San Diego now has Advanced EMT.

[exodus]

The Advanced EMT in San Diego County are allowed to perform the following skills (per B-327):

• ETAD (Combitube) / Pharyngeal (King) Airways
• Blood Glucose Monitoring
• Administer the following medications: Nitroglycerin, Aspirin, Glucagon, Albuterol, Narcan, Epinephrine

Skill sign off sheet: http://www.sdcounty.ca.gov/hhsa/pro...MS_EMTOptionalSkillsVerificationForm_2009.pdf

SD EMS: http://www.sdcounty.ca.gov/hhsa/programs/phs/emergency_medical_services/prehospital_system.html


So time to figure out what good this will do.

 

[TransportJockey]

Hmmm... almost like NM EMT-B with just a few (2) more meds.

 

[exodus]

Just found out, our company will be utilizing this level by requiring any EMT working on our Critical Care/RN rigs to have this card.

 

[MrBrown]

Sounds like a stripped down version of our Technician; ours have

- Ondansetron
- ASA
- GTN
- IM Glucagon
- Salbutamol nebules
- Acetamyophen
- Entonox
- Methoxyflurane
- LMA

 

[emt_irl]

emt's in ireland can give glucagon, epinephrine, salbutamol, gtn, asprin, glucose gel, entanox, and paracetamol. we can monitor blood glucose and 3 lead ecg's(no point listing the rest). we can only use opa's though but reckon lma's will come down the line

 

[JPINFV]

It actually looks like San Diego is using two different optional skills packages than EMT-IIs or AEMTs. Specifically the medication skills package and the airway skills package. Similarly, California is looking to introduce the AEMT in July with the rest of the changes of the EMT 2010 project.


http://www.emsa.ca.gov/about/EMT2010_Overview.asp

 

[Veneficus]

Maybe it is just me, but perhaps CA would have more money if they simplified their system considerably?

 

[MrBrown]

Maybe it is just me, but perhaps CA would have more money if they simplified their system considerably?

Why not just have Advanced EMT and Paramedic? Makes so much more sense

New Zealand has made moves to having only Paramedic and Intensive Care Paramedic although we are stuck with the Technician level for the vollies it seems, shame.

 

[Veneficus]

Why not just have Advanced EMT and Paramedic? Makes so much more sense

New Zealand has made moves to having only Paramedic and Intensive Care Paramedic although we are stuck with the Technician level for the vollies it seems, shame.

I like making our EMT-B level the "medical first responder" with a paid provider required to be a medic.

 

[eveningsky339]

I like making our EMT-B level the "medical first responder" with a paid provider required to be a medic.

I tend to disagree; the creation of new "AEMT" or "EMT-A" levels in several states would seem to indicate the need for an intermediate level of EMS provider.

That said, my ambulance service utilizes EMT-I's as they would EMT-B's. They do not replace medics. I don't think a three-level system is unnecessarily complicated by witnessing how my own company operates.

 

[Shishkabob]

I tend to disagree; the creation of new "AEMT" or "EMT-A" levels in several states would seem to indicate the need for an intermediate level of EMS provider.

Except the AEMT isn't really "new". It's just an EMT-B with a couple more advanced skills and some drugs... like a stripped down I/85. They are taking away the 'advanced' skills of the I/99 and making people become a Paramedic if they want that stuff.

 

[MrBrown]

I tend to disagree; the creation of new "AEMT" or "EMT-A" levels in several states would seem to indicate the need for an intermediate level of EMS provider.

That said, my ambulance service utilizes EMT-I's as they would EMT-B's. They do not replace medics. I don't think a three-level system is unnecessarily complicated by witnessing how my own company operates.

Most states in Australia have two levels (Paramedic/Intensive Care), Canada has two levels (PCP/ACP) as does the UK (ECA or Technician/Paramedic) and most of Europes ambulances are staffed with either RNs or very highly educated civilian Intensive Care Paramedics.

Three levels, no not a problem

- Some sort of basic first responder (firefighter/rural first responders in thier jammie pants) who can do basic airway care, oxygen, AED, nebules
- Paramedic (super ILS)
- Intensive Care Paramedic (ALS)

 

[terrible one]

Out of curiosity what is the difference between a paramedic and ICP in australia? In other words what can a ICP do that a paramedic cannot? Thanks

 

[triemal04]

It actually looks like San Diego is using two different optional skills packages than EMT-IIs or AEMTs. Specifically the medication skills package and the airway skills package. Similarly, California is looking to introduce the AEMT in July with the rest of the changes of the EMT 2010 project.


http://www.emsa.ca.gov/about/EMT2010_Overview.asp

I couldn't tell from the link; are they looking to follow the standards laid out in the Scope of Practise Model, or will this be a cert that is still only specific to the state, or in the case of San Diego, the county?

