# Anyone know if AEMT training exists in CA?



## Hotshot007 (Feb 29, 2012)

Hello all, I was wondering if there is anyone out there that knows of an Advanced EMT training course in CA. I checked the CA state EMSA website herehttp://www.emsa.ca.gov/personnel/EMT.asp#emt2 and found they have a section on it, but just not any resources on where you can take any classes for it, unlike paramedic and EMT courses which they have a detailed list of and when exactly each is expiring. 

Is it that that there are not any, or that it should be taken care of by your employer if at all, based on need, which in CA with the abundance of paramedics and proximity of hospital personnel whom go over and above these skills already, it's just not needed?

My own opinion is I would appreciate an AEMT course that would go more into depth on these subjects, especially going into more of the real impact, in terms of a pt's A&P, of these measures, because saying "You'll now more when you're a paramedic or nurse" gets real old. Yes, if I were in fact so inclined, I could probably look in a bunch of places and piece together from what the effect(s) would be under of these advanced measures, but I would prefer a uniform course that would build on my present knowledge and make the process flow easier and be more simple rather than having to cobble together the understanding from several not-easily transferable sources. Not to mention, while I do not plan on inserting any IV line unassisted within the near future, the specific understanding of what is going on could be very helpful for both me and my patient, for me furthering my knowledge, and for my pt., my understanding exactly what is going on allows me to anticipate problems and be ready to help with it. That's about all I can think of on the subject..


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## Amberlamps916 (Feb 29, 2012)

Not that I know of


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## JPINFV (Feb 29, 2012)

Hotshot007 said:


> Hello all, I was wondering if there is anyone out there that knows of an Advanced EMT training course in CA. I checked the CA state EMSA website herehttp://www.emsa.ca.gov/personnel/EMT.asp#emt2 and found they have a section on it, but just not any resources on where you can take any classes for it, unlike paramedic and EMT courses which they have a detailed list of and when exactly each is expiring.



http://www.emsa.ca.gov/personnel/files/EMT-I_II_P_MICN_Approved_Trng_Pgms.htm

Click on the AEMT tab at the bottom. Apparently there are only 3 current programs and 1 expired program in California. 


> Is it that that there are not any, or that it should be taken care of by your employer if at all, based on need, which in CA with the abundance of paramedics and proximity of hospital personnel whom go over and above these skills already, it's just not needed?



The history here is important. The AEMT level replaced the EMT-II (2) level on July 1, 2010. Prior to that, a county introducing the EMT-II/Limited Advanced Life Support (LALS) level had to show that the EMT-IIs were not going to displace paramedics. That, in addition to the numerous optional scope of practice tracks for EMT-Is (EMT-1, aka EMT-Bs) made almost all counties forgo recognizing EMT-IIs. The impression I get now, with the easing of the restrictions of AEMTs and the reduction of optional scope of practice packages for EMTs, that some counties are looking at AEMTs as a replacement for EMTs in contrast to the more traditional view that AEMTs would be replacing paramedics.


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## CodyVector (Jul 23, 2014)

That link is a dead link.


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## NomadicMedic (Jul 23, 2014)

CodyVector said:


> That link is a dead link.




It's over 2 years old. http://www.emsa.ca.gov/EMT


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## DesertMedic66 (Jul 23, 2014)

There really is not any AEMT classes in CA because they are not used. 

NCTI held a AEMT class with a focus on tactical medicine about a year or so ago.


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## avdrummerboy (Jul 23, 2014)

Only place that I ever heard of that did one, and this was our ICEMA inspector telling me this, was the SBDCoSD training center having one for their SAR guys.


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## JPINFV (Jul 23, 2014)

CodyVector said:


> That link is a dead link.



Not when it was posted.


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## CodyVector (Jul 25, 2014)

*A-EMT in california*

Some counties seem to use it. There are requirements on the California Gov website, but it isn't used? That doesn't make any sense.


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## DesertMedic66 (Jul 25, 2014)

CodyVector said:


> Some counties seem to use it. There are requirements on the California Gov website, but it isn't used? That doesn't make any sense.



