AEMT's, good Idea or Bad idea.

[Kavsuvb]

What's everyone's take on AEMT's, Good idea or Bad idea.

To me, I think AEMT's are a good idea because they are great for rural communities in America who don't have access to a Paramedic. On top of that they are a great stepping stone for EMT's who want to go to Paramedic school with a background and experience as an AEMT.

New Orleans EMS Launches Advanced EMT Scope - JEMS: EMS, Emergency Medical Services - Training, Paramedic, EMT News

New Orleans EMS is seeing success with its Advanced EMT program, allowing the service to accommodate a high call volume.

www.jems.com

 

[NomadicMedic]

Great idea, but not a replacement for a paramedic.

 

[mgr22]

What's everyone's take on AEMT's, Good idea or Bad idea.

To me, I think AEMT's are a good idea because they are great for rural communities in America who don't have access to a Paramedic. On top of that they are a great stepping stone for EMT's who want to go to Paramedic school with a background and experience as an AEMT.

New Orleans EMS Launches Advanced EMT Scope - JEMS: EMS, Emergency Medical Services - Training, Paramedic, EMT News

New Orleans EMS is seeing success with its Advanced EMT program, allowing the service to accommodate a high call volume.

www.jems.com

I may be generalizing too much, but don't rural communities need paramedics much more than cities and suburbs do, given longer response times and greater distances to definitive care? If so, wouldn't rural, paramedic-level initiatives be more constructive than compromising with AEMTs?

As for EMTs with career decisions to make, aren't most of them better off financially and professionally by skipping the AEMT level?

 

[DesertMedic66]

My personal take on the levels for EMS are:
EMT - used for stable interfacility transfers and discharges.
AEMT - used primarily for the 911 system.
Paramedic - used as an intercept and automatically dispatched out on the most critical calls.

 

[ffemt8978]

I may be generalizing too much, but don't rural communities need paramedics much more than cities and suburbs do, given longer response times and greater distances to definitive care? If so, wouldn't rural, paramedic-level initiatives be more constructive than compromising with AEMTs?

As for EMTs with career decisions to make, aren't most of them better off financially and professionally by skipping the AEMT level?

How would you maintain the paramedic skill set in low volume call areas? With AEMTs in these areas they can at least do some things on the way to a paramedic intercept instead of using high flow diesel only

 

[mgr22]

How would you maintain the paramedic skill set in low volume call areas? With AEMTs in these areas they can at least do some things on the way to a paramedic intercept instead of using high flow diesel only

Wouldn't it be just as important and just as hard to maintain AEMT skills?

Lack of practice is a challenge for all providers with low call volume. I don't know how to fix that, but I'd rather have an inexperienced medic than an inexperienced AEMT on an extended transport.

 

[Kavsuvb]

I may be generalizing too much, but don't rural communities need paramedics much more than cities and suburbs do, given longer response times and greater distances to definitive care? If so, wouldn't rural, paramedic-level initiatives be more constructive than compromising with AEMTs?

As for EMTs with career decisions to make, aren't most of them better off financially and professionally by skipping the AEMT level?

I would think AEMT's would be great in rural states and even in places like Alaska, Montana, Northern Maine, Vermont, and New Hampshire. Suburbs, it depends on how far are you from a hospital or a Paramedic intercept. I'm just thinking, rural communities where it would take you a half hour to get a Paramedic to intercept you

I know in the Military it would be great for USMC Force Recon units, US Army Ranger teams even Special warfare combatant watercraft teams. Even in the US Coast Guard, smaller cutters like the Sentinel-class cutters and the Marine Protector class cutters would be great for AEMT's. Small boat stations including Motor surf lifeboat stations, I can see AEMT's being utilized in those places.

 

[mgr22]

I would think AEMT's would be great in rural states and even in places like Alaska, Montana, Northern Maine, Vermont, and New Hampshire. Suburbs, it depends on how far are you from a hospital or a Paramedic intercept. I'm just thinking, rural communities where it would take you a half hour to get a Paramedic to intercept you

My point is that rural regions don't necessarily have to settle for AEMTs. Paramedics wouldn't take longer to respond than AEMTs if there were no AEMTs.

 

[ffemt8978]

Wouldn't it be just as important and just as hard to maintain AEMT skills?

Lack of practice is a challenge for all providers with low call volume. I don't know how to fix that, but I'd rather have an inexperienced medic than an inexperienced AEMT on an extended transport.

Not necessarily...AEMTs have fewer and less complicated skill sets but I agree it's an issue no matter what level of certification a provider has. I don't have the answer.

 

[M3dicalR3dn3ck]

I think it'd be better if AEMT was set up as a step moving from EMT to Paramedic instead of basically being Paramedic Light, but that said honestly it really depends on the specific service area being covered.

Some places (for example, my part time job) have a legitimate need for AEMTs. Most of our calls there only require an EMT or AEMT; that said we do have a plenty of calls that DO require a Paramedic, but most calls there are handled just fine by an AEMT and our AEMTs there know what they're doing and they're dang good at it.

On the flip side, at my full time job most of our calls either ONLY need an EMT or seriously need a Paramedic, with extremely little in between. Here the thing that AEMTs are best for is reducing the workload of the Paramedic, regardless of if said Paramedic's on that truck or a different truck intercepting the AEMT.

In short, AEMTs fill a niche that does exist in some areas, but I wouldn't necessarily consider it the answer to "We need ALS care on the truck but we can't afford a Paramedic"

 

[Summit]

AEMT should not be the highest level of care in a community.

AEMT should probably be the lowest level of care on an ambulance.

