Advanced medical emergency technician (AEMT) is a mid-level pre-hospital emergency medical service provider in the United States; the transition to this level of training from Emergency Medical-Intermediate (EMT-I ), which has little training, begins in 2013 and has been implemented by most states. at this time. The AEMT is not intended to provide definitive medical care in most cases, but rather to add critical pre-hospital care and provide prompt on-site treatment. AEMTs are most commonly used in ambulance services, in collaboration with EMTs and paramedics, but are also commonly found in firefighting departments as first non-conveyance responders. AEMT is empowered to provide a limited life support, which is beyond the scope of EMT.
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Education and training
Advanced EMT should be certified as EMT before seeking certification as AEMT in most states. However, in some countries AEMT is the introductory level and may not require prerequisites. Certification as AEMT involves classes that last from three to six months, the required referrals, curricula that are largely outlined by NAEMT but can vary slightly from one state to another. The AEMT training is organized at the state and federal level. At the federal level, the National Highway Traffic Safety Administration (NHTSA) has developed a minimum content and clock curriculum, known as the National Standard Curriculum, but this is not binding on the state. Along with class time, AEMT students are required to complete several hours of clinical experience in an ambulance of continued life support or other ALS environments such as emergency departments. During these clinical hours, AEMT students must successfully demonstrate practical knowledge of the skills learned. After completing all classes and hours of practical skills, AEMT students must successfully pass a standard psychomotor and cognitive assessment before they can be certified.
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EMT-I/85
EMT-I/85 is the EMT-I training level formulated by the National Registry of Emergency Medical Technicians in 1985. This level of training includes more invasive procedures than those covered by the EMT-Basic level, including IV therapy, the use of advanced therapy. airway devices, and provide advanced assessment skills. EMT-I/85 is usually given the same drug as EMT-B (oxygen, oral glucose, activated charcoal, epinephrine auto-injector (EpiPens), nitroglycerin, and measured dose inhalers such as albuterol). However, in some countries they are also allowed to manage naloxone, D50, and glucagon. Like all other EMT levels, the scope of their practice is governed by their country and/or Medical Director.
EMT-I/99
The EMT-I/99 level is the nearest certification level for paramedics, and allows many techniques not available for EMT-I/85 or EMT-Basic. These techniques include needle decompression from tension pneumothorax, endotracheal intubation, nasogastric tube installation, use of cardiac/EKG card monitors, and drug administration to control certain cardiac arrhythmias.
Advanced EMT
Advanced EMT or AEMT is a new mid-level EMS provider that has been introduced at the national level in accordance with the new national EMS scope practice model. AEMT replaces EMT-I/85 and EMT-I/99, but some countries continue to teach the same level, but they are not nationally recognized. The new scope comprises all EMT level skills, basic airway management and supraglottic airway insertion, intubated intubation of patients, use of CPAP devices, initiation of peripheral intravenous therapy, pediatric and adult intraosseous placement and some pharmacologic interventions outside the EMT Level. These pharmacological interventions include administration
- Non-drug intravenous fluids (eg 0.9% normal saline)
- Sublingual Nitroglycerin
- Epinephrine 1: 1,000 for anaphylaxis and Epinephrine 1: 10,000 for cardiac arrest
- Dextrose 50%, 25% dextrose, and glucagon for hypoglycemia
- Nalokson for opioid overdose
- Nitrous oxide for pain management
- Inhaled beta-agonist drugs (eg albuterol and ipratropium) for respiratory distress caused by asthma, COPD, etc.
Other countries may use different names for those mentioned above and often have a scope of practice beyond the minimum national standards. EMT-I/99 has a total of three recertification cycles to meet the transition requirements to the paramedical level, while EMT-I/85 has two recertification cycles to transition to AEMT.
Scope of practice
In addition to the standards set by the US Department of Transportation (DOT), some countries issue licenses for a more specialized level of training. The minimum psychomotor scope at the national level for AEMT includes
Alaska has EMT-II, which is very similar to the I/85 standard, and EMT-III, which is closer to the I/99 standard. The sponsoring physician can extend the EMT-III scope beyond the country-defined protocol by providing additional training and quality control measures. This means that additional drugs and procedures (including suture) can be performed by properly trained EMT-III. The EMT-III program is a short-lived program, and generally does not accept reciprocity with other countries.
California uses EMT designation equivalent to national EMT-Basic, and advanced EMT, which is mid-level or limited secondary life support, followed by paramedics, ALS levels.
Iowa EMT-Basics can manage EpiPen per protocol, incorporate Combitube, and regulate and maintain (but not start) untreated infusions as well as all other basic skills. EMT-Intermediates can form IV in addition to EMT-Basic skills. The Iowa's paramedics are NREMT-Intermediate/99 and not the highest-level treatment in Iowa. This allows them to insert ET tubes and perform needle decompression, manual defibrillation and drug administration. The Iowa Paramedic Specialist is NREMT-Paramedic. Iowa also has Critical Care support for Paramedic Specialists.
Massachusetts acknowledged the level of DOT EMT-B, AEMT, and EMT-P. EMT-Intermediates in Massachusetts follow the same protocols as EMT-Basic, but are allowed to initiate IVs, perform fluid resuscitation, perform ALS assessments, and incorporate advanced air ducts such as endotracheal tubes, Combitubes, and laryngeal mask airways. Intermediate levels in Massachusetts have been removed and replaced by EMT-Advanced; But most of the scope of practice remains the same.
Maine recognizes three levels, EMT Basic, EMT-Advanced, and EMT-Paramedic. EMT-Advanced in the state of Maine can provide many different treatments including IV therapy, ECG monitoring, 12 EKG lead placement, dextrose (D50), glucagon, and other medicines. Advanced EMT can also place the laryngeal mask breathing apparatus device and use CPAP when needed. Some treatments and medications require consultation with an online medical direction.