The general rule in California is that if it has to do with EMS, it doesn't make sense.


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## CodyVector (Jul 25, 2014)

That's a drag, as EMT-A would be a good qual to move from BLS unit to an ALS unit.


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## avdrummerboy (Jul 26, 2014)

I don't know, but with the min wage increases, you might see a few places start to reconsider getting up to speed on LALS and therefore getting some local colleges and schools on board with training. It's cheaper than dual ALS rigs.


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## CodyVector (Jul 26, 2014)

*Als emt (emt-a)*

Sounds logical to me. Well, we should start pushing for it in California. Way more cost effective, not to mention a good stepping-stone for Medic. Not reason not too. Besides EMT/Paramedic riggs should have AEMT's as drivers/assist Paramedic, and BLS units could have an AEMT as lead-EMT.
Maybe NAEMT will/can lobby for it's implementation in CA.


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## DesertMedic66 (Jul 26, 2014)

CodyVector said:


> Sounds logical to me. Well, we should start pushing for it in California. Way more cost effective, not to mention a good stepping-stone for Medic. Not reason not too. Besides EMT/Paramedic riggs should have AEMT's as drivers/assist Paramedic, and BLS units could have an AEMT as lead-EMT.
> Maybe NAEMT will/can lobby for it's implementation in CA.



There really isn't a stepping stone needed from EMT to medic. And with AEMT not a whole bunch gets added to your scope. 

Why pay for an AEMT wage to have them be a driver when you can pay an EMT wage?

BLS is BLS not ILS. Why have an AEMT be a lead EMT (if your a lead EMT you can only act to the EMT level). That's kind of like saying your an RN but you are a lead LVN.


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## CodyVector (Jul 27, 2014)

*AEMT discussion cont.*

Interesting points. On the state EMS website there is a way to look at AEMT's 'recognized' in California. Most of the active AEMTs are certified in counties that are rural (Far north NorCal, eastern Inland County EMS authority ext). Maybe it's more useful in the rural setting. Thoughts?


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## DrankTheKoolaid (Jul 28, 2014)

Majority of aemt (EMT 2). Are volunteer


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## Akulahawk (Jul 28, 2014)

CodyVector said:


> Interesting points. On the state EMS website there is a way to look at AEMT's 'recognized' in California. Most of the active AEMTs are certified in counties that are rural (Far north NorCal, eastern Inland County EMS authority ext). Maybe it's more useful in the rural setting. Thoughts?


I've met a few EMT-II's (now AEMTs) over the years in California and they were all from those rural counties. They said it was more cost-effective to have a LALS truck in certain areas instead of a full-up ALS truck. I suppose the idea was that the LALS folks could handle the majority of the calls and those few they couldn't, they'd be able to call for an air asset to fly a Paramedic in. 

As a Paramedic, I would love to have some extra hands that can do some ALS interventions under/at my direction.


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## chaz90 (Jul 28, 2014)

Akulahawk said:


> As a Paramedic, I would love to have some extra hands that can do some ALS interventions under/at my direction.



Or at least the occasional IV...how I miss thee, Colorado EMT-IV.


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## DesertMedic66 (Jul 28, 2014)

chaz90 said:


> Or at least the occasional IV...how I miss thee, Colorado EMT-IV.



That's one of the nice things about having more than 1 medic on scene


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## CodyVector (Jul 29, 2014)

*AEMT discussion cont.*

Well, after I revert basic this year AEMT cert will be my next goal. I believe in progressive learning.
I hope California adopts it, as everything i've read indicates a need/use/advantage of having LALS providers at a fraction of the cost and time of going through full blown paramedic school.


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## NomadicMedic (Jul 29, 2014)

CodyVector said:


> Well, after I revert basic this year AEMT cert will be my next goal. I believe in progressive learning.
> 
> I hope California adopts it, as everything i've read indicates a need/use/advantage of having LALS providers at a fraction of the cost and time of going through full blown paramedic school.




