AEMTs

NomadicMedic

NomadicMedic

I know a guy who knows a guy.
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My service is contemplating staffing a couple of trucks with AEMTs and putting a medic in a fly car in the middle. I wasn't a fan of ALS light for a long time, but after seeing some of the staffing issues we've had, I'm warning up to the idea.

Any thoughts?
 
Depends on your transport times and call mix, I would say. In my suburban service, we predominantly run BLS ambulances with ALS fly cars. This is much more flexible (and likely cheaper).

AEMTs with an ALS fly car is a step up from what we’ve got - AEMTs can start your ALS setups (get a line for the medic) and can comfortably transport sicker patients than EMTs can if the medic is unavailable.
 
AEMT's can do (depending on protocols, of course) everything that paramedics do on most ALS calls, and probably everything that has ever been proven to improve patient outcomes. Put the patient on a monitor / get an EKG, start an IV and give fluids, and give basic drugs like dextrose, narcan, epi, albuterol, etc. Where I grew up as a paramedic (western & central NYS) they also had intubation in their protocols, though they rarely if ever did it, and I personally wouldn't allow it if I were in charge of an EMS agency. These days with SGA's being so much better, hopefully they carry and are well trained on those.

I think well-trained AEMT's can be useful in the right system, you just have to use them appropriately. Their biggest limitation IMO isn't the skills that they can't do; it's their lack of education and (likely) experience with patient assessment as compared to your medics. On a critical call they should certainly be able to get things started (IV, EKG, etc) before the paramedic arrives, and then serve as the second medic.
 
@Remi, NYS collab protocols still have ETI for AEMTs (which is just nuts). As you say, education/assessment is the issue - but a fly car medic should alleviate that!
 
I'd say its a good idea. Most calls are BLS and it would be better if you had a medic in a sprint rig going to all the true ALS calls. AEMTs would be able to initiate a line and let the medic focus on other matters, making the process a lot smoother.
 
Realistically, there is not much I do day to day an AEMT couldn't. I work with a couple, and we have recently done the same you are contemplating. They are towards the end of their ALS preception now actually.

They are all great to have for the reasons listed above. The ones I work with regularly are perfectly capable of managing our normal patients and I absolutely utilize them as much as possible. I would trust them to also know when to call for help should they find themselves in a situation where they need a medic.

I think it is just a matter of using them appropriately, but I have found them to be useful to have around. We will see how they do as AIC soon.
 
in PA the AEMT can only attach the 12 Lead, and then transmit and await orders. They can not interpret rhythms nor have the training to do so. They also can only use the Monitor in AED mode. The AEMT can NOT start a line and push drugs IV unless under the direct supervision of a Paramedic, such as in a MICU situation. To start saying that they are "Second Medics"' I think is a bit of a stretch. To me they are just another tool in the box that is available to me as an ALS provider that I may, or may not use depending on the situation.
 
I think it can be a solid plan, especially in denser areas and with well-vetted EMTs
 
NomadicMedic said:
My service is contemplating staffing a couple of trucks with AEMTs and putting a medic in a fly car in the middle. I wasn't a fan of ALS light for a long time, but after seeing some of the staffing issues we've had, I'm warning up to the idea.
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Dude you were in delware for how many years?

Let me ask this: why not run two EMTs on every ambulance, and maybe two fly car medics (one handles the western half, the other the eastern)? AEMT levels vary by state (and sometimes by region), so what can an AEMT do that an EMT can't? and what would you need a medic for?

If you look at VA, there are plenty of areas where a paramedic doesn't get dispatched to many calls; the vast majority are handled by EMTs, EMT-E and EMT-Is. Do you need a paramedic for certain calls? absolutely.

Are you looking at it as a solution to your staffing issues, or because you think it's more efficient and a better utilization for resources? If it's the former, than I think it's a bad idea, but if it's the latter, than absolutely.
 
LALS can be a good, relatively cheap, way to bring some level of ALS to areas that don't presently have it. When backed up by relatively timely ALS, they become a very good resource. They can usually get things started and begin moving the patient toward definitive care, perhaps even doing a rendevous with ALS en route if necessary. Once ALS is on hand, the LALS provider then becomes a second set of trained hands for the ALS provider and can do "higher" ALS skills at the direction of the ALS provider but isn't allowed to do them on their own precisely because of the lack of education needed to determine when doing it is (and isn't) appropriate.

