National EMS Scope of Practice Model Revision

[Summit]

I wonder why AEMT hasn't become more popular. Employers could easily demand it for new providers at virtually no premium over an experienced EMT.

 

[Medic27]

I wonder why AEMT hasn't become more popular. Employers could easily demand it for new providers at virtually no premium over an experienced EMT.

From what I hear it's not very popular in the East... Idk why... In Idaho EMTs can get advanced modules IV/IO administration and do a lot of things AEMTs can do @ the discretion of our medical director.

 

[EpiEMS]

I wonder why AEMT hasn't become more popular. Employers could easily demand it for new providers at virtually no premium over an experienced EMT.

I agree...and they can bill more, too (ALS1 billing). Of course, in many places, paramedics are easy to come by.

 

[reaper]

A lot of it comes down to the class. Why do AEMT, when you can do Paramedic with just two extra semesters.

I think in out service we have two AEMTs out of 280 employees. Most EMT-Is upgraded to Paramedic and a few downgraded to Basic.

If you are going to spend the time and money, do what is better for you and your pts. Just go to Paramedic!

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[Medic27]

A lot of it comes down to the class. Why do AEMT, when you can do Paramedic with just two extra semesters.

I think in out service we have two AEMTs out of 280 employees. Most EMT-Is upgraded to Paramedic and a few downgraded to Basic.

If you are going to spend the time and money, do what is better for you and your pts. Just go to Paramedic!

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Some people aren't sure if they can handle the kind of curriculum, myself included. I may go advanced before paramedic and ride some years as an EMT-B before moving to EMT-A and then Paramedic. I am 18, so it's hard for me to put myself in the role of a paramedic at this age or 1 year from now. I'm almost 19, but if I ever did paramedic I would want to be 22-24. I think it's important to have at least a level below that. Just imo..

 

[reaper]

One of the best young medics I know, had his medic by 19. I watched him study and push himself. He now does fixed wing.



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[Bullets]

I'd agree with that. I think BLS providers could use a bit more in the way of medical skills (e.g. CPAP, albuterol) in national scope.

I forget that some states arent giving their EMTs these skills yet, but yeah, i agree.

From what I hear it's not very popular in the East... Idk why... In Idaho EMTs can get advanced modules IV/IO administration and do a lot of things AEMTs can do @ the discretion of our medical director.

Because its not needed. My county has 5 hospitals, one is a Level II trauma unit. One town in this county has a 30 minute ride to two level 2s and a level one. I have 5 24hr ALS trucks, 2 part time trucks, and a 24hr truck from an adjacent county that covers part of mine as a primary. Up to 8! ALS units are available for my county.
600k people live in 500sq miles. So thats less than 100k people and 70sq miles per truck. I rarely wait for ALS and they are pretty quick to get to use.

We are at the transition between suburban and rural (for NJ), the closer you get the the cities (NYC and Philly) the more concentrated the Hospitals and ALS get. We also have 13 helicopter flying around our state, plus the Coasties, PLUS NYPD who have been know to jump flights on Sandy Hook and the bay area.

Theres just so many hospitals, ALS units, HEMS, Coasties and such that there really isnt a need for an intermediate level of care

 

[DrParasite]

600k people live in 500sq miles. So thats less than 100k people and 70sq miles per truck. I rarely wait for ALS and they are pretty quick to get to use.

don't you deal with the evil empire primarily? I have heard horror stories about them, particularly when it comes to a rapid ALS response, particularly how it's far from rapid and control has some retards staffing it (and also some good friends of mine who aren't retarded)....

We are at the transition between suburban and rural (for NJ), the closer you get the the cities (NYC and Philly) the more concentrated the Hospitals and ALS get. We also have 13 helicopter flying around our state, plus the Coasties, PLUS NYPD who have been know to jump flights on Sandy Hook and the bay area.

you remember when it was just northstar and southstar? ahhh, memories..... and yes, now NJ is so inundated with helicopters, that there isn't a call volume to support them all. and 80% of all EMS calls in NJ are still handled without a paramedic.

