"Intermediate" Life Support Nomenclature

[EpiEMS]

What's your nomenclature preference for the AEMT/EMT-I levels? Collectively, do you term them ALS, ILS, or something in-between?

I'm a fan of ILS for in-system use, but based on billing criteria in my area, they're "ALS".

 

[NomadicMedic]

It's either BLS or ALS. Advanced/Is don't work without a paramedic in my system.

 

[TransportJockey]

In NM, they were ILS. Here in TX, they're usually ALS, because Paramedic level is designated MICU.

 

[EpiEMS]

@DEmedic, have you worked in a system with "ILS" providers running lead or running ILS units? I know DE doesn't have AEMTs.

@TransportJockey Texas has some interesting designations - I noticed there's classifications like "BLS with ALS capability" and "ALS with MICU capability" relating to equipment presence (e.g. glucometry and monitor/defibrillators, respectively).

 

[cruiseforever]

I would think Medicare would only pay for BLS or ALS.

 

[TransportJockey]

I would think Medicare would only pay for BLS or ALS.

State designation vs billing designation are not always the same thing.

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[Handsome Robb]

I would think Medicare would only pay for BLS or ALS.

There's BLS, ALS 1, ALS 2 and SCT. My understanding is the only difference between ALS 1 and 2 is the amount of "ALS" interventions performed. SCT is for those CCT transfers requiring a vent or IV pump.

I might be wrong but that's how it's been explained to me in the past.



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[EpiEMS]

There's BLS, ALS 1, ALS 2 and SCT. My understanding is the only difference between ALS 1 and 2 is the amount of "ALS" interventions performed. SCT is for those CCT transfers requiring a vent or IV pump.

I might be wrong but that's how it's been explained to me in the past.



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I concur with this understanding, it is more or less the same as the rules I've read.
The Medicare fee schedule, as per the CFR (also see link 2), is like this:
BLS
BLS - Emergency
ALS1
ALS1 - Emergency
ALS2
SCT
Paramedic Intercept

ALS 1 vs. ALS 2 is dependent on # and type of procedures. ALS 2 is three meds or one of the following: (1) Manual defibrillation/ cardioversion. (2) Endotracheal intubation. (3) Central venous line. (4) Cardiac pacing. (5) Chest decompression. (6) Surgical airway. (7) Intraosseous line.
And SCT is anything beyond EMT-P scope where a RT, RN, et. has to ride along.

 

[TransportJockey]

I concur with this understanding, it is more or less the same as the rules I've read.
The Medicare fee schedule, as per the CFR (also see link 2), is like this:
BLS
BLS - Emergency
ALS1
ALS1 - Emergency
ALS2
SCT
Paramedic Intercept

ALS 1 vs. ALS 2 is dependent on # and type of procedures.
And SCT is anything beyond EMT-P scope where a RT, RN, et. has to ride along.

SCT does not necessarily need a nurse. A designated SCT unit can be just paramedic/emt

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[EpiEMS]

SCT does not necessarily need a nurse. A designated SCT unit can be just paramedic/emt

For Medicaid purposes, I believe that the care must be above the baseline of a standard paramedic, as state-defined, thus a CCT paramedic, if you will, may qualify.

 

[akflightmedic]

The Floridian in me says "What's an Intermediate? What is this ILS you speak of?"

Do wish we had done away with the entire multi level mess...keep it simple. Basic or Medic. Done and far easier.

In Alaska we had EMR, EMT I, EMT II, EMT III and then MICP.

Ridonkulous and convoluted!

 

[hometownmedic5]

If we are talking about intermediates in a place where they can deliver advanced therapies(more or less having the meaning here of medications beyond BLS meds) then I can see calling them advanced life support, but only barely.

If we're talking about the IV/ETI only model of intermediate, then while they be more advanced than basics, they still aren't advance life support providers. Just being able to establish an IV isn't advanced, its just a pathway for advanced therapies.

All that being said, I would value an intermediate provider as a partner if I didn't work in a P/P system. They absolutely bring value to the table, but they aren't advanced level providers until they bring advanced level interventions to the table.

 

[akflightmedic]

They bring no more value than a well coached Basic.

 

[twistedMP]

Here in Georgia we have als and bls, als means medic on board and bls is 2 aemt/Emt-I or a basic/ aemt. Can't run 2 basics


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[EpiEMS]

The Floridian in me says "What's an Intermediate? What is this ILS you speak of?"

Do wish we had done away with the entire multi level mess...keep it simple. Basic or Medic. Done and far easier.

In Alaska we had EMR, EMT I, EMT II, EMT III and then MICP.

Ridonkulous and convoluted!

Definitely convoluted. I could have sworn they called their EMR level "ETT - Emergency Trauma Technician", you know, given all the outdoorsy stuff

If we're talking about the IV/ETI only model of intermediate, then while they be more advanced than basics, they still aren't advance life support providers. Just being able to establish an IV isn't advanced, its just a pathway for advanced therapies.

This is a good point - fortunately this is going away in all locations that I'm aware of, either through attrition or through regulatory action.

Here in Georgia we have als and bls, als means medic on board and bls is 2 aemt/Emt-I or a basic/ aemt. Can't run 2 basics.

Is that even true for an IFT ambulance?

 

[akflightmedic]

ETT!!!! My bad!!! LOL

I left AK in 2006 and haven't looked back. But yes it was ETT...I confused it with my Canadian brethren. LOL

 

[EpiEMS]

ETT!!!! My bad!!! LOL

I left AK in 2006 and haven't looked back. But yes it was ETT...I confused it with my Canadian brethren. LOL

I just love the acronym - it really does align to the EMR and EMT skill set...

Looking at AK's intermediate (i.e. between EMT and Medic) levels, I must say - they are far from rational. It seems like (at least at one point), they added cardiac drugs and ECG monitoring with only 50 hours of training ("EMT III")...which seems a bit, uh, suboptimal.

That being said, NYS (and RI) isn't (aren't) much better - AEMT-CC (and RI's AEMT-C) is (are) just crazy...

 

[Bullets]

The Floridian in me says "What's an Intermediate? What is this ILS you speak of?"

Do wish we had done away with the entire multi level mess...keep it simple. Basic or Medic. Done and far easier.

In Alaska we had EMR, EMT I, EMT II, EMT III and then MICP.

Ridonkulous and convoluted!

I understand the theory behind Alaskas system of certifications but it seems like in practice its not great. Seems like they have little to no actual Paramedics

But NJ has no intermediate level. BLS is 2 EMTs, ALS is 2 Medics. anything else is "enhanced" BLS. When i took psychomotor in New Hampshire they called AEMT/EMT an ALS unit, which its not

 

[EpiEMS]

I understand the theory behind Alaskas system of certifications but it seems like in practice its not great. Seems like they have little to no actual Paramedics.

They have pretty limited resources, it seems, except in the major cities. I see 470 paramedics to 3,926 EMT Is-IIIs (inclusive), which is below what might be considered a better resourced ratio, and I imagine they're not well distributed (given large rural areas with few to no ALS care).

 

[TransportJockey]

Especially when you figure a lot of the actual medics work for air medical systems. At least that's what an EMT that worked for us in Pecos but used to live in AK was telling us...