Personally I would rather replace a BLS truck with an LALS truck and wouldn't touch ALS staffing. If you have a ton of BLS trucks and they all are "upgraded" to LALS, then you can "save" the ALS resources for those instances where having full-up ALS is necessary. Furthermore, since it is possible for LALS trucks to be fully ALS equipped, doing ALS intercepts with a full-up ALS truck becomes easy as the Paramedic jumps into the LALS truck and has everything at hand instead of having to grab bags, monitor, drugs... the only thing the ALS provider needs to bring along is whatever controlled substances aren't available to the LALS truck and that's usually all contained in one small bag or box. Then the full-up ALS truck follows the LALS truck to the destination, picks up the ALS provider and off they go to the next call.
 
Never2Old said:
in PA the AEMT can only attach the 12 Lead, and then transmit and await orders. They can not interpret rhythms nor have the training to do so. They also can only use the Monitor in AED mode. The AEMT can NOT start a line and push drugs IV unless under the direct supervision of a Paramedic, such as in a MICU situation. To start saying that they are "Second Medics"' I think is a bit of a stretch. To me they are just another tool in the box that is available to me as an ALS provider that I may, or may not use depending on the situation.
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Thats pretty sad. EMTs can attach 12 leads and send them to the ED in my county. And AEMTs can initiate IVs and push drugs on their own.
 
We don't even have AEMTs in Arizona. lol. Your either basic or paramedic. Pretty much no BLS units anywhere. We only have EMT/Paramedic Units
 
Never2Old said:
in PA the AEMT can only attach the 12 Lead, and then transmit and await orders. They can not interpret rhythms nor have the training to do so. They also can only use the Monitor in AED mode. The AEMT can NOT start a line and push drugs IV unless under the direct supervision of a Paramedic, such as in a MICU situation. To start saying that they are "Second Medics"' I think is a bit of a stretch. To me they are just another tool in the box that is available to me as an ALS provider that I may, or may not use depending on the situation.
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Actually the AEMT in PA can run D10 for hypoglycemia, give IM Epi and glucagon, nebs and Narcan. That’s a pretty good start.
 
NomadicMedic said:
Actually the AEMT in PA can run D10 for hypoglycemia, give IM Epi and glucagon, nebs and Narcan. That’s a pretty good start.
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Our BLS providers can do Narcan, and the EPI Pen by standing protocol, but is the rest without direct ALS supervision? Maybe it is local to me or the Med Dir, but the ones I work with all have to wait for me to arrive on scene for the rest. I agree that this would be a great help!
 
NomadicMedic said:
Actually the AEMT in PA can run D10 for hypoglycemia, give IM Epi and glucagon, nebs and Narcan. That’s a pretty good start.
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That's like 60% of the "lifesaving" ALS stuff right thurr....
 
You know, looking at more AEMT protocols, much as I like the idea of the AEMT...a suitably equipped EMT can do pretty much everything short of the vascular access. CPAP, BIADs, IN naloxone (now in national scope for EMTs & EMRs), etc.

It's almost a case for just making EMT broader - or at least inclusive of what many more...up-to-date places have in scope - rather than adding an intermediate level.
 
At a minimum I think EMTs should be able to do IV Therapy. Here in Arizona, you rarely find an ambulance service that has 2 EMTs. Its always an EMT and a Paramedic. Think of how frustrating it would be if we didn't have Fire dispatch on every one of our calls. The Paramedic would pretty much need to do everything all the time.
 
A brief review of the protocols make me think AEMT is less paramedic light, but rather EMT heavy. very little cardiac stuff, but useful for other stuff. More like an EMT-I.

Why not run dual AEMTs on the truck, push for all your EMTs to complete AEMT as a condition of employment, and run the paramedic flycars? Raise the standards locally, one agency at a time.
 
AZEMSPRO said:
Think of how frustrating it would be if we didn't have Fire dispatch on every one of our calls.
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Frustrating? It would be amazing. 80% or more of the time they aren’t needed, and if you and your partner can’t manage/ improvise without them then you’re your standard “trapped in a box” provider.

AEMT/ paramedic sounds decent, and what @DrParasite is eluding to in his above post is something I wish a lot of fire departments here would get on board with. But, I don’t want to beat a dead horse and derail a thread.

Again though, without knowledge of when to perform, or not perform these skills what good is it to have the ability to do them? “I-can-give-Narcan-to-a-vomit-proned-patient-who-has-no-immediate-signs-of-life-threatening-opiate-ingestion-without-respiratory-depression-just-as-a-rule-out” still doesn’t sit quite right with me.

Sometimes knowing what we don’t know helps us grow, but usually the masses outweigh our humility and continue to stunt this fields attempts at professionalism, and an actual seat at the healthcare table.

A strong training coordinator can certainly elevate their company’s delivery model and see to it that the paramedic is utilized appropriately, as would the EMT’s and/ or AEMT’s.
 
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