# Emt advance?



## rescu (Dec 1, 2011)

Just a few questions about indiana's ems system.

I just received my EMT-Advanced from indiana about a month ago, I know the basic stuff added to my level as iv'sm basic cardiac monitoring, sugar checks and stuff like that but is there any place that has a more detailed scope of practice? 

My employer is doing research and my instructor is having trouble as well what the entire scope consist of. Can I transport more antibiotics, more fluids of different types, some people tell me I can push epi and nitro. 

Can some people clear this up, the state has yet to return my calls.

Thanks


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## pa132399 (Dec 1, 2011)

well this sounds like the advanced emt wasnt well thought out. if the person who just completed the course cant figure out what is in there scope of practice and they just finished the course. hopefully some light will get shed on this level of certification soon.


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## rescu (Dec 1, 2011)

You obviously did not fully read into the post.

I'm looking for things like fluid levels that can be transported and the like, the website has the basic information on indiana ems. The advanced emt level is very confusing even to the indiana ems commision, after talking with them they were not 100 percent sure on the EXACT scope. So the confusion goes well above our level. But thanks for the helpful input.


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## Anjel (Dec 1, 2011)

rescu said:


> You obviously did not fully read into the post.
> 
> I'm looking for things like fluid levels that can be transported and the like, the website has the basic information on indiana ems. The advanced emt level is very confusing even to the indiana ems commision, after talking with them they were not 100 percent sure on the EXACT scope. So the confusion goes well above our level. But thanks for the helpful input.



Well did you learn fluid levels in class? About the different antibiotics in question? If you didn't learn it you probably can't do it. 

I'd just wait to hear from the state. That is the only way you are going to get 100% accurate info. not off some internet forum.


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## Nervegas (Dec 1, 2011)

rescu said:


> You obviously did not fully read into the post.
> 
> I'm looking for things like fluid levels that can be transported and the like, the website has the basic information on indiana ems. The advanced emt level is very confusing even to the indiana ems commision, after talking with them they were not 100 percent sure on the EXACT scope. So the confusion goes well above our level. But thanks for the helpful input.



Fluid levels? I guess I am confused as to what exactly that term means. Are you referring to a 500cc vs 1000cc NS bag or more along the lines of D5W vs NS vs LR? And to be frank, I wouldn't do anything outside of the basic scope until you have spoken to a representative from whoever governs EMS in your state as to what exactly you are legally allowed to do or not, plus be in contact with the medical director to clarify as well, is your scope not listed in the protocols?


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## emt11 (Dec 2, 2011)

I'm confused in this totally. Does your state NREMT or is it state certification? I know for a fact that GA(my state) already has a full scope listed on the state's ems website. Honestly, I'm not sure what NREMT has as far as a national scope, or even if testing for NREMT is open for AEMT's.

From reading your post again, it sounds like your talking about a specific state level cert. and not NREMT's AEMT. Please, do correct me if I'm wrong.


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## Handsome Robb (Dec 2, 2011)

Straight from the NREMT website.... Description of Advanced EMT begins on page 25.

https://www.nremt.org/nremt/downloads/Scope of Practice.pdf

You're welcome.


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## pa132399 (Dec 2, 2011)

sorry if i came off kind of confused but this whole advanced emt seems like a giant cf. they keep pushing that its coming in pa but so far the only one area that has it is sullivan county and its the test pilot. its not really meant for suburban areas and i work in a city so we will never see it unless they start to do an aemt, medic on a truck. i would like to see what the finished product would be but it seems that they need to either start a fire under someones a** to get it going or its just never going to take off.


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## 18G (Dec 2, 2011)

How can you be an Advanced EMT and not know what your scope of practice is? And further, why would your instructors and superiors be clueless as to your scope of practice? The scope of practice should be very simple to find out and should be posted on your State EMS offices website. Or if you call your state EMS office I'm pretty sure someone will be able to direct you to your scope of practice pretty quickly. 

I would be a little afraid of taking care of patients when you have no clue what your allowed to do. So someone is telling you that you can give epi and NTG? What if you have a patient that should get NTG but you don't give it because your not sure that your allowed to? That's just craziness.

And just to point out, the NREMT DOES NOT create your scope of practice. Your state does that.


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## emt junkie (Dec 2, 2011)

18G said:


> And just to point out, the NREMT DOES NOT create your scope of practice. Your state does that.



Or Your Medical Dir. depending on what state your from.


