What IS the role of the AEMT?

[medicdan]

As more states work to implement the AEMT education and SOP standard as an addition to, then replacement to I/85, I'm hoping to learn more about how it's used elsewhere.

We have relatively few Is and they are used almost exclusively in rural or semi-rural towns, for Fire departments that may have extended response times for medics or privates to staff P/I (cost savings, I guess). It looks like the state may embrace the national education standard recommended SOP for As (IVs, IOs, Dextrose, Glucagon, Narcan, Albuterol, IM Epi for anaphylaxis, ASA, NTG, fluids).

How have your states, counties or regions used the AEMT level? I know some areas mandate it as the minimum education standard (Georgia comes to mind). Has your area used them mostly for rural departments? Staffing with paramedics? E/A trucks? How have your states expanded the SOP? How have privates used AEMTs for non-emergency transfers?

 

[bw2529]

My region has just done away with AEMT-Is and AEMT-CCs. They now only recognize EMT-Bs and EMT-Ps.

My agency (volunteer, 911) used to have a couple very active very good CCs, but they've now been forced to take the paramedic exam or drop down to basics. Fortunately they went the former route, rather than dropping down to Bs or out entirely. So now they are very active very good Ps.

We only had a couple Is. One has stopped running ambulance altogether and is recerting as a B for FD purposes and the other is in the process of moving up to P.

I think it is a shame. There is a huge jump from B to P and now there are no steps in between. I really would've liked to step up to I, then to P eventually, but now I'll probably wait much longer to start moving up due to the changes. As a volunteer with a full time job outside of EMS, and working towards a line officer position with the FD to boot, it is very difficult to imagine finding the time to make the leap from B to P.

Sorry if this was a little ranty/off topic.

 

[frdude1000]

I am an AEMT in Georgia. I work in a non-traditional role on a first response truck but I can speak to the rest of metro Atlanta. Having experience in Maryland, GA has a much different attitude towards EMS. Everything is held to a high standard and there is a lot of bureaucracy involved. EMT level is basically non-existant except for some of the more rural FD's. In order to be on a transporting unit, it is going to be EMT/I-85 or AEMT and above.

 

[emt11]

I am an AEMT in Georgia. I work in a non-traditional role on a first response truck but I can speak to the rest of metro Atlanta. Having experience in Maryland, GA has a much different attitude towards EMS. Everything is held to a high standard and there is a lot of bureaucracy involved. EMT level is basically non-existant except for some of the more rural FD's. In order to be on a transporting unit, it is going to be EMT/I-85 or AEMT and above.

That pretty much sums it up. Though I'll add in our state SOP. If you would like, PM me and I can send you a copy of my companies protocols as we run a I'85/AEMT/Paramedic system.

http://dph.georgia.gov/ems-procedures-forms-applications-resource-documents

Just scroll down a little and click on the AEMT only.

 

[unleashedfury]

we do not have AEMT or EMT-I in Pennsylvania. There has been discussion on rolling out such a program. but its been kicked around for so long who knows when it will ever take effect.

From what I gather of it EMT-I's are the standard BLS in some states, Which I could see the benefit.

But I could also see alot of smaller squads like around where I live that do maybe 200 calls a year shuttering their doors. due to higher education costs and the costs of carrying extra supplies that may expire long before they get used.

 

[medicsb]

Generally, it i my hope that the AEMT will replace most paramedics and many EMTs. But, I'm not holding my breath.

 

[unleashedfury]

Generally, it i my hope that the AEMT will replace most paramedics and many EMTs. But, I'm not holding my breath.

IMO, I think once the PADOH gets the AEMT program up and running I see it taking at least 10 years to have any effect.

How many BLS providers that have been EMT-B's since the 80's are willing to go back to school to move up or move out. How many squads are gonna resist the changes and avoid the upgrade kicking and screaming to the last minute.

I could see it beneficial especially in Rural Pa, where wait times to EMS or ALS is half hour or more. It could also help alleviate the issues we currently face with a strained system.

 

[Mariemt]

We do not have any on our squad but would love to see some. Emtb can no longer monitor iv fluids. Which sucks in our area due to a lot of IFT. So our few medics can be tied up transferring a stable pt.
Most of the time the hospital with put a hep lock in but not always .

 

[Onsite Innovations Medic]

AEMT is used in NY as an advanced EMT or as suffolk county calls in an EMT - CC or critical Care. We tossed the EMT - I A couple of years ago. EMT-CC is like a medic with less school, rotations, and $8,000.00 more in your pocket.

 

[Christopher]

I think it is a shame. There is a huge jump from B to P and now there are no steps in between.

There are no real need for any intermediate steps between B and P in reality. Perhaps we should have steps between the educational level of current P's and the interventional scope of practicing P's.