I don't believe it's progressive learning. I believe it's a patchwork of skills, without the true education necessary to make critical thinking behind those skills valid. Fewer ALS providers means that ALS is used only when it's truly needed. ALS providers will see more sick patients, and have more opportunities to perform ALS interventions.

It's my belief that there should be two levels of certification. 

EMT – A, a provider who functions as an ambulance attendant and receives training more closely aligned with that of a CNA. These providers would not routinely respond alone to an emergency, but would be utilized to transport non-acute patients and interfacility calls

Paramedic. A degreed professional who is able to provide emergency care and treatment to sick and injured people. These professionals would work with the EMT-A to provide care to acutely ill patients or provide advanced care during interfacility transports. 

That's it. Two levels of care.


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## medicdan (Jul 29, 2014)

DEmedic said:


> I don't believe it's progressive learning. I believe it's a patchwork of skills, without the true education necessary to make critical thinking behind those skills valid. Fewer ALS providers means that ALS is used only when it's truly needed. ALS providers will see more sick patients, and have more opportunities to perform ALS interventions.
> 
> It's my belief that there should be two levels of certification.
> 
> ...



I agree with your vision for fewer ALS providers to maintain skills, but perhaps see the world differently. The recent EMS managers I've spoken with have quoted that 70-80% of their emergency volume is BLS-- that is, mechanical falls, psych /EDPs and the like. EMD protocols have gotten sensitive and specific at identifying which patients may require advanced assessment and treatment but there is an important role for BLS providers in 911. 

Every system is different, I understand that, but I think you need to consider the important role BLS has for 911, even of only first response before ALS (and beginning to transport for an intercept).

I am really intrigued by the AEMT level-- I like the emphasis on pathophysiology, and think the skills are reasonable without diluting the skills of paramedics. I still want to see them in action, and think the best place to start is as partners to senior paramedics. This allows for skill and assessment development under an (experienced) preceptor and more skilled assistant than PB of the defecation hits the ventilation (while waiting for a second paramedic). 
I would love to see AEMT EMD guidelines, I'm not sure i understand how AEMT vehicles are dispatched.


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## NPO (Jul 30, 2014)

It might be nice to consider AEMT for use like many places use EMT-D, EMT-IV, EMT-AA etc. Allow EMT B to staff BLS units but require an AEMT to partner with a medic. My system uses single medic units so having an EMT with a larger scope would be nice, IVs monitors etc. Even if you don't want an EMT interpreting, there are systems who allow EMTs to hook up, acquire and transmit. Just done simple stuff to take tasks off of the medics shoulders. 

I used to work for an IFT company who required additional training and testing to show competence to staff a CCT unit exclusive for acute strokes and STEMIs. Obviously didn't expand your scope just made sure you knew how to do the things that feel under the "Set up ALS procedures" in the policies and understand things like basic rhythms, 12 lead set up, etc


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## NPO (Jul 30, 2014)

DEmedic said:


> I don't believe it's progressive learning. I believe it's a patchwork of skills, without the true education necessary to make critical thinking behind those skills valid. Fewer ALS providers means that ALS is used only when it's truly needed. ALS providers will see more sick patients, and have more opportunities to perform ALS interventions.
> 
> It's my belief that there should be two levels of certification.
> 
> ...


I want to disagree. I'm not saying you're view doesn't have merit but I don't like the idea of the desperity between the two. I counter propose a third level. Similar to AEMT.

Make EMT B uncommon and used for like you suggest but maintain some emergency care skills nessicary for immediate life threats. Perfect for rural fire Dept, volly Dept's, IFT and non-emergency medical transport (gurney van).

The AEMT would be as common as EMTB is today, but a slightly higher scope to assist the medic. Keep in mind I'm basing this off of CA EMT scopes. 

I would even like to consider options to raise the paramedic level of care, including a degree as you suggest. 

In my perfect world.


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## JPINFV (Jul 30, 2014)

The problem with AEMT is how it's used. Used as an EMT++, then it's great. Utilized as a lightweight, quasi-paramedic? Problematic. The problem is that it's more likely to be used as the latter than anything else.