Theres just so many hospitals, ALS units, HEMS, Coasties and such that there really isn't a need for an intermediate level of care

respectfully disagree. There are numerous calls I can remember where I wish I could have dropped a king airway, or checked a BGL (or even given sugar), or given albuterol on a wheezing patient..... or benadryl for a minor allergic reaction. I recall one particular day (I think I was working for Linden EMS at the time, and I think somehow we ended up by Carteret), when the patient has having an allergic reaction to something, not at the level of needing epi, but did need some benedryl.... And we had to wait for a paramedic unit from Rahway or Perth to give the patient benedryl....Oddly enough, all these skills are in my scope of practice as an EMT in NC....

NC just revamped their EMT program, and it is a minimum of 190 hours (166 hours of didactic and 24 hours of clinical time). There is no maximum level as per the state. We have a state wide EMR program (which is 80 hours), and some of the volunteer fire departments couldn't do that, so they have a county version first responder program.

If it was up to me, I'd get rid of the EMR program altogether, and make the minimum level of prehospital training EMT. If they need something to help out the EMTs, they can take an 8 hour first aid course. The EMRs can transition to EMTs (with a 110 hour transition course), but after that, be done with it. I still support volunteers, and the volunteer system, provided they are able to provide the same services as their career counterparts. Same levels of training, same equipment (I will let the response times slide a little bit due to the nature of some rural systems), and same competencies, but if they can't do it, than it's time to replace them with someone who can.

 

[DrParasite]

I don't disagree - but as our levels are designed now, EMT & paramedic are fundamentally different jobs, so I'm not sure that EMT & paramedic are the levels to keep, unless EMT is the first response (non-transport) level & paramedic is the only transporting level. (Perhaps keeping EMTs for IFT.)

Ehhhhhhhh how are they fundamentally different? They both pick people up, stabilize them to the best of their ability, and take them to definitive care. Yes, one has a lot of tools to chose from, and a lot more interventions to give, but they do similar jobs, and there are still plenty of states that run tiered systems where not every ambulance has a paramedic on it....

I would like to see EMT be the basic first response level, and AEMT and paramedic be paired up for the ALS ambulance. Maybe even make it EMT and paramedic, where the EMT needs to become an AEMT within 2 years as a condition of employment. But in my experience, the majority of calls in EMS don't require a paramedic, they need a proper assessment to confirm the patient won't die during the transport, followed by a comfy ride to the hospital.

 

[Medic27]

I forget that some states arent giving their EMTs these skills yet, but yeah, i agree.


Because its not needed. My county has 5 hospitals, one is a Level II trauma unit. One town in this county has a 30 minute ride to two level 2s and a level one. I have 5 24hr ALS trucks, 2 part time trucks, and a 24hr truck from an adjacent county that covers part of mine as a primary. Up to 8! ALS units are available for my county.
600k people live in 500sq miles. So thats less than 100k people and 70sq miles per truck. I rarely wait for ALS and they are pretty quick to get to use.

We are at the transition between suburban and rural (for NJ), the closer you get the the cities (NYC and Philly) the more concentrated the Hospitals and ALS get. We also have 13 helicopter flying around our state, plus the Coasties, PLUS NYPD who have been know to jump flights on Sandy Hook and the bay area.

