Where I live (Sacramento, Ca), there is only an EMT-B right to EMT-P. I am not sure if they are combining the two classifications, or doing away with one. What I am trying to find out what is the main differentness between EMT-B to an EMT-I (If your EMS system does not use the term EMT-B and EMT-I, I am saying the same thing as EMT-I and EMT-II)
Here in NM the differences are:
EMT-BASIC (EMT-B):
(1) The following allowed skills, procedures, and drugs may be performed without medical
direction:
a. Basic airway management
b. Use of basic adjunctive airway equipment
c. Suctioning
d. Cardiopulmonary resuscitation, according to current ECC Guidelines
e. Obstructed airway management
f. Bleeding control
g. Spine immobilization
h. Splinting
i. Scene assessment, triage, scene safety
j. Use of statewide EMS communications system
k. Childbirth (Imminent Delivery)
l. Glucometry
m. Oxygen
n. Other non-invasive procedures as taught in EMT-B courses adhering to DOT
curricula
o. Wound management
(2) The following require Service Medical Director Approval
a. Allowable Skills:
1. Mechanical positive pressure ventilation.
2. Use of multi-lumen, supraglottic, and laryngeal airway devices (examples:
PTLA, Combi-tube, King Airway, LMA) 3. Pneumatic anti-shock garment
4. Application and use of semi-automatic defibrillators
5. Acupressure
6. Transport of patients with nasogastric tubes, urinary catheters, heparin/saline
locks, PEG tubes, or vascular access devices intended for outpatient use
b. Administration of approved medications via the following routes:
1. Nebulized inhalation
2. Subcutaneous
3. Intramuscular
4. Intranasal
5. Oral (PO)
c. Allowable Drugs
1. Oral glucose preparations
2. Aspirin PO for adults with suspected cardiac chest pain
3. Activated charcoal PO
4. Acetaminophen PO in pediatric patients with fever
5. IM auto-injection of the following agents for treatment of chemical and/or nerve
agent exposure:
a. atropine
b. pralidoxime
6. Albuterol (including isomers), via inhaled administration
7. Ipratropium, via inhaled administration, in combination with or after albuterol
administration
8. Epinephrine via auto-injection device
9. Administration of naloxone by SQ, IM, or IN route
10. Administration of Epinephrine, 1:1000, no single dose greater than 0.3 ml,
subcutaneous or intramuscular injection with a pre-measured syringe or 0.3 ml
TB syringe for anaphylaxis or status asthmaticus refractory to other treatments
under on-line medical control. When on-line medical control is unavailable,
administration is allowed under off-line medical control if the licensed provider
is working under medical direction using approved written medical protocols.
d. Patient’s Own Medication that May be Administered
1. Bronchodilators using pre-measured or metered dose inhalation device
2. Sublingual nitroglycerine for unrelieved chest pain, with on line medical control
only
EMT-I:
EMT-INTERMEDIATE (EMT-I):
(1) The following allowed skills, procedures, and drugs may be performed without medical
direction:
a. Basic airway management
b. Use of basic adjunctive airway equipment
c. Suctioning
d. Cardiopulmonary resuscitation, according to ECC Guidelines
e. Obstructed airway management
f. Bleeding control
g. Spine immobilization
h. Splinting
i. Scene assessment, triage, scene safety
j. Use of statewide EMS communications system
k. Childbirth (Imminent Delivery)
l. Glucometry
m. Oxygen
n. Wound management
(2) The following require Service Medical Director Approval:
a. Allowable Skills:
1. Mechanical positive pressure ventilation.
2. Use of multi-lumen, supraglottic, and laryngeal airway devices (examples:
PTLA, Combi-tube, King Airway, LMA)
3. Pneumatic anti-shock garment 4. Application and use of semi-automatic defibrillators
5. Acupressure
6. Transport of patients with nasogastric tubes, urinary catheters,
heparin/saline locks, PEG tubes, or vascular access devices intended for
outpatient use
7. Peripheral venous puncture/access
8. Blood drawing
9. Pediatric intraosseous tibial access
10. Adult intraosseous access
b. Administration of approved medications via the following routes:
1. Intravenous
2. Intranasal
3. Nebulized inhalation
4. Sublingual
5. Subcutaneous
6. Intradermal
7. Intraosseous
8. Endotracheal (for administration of epinephrine only, under the direct
supervision of an EMT-Paramedic, or if the EMS service has an approved
special skill for endotracheal intubation)
9. Oral (PO)
10. Intramuscular
c. Allowable Drugs
1. Oral glucose preparations.
2. Aspirin PO for adults with suspected cardiac chest pain.
3. Activated charcoal PO
4. Acetaminophen PO in pediatric patients with fever
5. IM auto-injection of the following agents for treatment of chemical and/or
nerve agent exposure:
(i) atropine
(ii) pralidoxime
6. Albuterol (including isomers) via inhaled administration
7. Ipratropium, via inhaled administration, in combination with or after
albuterol administration
8. Naloxone
9. I.V. fluid therapy (except blood or blood products)
10. 50% Dextrose – intravenous
11. Epinephrine via auto-injection device
12. Epinephrine (1:1000), SQ or IM for anaphylaxis and known asthmatics in
severe respiratory distress (no single dose greater than 0.3 cc)
13. Epinephrine (1:10,000) in pulseless cardiac arrest for both adult and
pediatric patients. Epinephrine may be administered via the endotracheal
tube in accordance with ACLS and PALS guidelines.
14. Nitroglycerin (sublingual) for chest pain associated with suspected acute
coronary syndromes. Must have intravenous access established prior to
administration or approval of online medical control if IV access is
unavailable.
15. Morphine, fentanyl, or dilaudid for use in pain control with approval of on-
line medical control
16. Diphenhydramine for allergic reactions or dystonic reactions
17. Glucagon, to treat hypoglycemia in diabetic patients when intravenous
access is not obtainable 18. Promethazine and anti-emetic agents, for use as an anti-emetic
19. Methyprednisoline for reactive airway disease/acute asthma exacerbation
20. Hydroxycobalamine
d. Patient’s Own Medication that May be Administered
1. Bronchodilators using pre-measured or metered dose inhalation device
2. Sublingual nitroglycerine for unrelieved chest pain. Must have intravenous
access established prior to administration or approval of online medical
control if IV access is unavailable.