AEMT is so NOT "medic light" any more than EMT is "medic light." EMT-I-99 was "medic light (on education)"

 

[PotatoMedic]

I say we just need the rode island cardiacs.

 

[Tigger]

Rural communities are the places where the paramedic scope of practice can actually make a difference. I was never sharper then working in the sticks, we had very few paramedics for a large area and were seeing mostly sick patients.

Without knowing the state scope, it would be difficult to assess in what ways AEMTs are making a significant difference. If they can place SGAs and EMTs cannot, that would be important. If they can acquire and transmit a 12 lead and EMTs cannot, that would be better.

Our EMTs pretty closely mirror the national scope of practice AEMT scope (CPAP, SGAs, IV/IO access, D10, Zofran, AA nebulizers, 12 lead acquisition and transmit).

AEMT in Colorado can actually do quite a bit now. They do not interpret EKGs which I think will always be a limiting factor. However:
Glucagon, nitro spray/paste, IV Tylenol, nitrous, fentanyl and morphine (with online med control order), benadryl, IN Versed and PR Valium for seizure control.

Not a substitute for a paramedic but definitley could provide some help awaiting one.

 

[DrParasite]

From the article:

Advanced EMTs in the state of Louisiana have a liberal scope, allowing medical directors to sign off on interventions and medication administration as they see fit. For New Orleans EMS, this allowed the implementation of Advanced EMTs to practice far closer to a paramedic scope of practice than an EMT’s as long as proper education is provided within the agency. For New Orleans EMS, that meant designing classes and in-services to train their AEMT providers to administer medications such as narcotics, antiemetics, some cardiac medications like nitroglycerin and epinephrine 1:10,000, sodium bicarbonate, and respiratory medications like steroids and magnesium sulfate.

Cool.... I would think cardiac arrests would warrant a paramedic, but I guess not

I think it was Charlottesville-Albemarle Rescue Squad that used to publish their dispatch criteria, and it was surprised me how many calls were handled by just the EMT crew or EMT/Advanced.

There are a lot of "minor" ALS calls that simply need fluids, or minor interventions and a comfortable ride to the hospital. However, there are definitely calls where having a paramedic on the call to provide the full scope of paramedic interventions are absolutely clinically indicated.

 

[PotatoMedic]

This is an interesting read. Mostly the secondary data of how often potentially life saving interventions are performed.

Using Red Lights and Sirens for Emergency Ambulance Response: How Often Are Potentially Life-Saving Interventions Performed? - PubMed

In this large national dataset, RLS responses were very common (86%) yet potentially life-saving interventions were infrequent (6.9%). These data suggest a methodology to help EMS leaders craft targeted RLS response strategies.

pubmed.ncbi.nlm.nih.gov

https://nasemso.org/nasemso-document/rls-ems-response-potentially-lifesaving-interventions

 

[Kavsuvb]

Rural communities are the places where the paramedic scope of practice can actually make a difference. I was never sharper then working in the sticks, we had very few paramedics for a large area and were seeing mostly sick patients.

What about states like Alaska, Montana, Maine, New Hampshire, and Vermont? Would AEMT's be of useful in those rural states

 

[Kavsuvb]

I say we just need the rode island cardiacs.

You know I am so jealous of Rhode Island EMS.

 

[Tigger]

What about states like Alaska, Montana, Maine, New Hampshire, and Vermont? Would AEMT's be of useful in those rural states

Could they be more useful than two EMTs showing up? Sure. Doesn’t make them a substitute for paramedics, but there are many areas of northern New England where it might take a while to be seen by a paramedic, though you probably eventually will be.

I broke my back in rural Vermont 11 years ago, a paramedic was dispatched with a 30 min ETA so we went to to the hospital. Would have been cool if the AEMTs that scooped me had any sort of analgesia on board.

 

[DrParasite]

This is an interesting read. Mostly the secondary data of how often potentially life saving interventions are performed.

Using Red Lights and Sirens for Emergency Ambulance Response: How Often Are Potentially Life-Saving Interventions Performed? - PubMed

In this large national dataset, RLS responses were very common (86%) yet potentially life-saving interventions were infrequent (6.9%). These data suggest a methodology to help EMS leaders craft targeted RLS response strategies.

pubmed.ncbi.nlm.nih.gov

https://nasemso.org/nasemso-document/rls-ems-response-potentially-lifesaving-interventions

is it really any surprise to anyone that EMS doesn't save nearly as many lives as we think? We give pain meds, we give anti-nausea meds, we give people a comfortable ride to the ER.... But most ambulance crews aren't performing life threatening interventions every shift. We do a lot of handholding and comfort measures, especially in all ALS systems.

 

[Kavsuvb]

Could they be more useful than two EMTs showing up? Sure. Doesn’t make them a substitute for paramedics, but there are many areas of northern New England where it might take a while to be seen by a paramedic, though you probably eventually will be.

I broke my back in rural Vermont 11 years ago, a paramedic was dispatched with a 30 min ETA so we went to to the hospital. Would have been cool if the AEMTs that scooped me had any sort of analgesia on board.

That's why Tigger, I think AEMT's are great for Rural communities and even rural states like Alaska, New Hampshire, Vermont, Montana, and Maine. I am talking about towns in Northern New England states such as Fort Kent, Maine, Houlton Maine, Eastport Maine, Pittsburg New Hampshire, and Derby Vermont. On top of that AEMT's would be great for the Islands such as Block Island and Nantucket as well.

If you have ever been up to Northern Maine, Vermont, and New Hampshire, you would know how long it would take to get a paramedic to you. If you have a paramedic dispatch ETA of 30 mins or more, then an AEMT would be great to get things going while en route to the Hospital or a paramedic intercept.