I really would've liked to step up to I, then to P eventually, but now I'll probably wait much longer to start moving up due to the changes. As a volunteer with a full time job outside of EMS, and working towards a line officer position with the FD to boot, it is very difficult to imagine finding the time to make the leap from B to P.

I's provide little practical benefit besides IV dextrose administration (which is what I believe is the only reasonable benefit known at that level). No improvement in education, simply the addition of skills without a known benefit to our patients.

As far as teasing out the education/time requirement for volunteers...I'm sympathetic to that side. I worked more than full time while attending paramedic school and understand where you're coming from. Our educational requirements in EMS are lax enough as it is, so I'm not certain this can be avoided by offering a middle step.

 

[EpiEMS]

The idea of the AEMT is pretty reasonable: it's to provide high-benefit, low-risk "advanced" interventions, per the National EMS Scope of Practice Model (http://www.ems.gov/education/EMSScope.pdf). For those who haven't read it, I strongly suggest it, as it clarifies a lot of issues that are only addressed at a high level elsewhere.

Having an 'intermediate' level between EMT and Paramedic is very reasonable if you envision the EMT and AEMT as technicians and the paramedic as an allied health professional. Not only does it provide a "bridge", but it allows smaller or less-well-off areas to provide care that may be of a high benefit. That being said, I see AEMT as potentially problematic if you want a fully professionalized EMS -- if anything, in such a system, what we call AEMT would need to be the entry level, something closer to the Canadian system in the metropolitan areas.

 

[Christopher]

The idea of the AEMT is pretty reasonable: it's to provide high-benefit, low-risk "advanced" interventions, per the National EMS Scope of Practice Model (http://www.ems.gov/education/EMSScope.pdf). For those who haven't read it, I strongly suggest it, as it clarifies a lot of issues that are only addressed at a high level elsewhere.

I've read it and it is hardly convincing that AEMT is a required level of care. The only skills that are not EMT level (at least in my state) are IV/IO, fluids, glucagon, D50, and nitrous....yawn.

Not a worthwhile addition to EMT.

 

[EpiEMS]

I've read it and it is hardly convincing that AEMT is a required level of care. The only skills that are not EMT level (at least in my state) are IV/IO, fluids, glucagon, D50, and nitrous....yawn.

Not a worthwhile addition to EMT.

In the context of the National scope, excluding all state-specific factors, I found it reasonable. If the National scope were truly that, then it makes a lot of sense. These aren't high-risk interventions, and they can be beneficial at fairly low cost.

On top of the EMT, in a rural area with long transport times, absent ALS, this "limited ALS" or "ILS", if you prefer, can be beneficial with fairly low cost.

 

[unleashedfury]

In the context of the National scope, excluding all state-specific factors, I found it reasonable. If the National scope were truly that, then it makes a lot of sense. These aren't high-risk interventions, and they can be beneficial at fairly low cost.

On top of the EMT, in a rural area with long transport times, absent ALS, this "limited ALS" or "ILS", if you prefer, can be beneficial with fairly low cost.

This is where I could see the ILS beneficial where locations that cannot afford to maintain a ALS truck and one is far far away.

OTOH ASA and NTG can warrant ECG changes that could prevent a patient being appropriatley triaged as for experiencing a MI at the moment. So if were gonna give Cardiac meds shouldn't at least 12 Lead ECG tracing to be sent to the recieving ED be completed in cohorts with Medical Direction before administering said drugs?

 

[Tigger]

This is where I could see the ILS beneficial where locations that cannot afford to maintain a ALS truck and one is far far away.

OTOH ASA and NTG can warrant ECG changes that could prevent a patient being appropriatley triaged as for experiencing a MI at the moment. So if were gonna give Cardiac meds shouldn't at least 12 Lead ECG tracing to be sent to the recieving ED be completed in cohorts with Medical Direction before administering said drugs?

I don't believe ASA has ever been shown to alter 12 leads. I have no issues with "ALS-lite" being more reliant on transmission and consultation with ED physicians given the lack of education.

 

[EpiEMS]

I have no issues with "ALS-lite" being more reliant on transmission and consultation with ED physicians given the lack of education.

I tend to think the major problem with the "ALS-lite" is when it turns into what parts of New York State, for example, have: systems where personnel are performing much higher risk procedures with less education than might be considered optimal (not that EMS in the US is anywhere near optimal) in areas that have higher standards. A very tightly linked issue is the "good enough" mindset, the "why do we need full ALS when ILS can do all that" or, in NYS, "why do we need medics when we have AEMT-CCs?" and this can prevent system-wide improvement, I'd say.


For those who don't like the idea of the AEMT, would you say that it should be done away with, or that, say, the AEMT scope and education should become the EMT level, which would "go away" (perhaps be folded into EMR as we move into the Canadian mold)? Or is there another alternative?