# AEMT- Scope of practice issues



## Lil Medic (Feb 21, 2013)

So, I am currently undergoing the “new” national AEMT training and have a few things I would like comment on.

First, what is with the scope of practice? Pediatric IOs but no adult? It’s hard for me to see the reasoning behind that decision. (I’m from Oregon and that may just be the state's limits I haven’t checked, but the prior Oregon intermediate had way more skills than the AEMT does now [inculding Adult IOs] and with fewer lecture hours to boot so I doubt it.)

Or how about that we can hook up a 12 lead, but not interpret the results? Now this one is a little easier to grasp. My thoughts are that the basics were already doing this anyway so they figured they want to just make it apart of the advanced scope, and cardiac interpretation can be a little sticky at times, but honestly… if the AEMT is supposed to be the poor man’s paramedic as I think is what the point of it is. I think they might as well tack on the extra few weeks of cardiac monitoring. Half the class' curriculum is all review anyways. 25% of the time it feels like a basic class, so why not replace that basic refresher stuff that the whole class should be required to know before hand and apply that time to learning an additional skill that rural areas could actually benefit from? I suppose skill upkeep could be brought into question and how often they will actually use the skill, is it enough to keep it sharp? Thoughts on this would be great.

There's more scope issues but I'd like to focus on these two for now.

And finally, this isn’t related to the scope of practice, but I’m not really seeing any desire for AEMTs out there. Granted it's still in the "trial" process I think, but what are your opinions on whether or not people will start requesting AEMT’s as opposed to basics or medics? I can see it in hospitals because AEMTs can draw blood and start IVs (Which is fantastic) but how long until a real demand starts showing up in the field, if ever?


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## Shishkabob (Feb 21, 2013)

If you want to do Paramedic things, become A Paramedic.   An AEMT is what it is... An EMT with a little more education and a little more skills.

You won't see an increase in demand just like there really wasn't for Intermediates, which is what an AEMT is, but just does away with the I85 and I99 confusion.


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## rogersam5 (Feb 21, 2013)

I am an AEMT in Maine and can do a lot more then basics can, and at least a little more then the NR Scope (i don't really even know what the NR's scope is...)

Basics here can do little more then transport and take vital signs. An AEMT can handle most non-cardiac medical emergencies, and first-line trauma stuff. we have a handful of meds, cardiac monitoring, 12-lead acquisition (with add on training you sort of can interpret, but no cath-labs or anything), IVs, Adult and Pedi IO, BIADs... and some other stuff...

I am with you though and it doesn't really seem all that practical, most of the course is review (even with Maine's expanded scope)


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## Handsome Robb (Feb 22, 2013)

For what it's worth AEMTs are used plenty, just not everywhere. The agency I work for runs Medic/Intermediate (or AEMT for the purpose of this thread) or Medic/Medic. No EMT-Bs are allowed on ambulances in the county I work in unless an MCI has been declared and even then I've never seen or heard of an EMT-B on one of our trucks. 

12 lead interpretation is more than just a few hours spent on ECG interpretation...there's a lot more to them than just rhythm and "is there ST elevation?"

The beauty of teaching EMTs and AEMTs to place and capture 12-leads is that in those areas where medics are hard to come by, they can still capture a 12-lead immediately and transmit it to the ER for a physician to interpret. 

Pediatric vs Adult IOs...can't answer that one for you. 

As far as less skills with more class hours take a look at Australia, for example, their Paramedics have a university degree and have a smaller scope than American Paramedics, who generally only have a certificate or an AA/AS.


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## medictinysc (Feb 22, 2013)

AEMT's will have their place, but,  nothing will ever devalue a good street paramedic.  I work with a fellow that is going through the AEMT course now. Unfortunately the state I live in wont recognize the new skills.


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## SloEd (Feb 24, 2013)

In my state Advanced EMTs are allowed to do both adult and pediatric IOs. I think the purpose of NR testing with manual needles and a pediatric leg is that if you can do the ped manual IO you can for sure do the drill and adult IOs. The reverse doesn't apply. So, NR tests the hardest IO scenario and assumes you can do the easier IO scenarios.


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