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## EMTGuide (Aug 4, 2014)

I'm going to echo others sentiments. It is really about the need for the community of employers in a given area. Care level will depend upon demand and other choices. Larger cities are not going to need this level of care and that is why you hardly see training options for it in California.


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## MrJones (Aug 4, 2014)

As an interesting (at least to me) aside, you'll note that the overwhelming majority of those who think AEMT is a good idea are EMTs, while the overwhelming majority of those who don't are Paramedics. 

Why do you reckon that is? I have my (typically cynical) opinion, but I'm interested in what others think.


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## NomadicMedic (Aug 4, 2014)

Because EMTs believe with some extra training they can do it all and medics realize that even with medic school behind us, we're still woefully under educated?


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## DesertMedic66 (Aug 4, 2014)

DEmedic said:


> Because EMTs believe with some extra training they can do it all and medics realize that even with medic school behind us, we're still woefully under educated?



This sums it up very well


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## MrJones (Aug 4, 2014)

DEmedic said:


> Because EMTs believe with some extra training they can do it all and medics realize that even with medic school behind us, we're still woefully under educated?



That's a very tactful way of expressing what I was thinking. Much more so than I would have been able to come up with.


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## CodyVector (Feb 27, 2017)

Time to revisit this thread. Despite some interesting ideas on here, and years passing, my opinion hasn't changed. 
AEMT training should be more prevalent. AEMT's can drop IV's, that's one less thing my partner has to do while juggling swords and torches. 
It would make a good stepping-stone on the way to Medic.
Crawl, Walk, Run, Fly.


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## CALEMT (Feb 27, 2017)

A 3 year dormant period. Impressive, at least you were in the initial discussion and not some new guy doing a necro thread bump.


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## DesertMedic66 (Feb 27, 2017)

You could have went through 3 paramedic programs in that 3 years...


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## CodyVector (Feb 27, 2017)

CALEMT said:


> A 3 year dormant period. Impressive, at least you were in the initial discussion and not some new guy doing a necro thread bump.


Yep. Still stuck in the same mode of frustration I've experienced so many times in life. Coming back to the same self-evident conclusions; conclusions people, simply out of human nature, resist because of the ego's defense against change.


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## CodyVector (Feb 27, 2017)

DesertMedic66 said:


> You could have went through 3 paramedic programs in that 3 years...


Not really. I'm an Executive Protection Agent, and have other vocations and avocations.


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## GMCmedic (Feb 27, 2017)

I realize this is an old thread but since im here and its bumped. 

I worked in a system that had AEMT's and protocols for them to use. That was great, except, I have no idea what their scope of practice is because i was never an AEMT. 

There are two types of patients. ALS and BLS. Imagining a 3rd type that I shall refer to as "Not quite ALS", seems like the answer to a question nobody asked.


As an EMT I once made the argument that if we could start IVs we could help our medic out. That was a stupid argument.

In reality juggling swords and torches while starting IV's isnt that hard.


Sent from my SAMSUNG-SM-G920A using Tapatalk


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## CodyVector (Feb 27, 2017)

GMCmedic said:


> I realize this is an old thread but since im here and its bumped.
> 
> I worked in a system that had AEMT's and protocols for them to use. That was great, except, I have no idea what their scope of practice is because i was never an AEMT.
> 
> ...


Meh. Progressive learning is just common-sense. If AEMT is "just a mishmash of skills" then it probably needs to be refined, and more well thought-out. California doesn't want to use it because California's rulers are narcissistic tyrants who are also know-it-alls, but I digress. There is no reason why an ALS EMT couldn't be an AEMT and help his Medic out a bit more while practice the art of prehospital medicine at a slightly higher level.


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## NomadicMedic (Feb 27, 2017)

I actually enjoy having an AEMT as a partner. An extra set of hands to perform skills is nice, and it leaves me time to do my paramagic while he gets the IV. 

But AEMT as "the als provider" on an ambulance. Nope.