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## usafmedic45 (Dec 2, 2011)

pa132399 said:


> well this sounds like the advanced emt wasnt well thought out. if the person who just completed the course cant figure out what is in there scope of practice and they just finished the course. hopefully some light will get shed on this level of certification soon.



It was not.  Welcome to Indiana.   We were supposed to upgrade the Advanced EMTs to EMT-I/99 a few years back and instead they just created another level for that.  


To the OP, the protocols are going to vary somewhat between services.  Talk to whatever service you affiliated under and you should be given a copy of the protocols.  Luckily, Indiana does not have statewide mandatory protocols. 



> Your state does that



Nope.  Literally there's a statute (or was, the last time I checked was several years ago) here that says at the ALS (paramedic) level that providers can do whatever there medical director says they can do so long as he can prove they are reasonably trained for it.  Illinois used to have a similar loophole for all levels of EMS provider.  It's definitely a coastal habit to have the locked in, no variability statewide protocol.


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## Handsome Robb (Dec 2, 2011)

18G said:


> And just to point out, the NREMT DOES NOT create your scope of practice. Your state does that.



I'm not stupid. I simply pointed out a model of an AEMT scope of practice as presented by the NREMT. Don't be so grouchy, it's a beautiful day!


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## Tigger (Dec 2, 2011)

NVRob said:


> I'm not stupid. I simply pointed out a model of an AEMT scope of practice as presented by the NREMT. Don't be so grouchy, it's a beautiful day!



The NREMT is stupid for calling that document a scope of practice. I know they say it's a "model" but that is just creating unnecessary confusion. A national standard curriculum would have been a better choice.


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## Handsome Robb (Dec 2, 2011)

Tigger said:


> The NREMT is stupid for calling that document a scope of practice. I know they say it's a "model" but that is just creating unnecessary confusion. A national standard curriculum would have been a better choice.



Now you're just being nit-picky. Curriculum implies educational standards, which that document doesn't go into detail about so personally I'd say model fits just fine.

I'll agree to disagree though.


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## 18G (Dec 2, 2011)

NVRob said:


> I'm not stupid. I simply pointed out a model of an AEMT scope of practice as presented by the NREMT. Don't be so grouchy, it's a beautiful day!



I wasn't thinking you were stupid at all. The NREMT is only a testing organization. They don't even present a scope of practice. They test on objectives given to them. They don't create their own.


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## Handsome Robb (Dec 2, 2011)

18G said:


> I wasn't thinking you were stupid at all. The NREMT is only a testing organization. They don't even present a scope of practice. They test on objectives given to them. They don't create their own.



Gotcha. Sorry for calling you grouchy.


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## 18G (Dec 2, 2011)

NVRob said:


> Gotcha. Sorry for calling you grouchy.



It's cool.. actually I am grouchy. After working overnight last night and doing an almost 7hr round trip and than on the way back we were sent to transport a patient to Wash, DC which was about a 4hr round trip... and I was only able to sleep for about two hours when I got home... so yeah... lol.


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## rescu (Dec 3, 2011)

*emt a*



pa132399 said:


> sorry if i came off kind of confused but this whole advanced emt seems like a giant cf. they keep pushing that its coming in pa but so far the only one area that has it is sullivan county and its the test pilot. its not really meant for suburban areas and i work in a city so we will never see it unless they start to do an aemt, medic on a truck. i would like to see what the finished product would be but it seems that they need to either start a fire under someones a** to get it going or its just never going to take off.



Your exactly right the training in class is very straight forward however there are gray areas and those are what confuses me. The nremt has a different scope than the state of indiana but indiana is transitioning names at this time which confuses me. I will not use this is a confident answer for my practice however I needed some input which I've called several agencies which keep pushing me from place to place. 

State ems website gave simple answers but nothing solid. We were taught io's and ej's as well as various drug facts but those are not within scope according to state so its very confusing. Thanks for all the inputs though.


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## usafmedic45 (Dec 3, 2011)

> Does your state NREMT or is it state certification?



State certification at all levels but only at the paramedic level (and maybe the intermediate level) are the NREMT exams utilized. All states have their own certification, it's just a matter of whether they rely on NREMT to provide the testing materials, etc. 



> The nremt has a different scope than the state of indiana but indiana is transitioning names at this time which confuses me.



Once you get away from the Advanced EMT (old standard, the "Indiana" Advanced EMT), the state doesn't really have a "scope" at all.  It's left to the medical director to decide what people can do as ALS providers for the most part.  That is how it should be done honestly because cookie cutter protocols do not work in all locations. 



> The nremt has a different scope


The NREMT does not have a scope.  It's a testing organization. 