Michigan uses the National AEMT Registry check, but does not require ongoing national registration when AEMT updates.
New York State has AEMT-CC (Advanced EMT-Critical Care) certification, unique to New York, and more advanced than nationally recognized AEMT. In addition to the national practice sphere, New York also authorizes AEMT-CC to intubate patients and perform three lead ECG monitoring as well as twelve leads in certain countries, in addition to providing cardiovascular and cardiovascular medications, including cardioversion. In recent years, New York has expanded the AEMT-CC level to include certain narcotics administration and some additional skills. In order to transition to national standards, NYS has introduced additional AEMT certifications that meet national standards by 2013. It remains to be recognized by its regional EMS board for the region to begin implementing its use. However, progress has stabilized, with the most recent area to receive a new certification level is Nassau County (located on Long Island). Nassau recognizes this level by mid-2017. By 2018, NYS will begin a 10-year phase of unique AEMT-CC certification levels. However, one should note that there is no recognized advanced EMT certification in New York City except in voluntary agencies such as Hatzalah EMS and Central Park Ambulance. One of them functions as an EMT-B or Paramedic in FDNY and an affiliated service.
Oklahoma recognizes the EMT-Cardiac level to date. However, such levels have been removed and providers in Oklahoma at the EMT-Heart level have since been trained and certified to the paramedical level or relegated to EMT-I.
Pennsylvania uses the National AEMT Registry exam, but does not require ongoing national registration when AEMT updates. The Pennsylvania scopec for AEMTs is similar to the national scope except that Pennsylvania does not allow AEMTs to administer intravenous nalaxone in Pennsylvania, AEMTs can not function independently and Paramedics should be called for every call where Care is required above the BLS level (even if the IALS provider is able to intervene )
The first level provider of Rhode Island ALS is EMT-Cardiac, unique to Rhode Island and Virginia. (Virginia recently discontinued the Cardiac Tech program.) EMT-C is a certification between EMT-I and EMT-P, enabling the use of more heart medications than EMT-I, but less than EMT-P. The time and cost of the EMT-C program is generally less than one-third of the EMT-P program. EMT-C or higher licenses may be required by the Rhode Island fire department, which provides emergency medical services in most states.
Tennessee EMT is licensed in the EMT-IV (Intravenous Therapy) Level or EMT-Paramedic Level. EMT-IV is trained for NREMT-B standards in accordance with DOT regulations, as well as receiving additional training in advanced airway management, 1: 1000 epinephrine administration in anaphylaxis, administration of nebulized beta-2 agonists and aerosols such as Xopenex and albuterol, administration of D50W and D25W, therapy and IV access, and support of trauma life including the use of MAST pants. EMT-IV may also provide nitroglycerin and aspirin in the event of a cardiac emergency, and may provide glucagon. EMT-IVs can also set the Mark 1 automatic injector kit for the suspected organophosphate poisoning and suspected nerve gas exposure. The State of Tennessee Board of EMS is currently evaluating allowing EMT-IV to manage naloxone and nitrous oxide as well. The Board has received new levels of EMR, EMT, EMT-Advanced, and Paramedic. Gap analysis has been completed by the state and the board has moved to allow up to 4 years for EMT-IV to transition to EMT-Advanced through an eight-hour course, choosing to let all EMT-IV and Paramedics below the current standards updated as usual for this cycle.
In Virginia, the first level of ALS is EMT-Enhanced (formerly Shock Trauma), which is unique to Virginia. This is basically equivalent to EMT-I/85. EMT-Enhanced can start IV channels, perform dual-lumen airway insertion, and manage some drugs such as D50W, glucagon, albuterol, epinephrine, and sometimes narcotics. They can not, however, administer any cardiac medication. The next level of ALS is EMT-Intermediate, which is equivalent to I/99 certification level. In most areas, EMT-I operates under the same protocol as EMT-Paramedic. There are several procedures that paramedics can only do, including rapid sequence intubation, surgical cricothyrotomy, and needle cricothyrotomy. Virginia ends Cardiac Tech level and replaces it with Intermediate level.
In Washington state, the EMT-Basic protocol is similar to that in Iowa. EMT-B certified personnel can manage EpiPen per state protocol and can enter Combitube. The Washington EMT-B can manage and maintain untreated IVs, but EMT-I certification is required to start IV.WA Office of Emergency Medical and Trauma System (May 2009) Some regional protocols (such as Jefferson) receive EMT/ILS Tech which, in addition to all EMT-I and EMT-B skills, can manage D50W, naloxone, albuterol, and now can compose epinephrine in addition to using EpiPen.
Wisconsin offers EMT-IV-Technician certification for EMT-Basic, which enables them to start basic IV lines, treat hypovolemic shock, and manage naloxone, D50W, and a limited number of other drugs. This level of training is often used in non-urban areas where hospitals may be sparse and sophisticated life support buffs or aeromedical transport can take a lot of time. In addition, some private ambulance companies employ EMT-IV Technicians for transport interfacility requiring only IV therapy and do not require special care of paramedics.
See also
- Emergency medical emergency response by state
- National Registration of Emergency Medical Technician
- National Association of Emergency Medical Technicians
- Emergency Medical Services in the United States
- Emergency medical technician Wilderness
- Medika
- Battle Officer
- Corpsman
- 68W
- Rescue team
- Pararescue
References
External links
- National Registration of Emergency Medical Technician
- National Association of Emergency Medical Technicians
- National EMS Warning Service
- National Highway Traffic Safety Agency, Office of Emergency Medical Services
- The Difference Between EMT and Paramedic
- EMT City, a great community for EMT and Paramedic
Source of the article : Wikipedia
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