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## hometownmedic5 (Feb 28, 2017)

AEMTs bring nothing critical to the table, plain and simple. Sure, its nice to have a partner you can delegate responsibilities too, but they don't have enough ALS skills to justify the rank. I guess I would rather have an A over a B as a partner if I couldn't work with a medic, but not by so much as to justify mandating their existence.

AEMTs were created as a stop gap measure for services that couldn't afford paramedics so that they could call themselves (and bill for) ALS services. They continue to exist for the same reason. I'm in no way saying they're valueless. What I'm saying is that their value is limited.

I agree with the nomad. An A in a P/A configuration, winning. B/A, unless you're working in a system where the medics exist, are coming, and will actually get there; all you're doing is pretending your ALS and that's not good medicine. Ive seen systems where the medics are intercept only, spread too thin, and are most likely not going to get anywhere in time to actually intervene in the patients status in a positive manner; but on paper they look good so the powers that be call it a working system.


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## VentMonkey (Feb 28, 2017)

hometownmedic5 said:


> Ive seen systems where the medics are intercept only, spread too thin, and are most likely not going to get anywhere in time to actually intervene in the patients status in a positive manner; but on paper they look good so the powers that be call it a working system.


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## CodyVector (Feb 28, 2017)

NomadicMedic said:


> I actually enjoy having an AEMT as a partner. An extra set of hands to perform skills is nice, and it leaves me time to do my paramagic while he gets the IV.
> 
> But AEMT as "the als provider" on an ambulance. Nope.


Agreed. IMHO the EMT-Paramedic should remain the ALS provider, above all. But that is no reason to hamstring yourself by nerfing the EMT.


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## NomadicMedic (Feb 28, 2017)

CodyVector said:


> Agreed. IMHO the EMT-Paramedic should remain the ALS provider, above all. But that is no reason to hamstring yourself by nerfing the EMT.



Is that english?


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## DesertMedic66 (Feb 28, 2017)

NomadicMedic said:


> Is that english?


I'm not sure


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## EpiEMS (Mar 1, 2017)

CodyVector said:


> Agreed. IMHO the EMT-Paramedic should remain the ALS provider, above all. But that is no reason to hamstring yourself by nerfing the EMT.



Tightening or restricting the scope of the EMT isn't exactly the issue here.


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## CodyVector (Mar 21, 2017)

Well, we've come full circle. Back to the original question; "Is there any AEMT training in California"


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## VentMonkey (Mar 21, 2017)

CodyVector said:


> "Is there any AEMT training in California"


"No."


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## hometownmedic5 (Mar 21, 2017)

Is google down for maintenance?

California is a big state. Perhaps the class is offered somewhere in the state, but i(we) have no way of knowing where you are, how far you're willing to travel, what your availability is, what you're willing to pay, and probably a dozen other factors. 

If you're in San Diego and theres a class in Mendocino, is that going to work for you? I doubt it, and whomever went to the trouble of finding that class for you is never going to see a return on their investment.

All of these questions can be answered by you, along with finding the information you seek by yourself. Go forth and research.


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## VentMonkey (Mar 21, 2017)

I think I still like my answer better. I even put it in quotations.


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## hometownmedic5 (Mar 21, 2017)

Your answer was definitely on point, and with an admirable economy of words.


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## VentMonkey (Mar 21, 2017)

hometownmedic5 said:


> Your answer was definitely on point, and with* an admirable economy of words*.


I am quite _frugal_ with my vocabulary.


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## TransportJockey (Mar 22, 2017)

CodyVector said:


> Well, we've come full circle. Back to the original question; "Is there any AEMT training in California"


Yes. Paramedic. Compared to a lot of the us, is right at aemt 

Sent from my SM-N920P using Tapatalk


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## VentMonkey (Mar 22, 2017)

TransportJockey said:


> Yes. Paramedic. Compared to a lot of the U.S., is right at aemt


Sad, but true.

http://file.lacounty.gov/SDSInter/dhs/207171_ParamedicInfoSheet8-15-2016.pdf


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## CodyVector (Mar 24, 2017)

VentMonkey said:


> "No."