> State ems website gave simple answers but nothing solid. We were taught io's and ej's as well as various drug facts but those are not within scope according to state so its very confusing.



You were taught to the NREMT-I/99 standard then.  Just because you're taught to do something does not mean you will get to do it everywhere you work.  Stop worrying about the state and focus on the protocols at your local level.  That is what is really going to matter.  You should have an ALS agency you're affiliated through.  Talk to whomever is in charge and have them give you a copy of the protocols to study.  That is how you finger out what you can and cannot do.  Even if the state says you can do something, it does not mean your medical director will allow it.


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## 18G (Dec 4, 2011)

usafmedic45 said:


> It's left to the medical director to decide what people can do as ALS providers for the most part.  That is how it should be done honestly because cookie cutter protocols do not work in all locations.



I don't really agree with every Medical Director making protocols based on their own opinion. Statewide protocols offer uniformity and are usually based on a committee consensus. As an ALS provider state-wide protocols allow mobility and continuity of care since you will be operating under the same protocols. 

I do feel there should be a little leeway in some circumstances with granting certain exemptions depending on performance level of the EMS system but the foundational protocols should be the same everywhere in the state.

Pathophysiology doesn't change from town to town.


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## rescu (Dec 4, 2011)

*EMt advance*



18G said:


> I don't really agree with every Medical Director making protocols based on their own opinion. Statewide protocols offer uniformity and are usually based on a committee consensus. As an ALS provider state-wide protocols allow mobility and continuity of care since you will be operating under the same protocols.




I feel this subject got carried away to many different direction, which I never intended to happen. I evidently did not explain myself fully. I will try one last time to clarify based on all the responses. 

I know all the protocols in my county at the advanced level we are under a hospital protocols and under a med director like all are. There are 2 hospitals in the area one has advance level protocols the other does not. We are under the one that has them. In the protocol book 95% of the operations we will do say bls skills then IV, Monitor for doumentation and accu-check. That with a few other small add ons is the extent of our scope in indiana. 

However the thing that confused me was area's not fully explained. For example a basic in indiana can not transport a patient with various fluids, IE: antibiotics, nutrition that is running, potassium over the 20 level and so on. Those things even in most emt-b classes are not fully taught until you reach the field and understand them in depth. So my question was directed toward those areas, are we allowed to transport different types of fluids than the basic, "did we expand that part of our scope?". I did not ask you guys on this forum to give me an answer and I was going to run with it as 100 percent right, but I wanted to get other inputs while I was waiting on an answer from the state office. 

On the website it considers advance level a basic-advance. My cert says EMT advance. The NREMT considers is an Advance EMT. As far as insurance goes IV's, cardiac montioring and accu-checks are not considered als if its by a bls person, obviously. So my original question was just to shed some light on this level and see if any body else had trouble getting a black and white answer on this level. As far as emergency care for the patient I do not have any trouble deciphering my scope it is with patients that are stable who are hooked up to a fluid that i'm not sure if I can transport, and also the confusion between is an advance a bls that can do 3 or 4 als skills or considered an als provider. 

Thanks for the input never intended this to be a name throwing game.


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## usafmedic45 (Dec 4, 2011)

> Pathophysiology doesn't change from town to town.



No, but unfortunately the skill levels of the providers (mostly due to differing call volumes) often do and what is a good idea in downtown Philly ("Pick up, haul ***" because you're 10 minutes from a variety of excellent hospitals) isn't going to be the best approach in East Bum****, PA where you are 40 miles from the nearest hospital and you have to stabilize the patient for the much longer prehospital interval.  The reverse also applies because you could harm patient outcomes by increasing the prehospital interval on close-in calls by having excessively aggressive protocols which would make providers more tempted to "stay and play". 

There should be an accepted statewide minimum but moving above that should always be allowed.


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## usafmedic45 (Dec 4, 2011)

rescu said:


> i feel this subject got carried away to many different direction, which i never intended to happen. I evidently did not explain myself fully. I will try one last time to clarify based on all the responses.
> 
> I know all the protocols in my county at the advanced level we are under a hospital protocols and under a med director like all are. There are 2 hospitals in the area one has advance level protocols the other does not. We are under the one that has them. In the protocol book 95% of the operations we will do say bls skills then iv, monitor for doumentation and accu-check. That with a few other small add ons is the extent of our scope in indiana.
> 
> ...


Ask your medical director.  Why is that so difficult?  Some state level paper pusher isn't the person to ask which is why they keep blowing you off.  Ask the person who would actually know.


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