Theres just so many hospitals, ALS units, HEMS, Coasties and such that there really isnt a need for an intermediate level of care

Lol try coming to Idaho, but I also like the NW best our medical scope as a whole is less stringent

 

[johnrsemt]

Where I work PT, the Advanced can run a full code; they do all but about 6 of the Medic Level Meds, can't intubate, or cric or needle decompress. Other states don't use them at all.
Education wise (certificate) is about 1/2 of paramedic and a lot less money

 

[Medic27]

Where I work PT, the Advanced can run a full code; they do all but about 6 of the Medic Level Meds, can't intubate, or cric or needle decompress. Other states don't use them at all.
Education wise (certificate) is about 1/2 of paramedic and a lot less money

Which states are we talking about "Other states don't use them at all." ... At least where I am from we have some of the lenient scopes of practice (Idaho), I can't think of more than half a dozen times where our main county has needed a cric, tbh even a needle decompression. Although, intubation may be within the scope of practice and I have seen it done firsthand, (I realise not all the time can we wait) but it seems like a lot of these are last resort efforts. I do like your area how they employee EMTs and Paramedics.

 

[reaper]

Which states are we talking about "Other states don't use them at all." ... At least where I am from we have some of the lenient scopes of practice (Idaho), I can't think of more than half a dozen times where our main county has needed a cric, tbh even a needle decompression. Although, intubation may be within the scope of practice and I have seen it done firsthand, (I realise not all the time can we wait) but it seems like a lot of these are last resort efforts. I do like your area how they employee EMTs and Paramedics.

But, this comment shows why you need educated providers. None of the treatments you listed are "last resort". If they are needed, they are needed right away. This comes down to the old saying, just because you can do a skill, doesn't mean you know why you are doing it!

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[Medic27]

But, this comment shows why you need educated providers. None of the treatments you listed are "last resort". If they are needed, they are needed right away. This comes down to the old saying, just because you can do a skill, doesn't mean you know why you are doing it!

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Understandably so but you can't put a paramedic or a pair in every city in the US... I don't know about you, but 90-95% of calls I have gone on typically aren't emergencies. I think you were missing my point. In terms of budget I would rather have them spread out equally versus only in the county. Like said many states can't even do those skills. Here a paramedic can do a paracardiocentesis in the field, it doesn't mean they should....

 

[EpiEMS]

Understandably so but you can't put a paramedic or a pair in every city in the US.

Well, that's not true...it just depends on what resources municipalities choose to allocate to EMS.

 

[Medic27]

Well, that's not true...it just depends on what resources municipalities choose to allocate to EMS.

Sure, but I don't see this being accomplished anytime soon? Not impossible, but you are going to have a ton of interior politics to deal with.

 

[EpiEMS]

Sure, but I don't see this being accomplished anytime soon? Not impossible, but you are going to have a ton of interior politics to deal with.

Certainly true! But we can't claim that cities *can't* staff EMS effectively, it's more that they "won't".

 

[VentMonkey]

Understandably so but you can't put a paramedic or a pair in every city in the US... I don't know about you, but 90-95% of calls I have gone on typically aren't emergencies. I think you were missing my point. In terms of budget I would rather have them spread out equally versus only in the county. Like said many states can't even do those skills. Here a paramedic can do a paracardiocentesis in the field, it doesn't mean they should....

Clarify, because your "point" is awful confusing to me. I don't think you're understanding the bigger picture of EMS and its logistics.

How long have you actively been in, and around this field? Have you sat in on any meetings at any EMS departments, or taken any EMS management courses?

With all due respect, I don't think you have a clue what you are talking about. @reaper had a good point when he mentioned levels of education.

A good paramedic understands why they should not be doing something long before jumping into a procedure and can, with hardly batting an eye, recognize when something taught but not often performed needs to take place. You cannot (and should not) condense this into a shorter course; the coursework should be extended.

As it stands now, our national curriculums educational standards, even at the advance provider levels, are severely lacking.

 

[Medic27]

Certainly true! But we can't claim that cities *can't* staff EMS effectively, it's more that they "won't".

Agreed, with this though taxes would increase. Not all paramedics work full-time, and we can't staff a small little city generating barely enough to keep the town hall going lol

 

[reaper]

Seen it happen in FL years ago. The state mandated ALS coverage in every county. Now, there were some rural counties that only had two ALS trucks and a few BLS trucks, but they still had Paramedic coverage when needed.

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