Ive searched off & on for years, high & low... the only program I ever found was at EMSTA in San Diego county, and then it was primarily for Border Patrol Agents with some extra seats...

Practically speaking, the answer is indeed "No."


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## Jim37F (Mar 24, 2017)

CodyVector said:


> Ive searched off & on for years, high & low... the only program I ever found was at EMSTA in San Diego county, and then it was primarily for Border Patrol Agents with some extra seats...
> 
> Practically speaking, the answer is indeed "No."
> 
> ...


Out of sheer curiosity I looked at their course catalog, only EMT Basic and Paramedic are listed, so it looks like AEMT has gone the way of the dodo bird...


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## DesertMedic66 (Mar 24, 2017)

Around 3-4 years ago NCTI in riverside offered a AEMT class for one time only haha


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## CodyVector (May 3, 2017)

CodyVector said:


> Ive searched off & on for years, high & low... the only program I ever found was at EMSTA in San Diego county, and then it was primarily for Border Patrol Agents with some extra seats...
> 
> Practically speaking, the answer is indeed "No."
> 
> ...



-Thanks for this link. Co-incidentally this was the local community college near Redondo Beach, where I grew up. I may actually do this program! 
Thanks again 


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## CodyVector (May 3, 2017)

VentMonkey said:


> Sad, but true.
> 
> http://file.lacounty.gov/SDSInter/dhs/207171_ParamedicInfoSheet8-15-2016.pdf



I meant THIS link. 
Cheers


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## Agg04 (May 8, 2017)

When I first started pursuing this career field I was shocked on how different it can be according to the area, not just the state. Here in South Florida its unheard of to me of any AEMT's or even EMT's who have an IV cert. Its either EMT-B or Paramedic. Simple as that. Now I'm looking into moving to Denver and a lot of jobs require different things compared to South Florida. Down here you will never see a job posting for AEMT or an IV cert. Paramedics are very common down here just because getting a job as an EMT-B isn't worth it or damn near impossible to find a good one. Also just to add in there I have not heard of a department or company thats runs strictly just a BLS unit down here, everything seems to be ALS. But as I was looking at jobs in Denver it seems like they are looking for a lot more Medics than they are EMT's. And if they are looking for an EMT, from what i have seen, they almost always require an IV cert. Which tells me that they are over saturated with EMT's and not paramedics (all speculation of course) and in Florida there is a over saturation of both. I did notice that getting into a Medic program is harder than any of the ones in my area, judging from the ones I looked at. Requiring pre reqs such as Anatomy and Physiology, Biology etc. (something like that). Which looks like it causes a lot more job openings for paramedic that way than it does in South FL. But down here all I need is my Florida state license from EMT to get into the program. I know at least the program that i plan on attending for medic is very rigorous and usually have a quite a few drop outs. It interests me how different some areas are compared to others.


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## Brydandon (May 1, 2020)

My grandmother said that this was the same exact argument they had with the job of Nurse.

Before there was the one title of Nurse that ruled Queen of the hospital setting, now the title Nurse has a good number of sub-branches, LVN/LPN, RN, BSN, Nurse Practitioner, etc. Even succumbing to the rise of the Physicians Assistants... Which is the job description of the Original Nurse.

So far the inevitable split has happened to Paramedic ruling King of the prehospital setting; EMR, EMT, AEMT, EMT-P, CCT, and in some countries Emergency Care Practitioner.

Hate it or Love it its happened. Why not work with it instead of against it?

Take this Corona pandemic for example, it takes 350 extra hours on top of EMT to become an AEMT in most states. Think about it on a level of time constraints and places needing a more fast track bridge to some limited ALS skilled personnel vs time a governing body doesn't have to train individuals for years in Paramedic school during a pandemic or terrorist attack.

Its just hands down a game changer to have AEMT education available, especially during times of mass crisis, when you need EMTs able to push IVs, Etc. asap.


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## Seirende (May 1, 2020)

CALEMT said:


> A 3 year dormant period.



I'm sensing a pattern.