 

[JPINFV]

How California currently works is there are 3 levels. The EMT-1 (EMT-B), EMT-2 (EMT-intermediate, rare), and EMT-P. For the EMT-1 and EMT-2 levels, there are several "optional skill packages" that the counties can adopt. So if an EMT-1 goes through, say, the medication package in SD, I believe that he should be able to be signed off on the package without a new class if he moves to another county that uses that package. For example, if the EMT-B with the package moved to Orange or Los Angeles counties, then he wouldn't be able to provide those interventions since those areas don't use that package.

I just went through the changes listed on the link. From what it looks like (I'm admitedly not that familiar with the scope of EMT-2s in California since they are extremely rare), the EMT-2 is somewhere between the current EMT-I/85 and EMT-I/99. Essentially the changes being made are bringing the EMT-2 down to the standardized AEMT level with the certification exam being moved to the NREMT in July 2013. From what I've read earlier, there may be a few interventions that the AEMT can provide that the current EMT-2s can't and they aren't looking at including those interventions at this time.

Based on the fact that AEMTs are still going to be considered a "limited advanced life support (LALS)" provider and an impact study has to be done if an agency wants to decrease service from ALS to LALS. As such, I highly doubt that the changes are going to mean much since most urban areas probably aren't going to accredited AEMT providers, even if it is a little easier now per statute. What I can possible see happening is some services looking at this as an EMT+ than a limited paramedic.

On an interesting side note, current EMT-2s in California will be able to keep their current scope of practice if the county allows them to work as one. So there's the possibility of California having a 4 tiered system, EMT, AEMT, grandfathered EMT-2s, and paramedics. If EMT-2s weren't limited to very rural areas (there are an entire 2 schools that produce EMT-2s in the entire state), then this could be confusing. However it is essentially a non-issue.

Edit:

Going through the EMT-B changes, a lot of the changes here appear to be more house keeping than anything else, especially with standardizing terms (good bye EMT-1 and EMT-2 terms). That said, they are getting rid of the stupid supervised manual defibrillation optional skill. It also looks like the state is getting rid of the medication package currently used in San Diego. http://www.emsa.ca.gov/about/files/EMT2010/Ch2EMTRegsApprovedByEMSComm.pdf Bottom of page 17 to bottom of page 19.


Edit 2: It looks like California is also introducing a central registry for EMS providers
http://www.emsa.ca.gov/about/files/EMT2010/Ch10CentralRegisryApprovedByEMSComm.pdf

 

[MrBrown]

Sounds awfully confusing.

To give you an idea of how we are working down here at the moment we are moving from five levels (first responder, BLS, IV/Cardiac, ILS and ALS) to three; essentially eliminating first responders and the IV/Cardiac level.

Nobody new is allowed to practice at the two old levels but people at those levels have till 2012 to either go up to Technician (BLS) or Paramedic (ILS) or they will be automatically moved down. If you are an IV/Cardiac level Officer come 2012 and have not upskilled to Paramedic (ILS) you get moved to Technician (BLS) and if you are a First Responder you essentially become nothing. In other words they cannot keep an old scope of practice beyond 2012.

If you want to become a Paramedic (ILS) after 2012 you must do the Bachelors Degree and if you wish to become an Intensive Care Paramedic, you must do the Post Graduate Certificate.

Paramedic in this part of the world means what you might call a super-Intermediate in the US and Intensive Care Paramedic is ALS. Paramedics here can do 12 leads, cardiovert, all Technician drugs plus IV adrenaline, analgesia, anti-emetic, naloxone etc whereas Intensive Care has things like ketamine, midazolam, pacing, intubation, some have RSI etc.

 

[eveningsky339]

:wacko:

How about this:

EMR (current EMT-B)
EMT (current EMT-I/85)
Paramedic (current EMT-P)

 

[EMSLaw]

This has all been worked out in the new scope of practice model, no? Why reinvent the wheel - again.

 

[LucidResq]

This level of care sounds a lot like the EMT-B with IV approval in CO.

EMT-Bs can use Kings and Combitubes, the caveat in the Colorado Board of Examiners Rules that define authorized medical acts for EMTs define these as "Medical skills and acts not specifically addressed in the National Standard EMT Curricula and additional local training is recommended. As such, medical directors shall ensure that individuals performing these skills and acts obtain appropriate additional training." However, these are now commonly taught in the initial EMT-B program.

Nitro (patient assisted), aspirin, albuterol MDIs (patient assisted), and epinephrine autoinjectors are all allowed for EMT-Bs and taught in EMT class.

With a simple class of a minimum of 24 class hours, plus 10 successful sticks, 8 of which acquired on actual patients through clinical time, an EMT-B gains IV approval. Allowed medications are crystalloids, IV dextrose and intranasal or IV naloxone.

 

[JPINFV]

This has all been worked out in the new scope of practice model, no? Why reinvent the wheel - again.

...because they can?