this is exceptionally uncommon and unpopular with National Registry, who favor the use of the King and Combi's by the AEMT, leaving intubation to Paramedics. I hope that I have managed to _*logical*_ (an ideal you seem endeared to) explanation of just some of the "minor" differences between an AEMT and a Paramedic; now if you could do us all a favor and stop embarrassing this profession by crawling back to the dark corners where you found this thread to begin with, myself and my fellow AEMT's would appreciate it. Good day to you sir.


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## Chris07 (May 4, 2015)

FireWA1 said:


> I would love to have an MD or DO come to my door if I call 911!



...if you think system abuse is bad now...just wait until people find out we're sending physicians to every 911 call!


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