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## Akulahawk (May 2, 2020)

Brydandon said:


> Take this Corona pandemic for example, it takes 350 extra hours on top of EMT to become an AEMT in most states. Think about it on a level of time constraints and places needing a more fast track bridge to some limited ALS skilled personnel vs time a governing body doesn't have to train individuals for years in Paramedic school during a pandemic or terrorist attack.
> 
> Its just hands down a game changer to have AEMT education available, especially during times of mass crisis, when you need EMTs able to push IVs, Etc. asap.


Actually, the AEMT is more a cost-saver post for employers and/or communities that find having Paramedic services too expensive. Paramedic training can be done in about 6 months, though it is usually done over 1-2 years. AEMT training can be done much faster than that but the education the AEMT gets is quite limited compared to what a Paramedic gets. The best utilization of an AEMT, in my opinion, is to act as another set of "trained hands" for a Paramedic. When with a Paramedic, the AEMT usually has a wider scope than when they're not simply because it's the Paramedic deciding what needs to be done or not. In any very large scale incident, often the level of transport provider is less important than simply having transport. It's when local resources become too impacted to function that things start getting truly bad because they've been completely overwhelmed.  


Seirende said:


> I'm sensing a pattern.


Perhaps a 2-3 year pattern...


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## hometownmedic5 (May 2, 2020)

Brydandon said:


> Its just hands down a game changer to have AEMT education available



The only time Intermediate/Advanced was a game changer was when "they" figured out they could hire I's, pay them much less than basics, and still get to bill ALS, and paint it on the side of the truck. If it was the revolutionary EMS cert you make it out to be, you wouldn't have to look so hard to find a course to get the card.

That level of EMS cert has always been and will always be a half measure designed and supported for the express purpose of increasing billing rates. The minimal skill set increase over BLS doesn't justify the time and expense to get the training. As it stands now, Basics in even some of the most outdated EMS states has largely caught up to I/A level; and if the COVID protocol waivers stick, there won't be more than an inch of daylight between a B and an A in Massachusetts.


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## NomadicMedic (May 2, 2020)

We use AEMTs as a force multiplier. We have moved the majority of our paramedics back to fly cars and we staff ambulances with basics/AEMTs.

The vast majority of calls dispatched as ALS can be effectively and safely managed by an AEMT.

Id rather have fewer, better trained paramedic that I can pay more, than a cadre of mediocre medics, just because we want (or need) to staff every truck to the paramedic level.


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## MonkeyArrow (May 2, 2020)

NomadicMedic said:


> The vast majority of calls dispatched as ALS can be effectively and safely managed by an AEMT.


Does your system allow AEMTs to interpret 12 leads?


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## NomadicMedic (May 2, 2020)

MonkeyArrow said:


> Does your system allow AEMTs to interpret 12 leads?



No, very few places do. But if a medic arrives and gives it a look and it’s not an acute STEMI, hey can downgrade to an AEMT. Also, an A can transmit a 12 and transport, starting a line and giving NTG and ASA if there is no medic available.

As an example, a patient presented at urgent care with chest pain, hx of PE. 12 lead non diagnostic. Patient was stable and I downgraded to the AEMT. Totally appropriate. 

If you “what if” every call, you have paramedics transporting lots of low acuity calls and wasting your resources. 

I’d love to see basic EMT eliminated and AEMT the entry point for any 911 response.


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## MonkeyArrow (May 2, 2020)

NomadicMedic said:


> If you “what if” every call, you have paramedics transporting lots of low acuity calls and wasting your resources.


I wasn’t suggesting that. My main question was that you have paramedics dispatched to every chest pain call and they still assess the patient and then can make a determination to allow the A to transport? AEMTs aren’t getting dispatched to chest pain type calls alone?


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## Jim37F (May 2, 2020)

In any case, I don't think too many people are dying from Corona because they spent a few minutes in a BLS ambulance vs an ALS one...


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## NomadicMedic (May 2, 2020)

MonkeyArrow said:


> I wasn’t suggesting that. My main question was that you have paramedics dispatched to every chest pain call and they still assess the patient and then can make a determination to allow the A to transport? AEMTs aren’t getting dispatched to chest pain type calls alone?



Gotcha. I'm so used to fighting off the "what if" doomsayers, I'm a little reactionary.

We don't have AEMT, or as we call them here "intermediate", dispatch criteria. It's been an ongoing project for our regional medical director, but C19 put a crimp in that. The expectation is that strokes, diabetics, mild allergic reactions and the like will be an Intermediate level dispatch. Our As now carry Epi 1:10 for arrests, Zofran, Benadryl and Toradol along with the legacy AEMT meds. They can do quite a bit on thier own. Having them start working an arrest with an SGA and IO placed and an Epi on board before the medic arrives makes life so much easier.

We still send a Paramedic to every ALS call, but if it's one of our guys, we're downgrading most of the "ALS lite" calls to the As. If we arrive simultaneously, we usually let the A lead the call until they need help or until they've got it and don't need a medic. Of course, some As are more competent than others so we're reviewing every Paramedicv to AEMT downgrade chart.

This summer I plan to run 8 of our current EMTs through the A program. I think they'll do well.


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## Akulahawk (May 2, 2020)

NomadicMedic said:


> I’d love to see basic EMT eliminated and AEMT the entry point for any 911 response.


If you've got a non-tiered system, and your system won't support P/P 911, I absolutely agree with this. In a tiered system, you could do E/E, E/A, A/A, P/P or P-fly car and be able to handle most call types very effectively and efficiently. I would prefer E/A or (better) A/A staffing for the lower tier of 911. A's can handle most of the stuff we get around here. Then with fewer P's, we can train them to a very high level and utilize them on those calls where they'd be most useful/helpful.


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## NomadicMedic (May 2, 2020)

Part of the rationale for moving medics off ambulances is because my service does a mix of 911 and ift. The ift is all BLS and it makes no sense to pay a paramedic to chauffeur a basic around on a bunch of hospice or SNF transfers. 

The goal is to move to basics on a mostly transfer truck that will occasionally get a 911call. AEMTs and a basic on the primary 911 trucks that will get the occasional ift. Paramedics in fly cars covering a larger area and only riding on calls that need paramedic level care. 

Making sure the medics don't get lazy and downgrade everything is where the QM is important.


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## DesertMedic66 (May 2, 2020)

NomadicMedic said:


> Part of the rationale for moving medics off ambulances is because my service does a mix of 911 and ift. The ift is all BLS and it makes no sense to pay a paramedic to chauffeur a basic around on a bunch of hospice or SNF transfers.
> 
> The goal is to move to basics on a mostly transfer truck that will occasionally get a 911call. AEMTs and a basic on the primary 911 trucks that will get the occasional ift. Paramedics in fly cars covering a larger area and only riding on calls that need paramedic level care.
> 
> Making sure the medics don't get lazy and downgrade everything is where the QM is important.


I think this would be the only type of system that would make me give up my flight job as long as the pay and benefits were good.


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## VentMonkey (May 2, 2020)

NomadicMedic said:


> Part of the rationale for moving medics off ambulances is because my service does a mix of 911 and ift. The ift is all BLS and it makes no sense to pay a paramedic to chauffeur a basic around on a bunch of hospice or SNF transfers.
> 
> The goal is to move to basics on a mostly transfer truck that will occasionally get a 911call. AEMTs and a basic on the primary 911 trucks that will get the occasional ift. Paramedics in fly cars covering a larger area and only riding on calls that need paramedic level care.
> 
> Making sure the medics don't get lazy and downgrade everything is where the QM is important.





DesertMedic66 said:


> I think this would be the only type of system that would make me give up my flight job as long as the pay and benefits were good.


Same.


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## NomadicMedic (May 3, 2020)

I’m not at the point where I’d recruit anyone I like and respect to this job... but give me a few years.


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## VentMonkey (May 3, 2020)

NomadicMedic said:


> I’m not at the point where I’d recruit anyone I like and respect to this job... but give me a few years.


No need. Just clone yourself and apply at different services throughout the nation. Win/ win.


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