Advanced emergency medical technician
An advanced emergency medical technician (AEMT) is a provider of emergency medical services in the United States. A transition to this level of training from the emergency medical technician-intermediate, which have somewhat less training,[1] began in 2013 and has been implemented by most states. AEMTs are not intended to deliver definitive medical care in most cases, but rather to augment prehospital critical care and provide rapid on-scene treatment. AEMTs are usually employed in ambulance services, working in conjunction with EMTs and paramedics; however they are also commonly found in fire departments and law enforcement agencies as non-transporting first responders. Ambulances operating at the AEMT level of care are commonplace in rural areas, and occasionally found in larger cities as part of a tiered-response system, but are overall much less common than EMT- and paramedic-level ambulances. The AEMT provides a low-cost, high-benefit option to provide advanced-level care when the paramedic level of care is not feasible. The AEMT is authorized to provide limited advanced life support, which is beyond the scope of an EMT.
Education and training[edit]
Advanced EMTs must be certified as EMTs prior to seeking certification as AEMTs in most states. However, in some states AEMT is the introductory level and may not require prerequisites.[1] Certification as an AEMT involves a class lasting from three to six months, the curriculum for which is largely outlined by the NAEMT but can vary slightly from state to state. AEMT training is regulated at both the state and federal level. At the federal level, the National Highway Traffic Safety Administration (NHTSA) has developed a minimum content and hour curriculum, known as the National Standard Curriculum, but this is not binding on the states. Along with classroom time, the AEMT student is required to complete several hours of clinical experience in an advanced life support ambulance or other ALS environment such as an emergency department. During these clinical hours, the AEMT student must successfully demonstrate full practical knowledge of skills learned. Upon completion of all classroom and practical skills hours, AEMT students must successfully pass a standardized psychomotor and cognitive assessment before they can be certified.
AEMTs are trained to provide Intermediate Life Support.Some states use terms such as limited advanced life support (LALS) to differentiate between the paramedic and AEMT scope of practices.
Historical[edit]
In the 1970s as EMS levels were being designated, the NREMT issued certifications at only two levels; EMT-ambulance and EMT-paramedic. During the late 1970s and early 1980s some states started their own designations at levels in-between EMT-A and EMT-P. In the early 80s, the NREMT Board of Directors adopted a new national certification; EMT-Intermediate, based on several state's recommendations. In 1985 the Department of Transportation developed the first national standard curriculum for this new level of EMT/intermediate. The 1985 course provided advanced knowledge and mainly three "advanced interventions" (at that time); IVs, MAST trouser application and use of the esophageal obturator airway. Simply stated, EMT-I care centered on trauma patients. Soon after 1985 some states started adding "enhancements" (skills) to the intermediate and others adopted a more expansive level called "cardiac care" which included some ACLS drugs. In 1994 a blue ribbon panel of EMS stakeholders gathered and endorsed the EMS Education and Practice Blueprint. That blueprint was to resolve the fragmented levels of intermediates used across the nation. In 1999 the Department of Transportation, based upon the blueprint, developed a national standard curriculum for the EMT-intermediate. Immediately it ran into political opposition and the National Association of State EMS Directors (now the National Association of State EMS Officials) asked the NREMT board to continue to offer intermediate certifications at both the former (I-85) and the new (I-99) designated levels.[2]
EMT-I/85[edit]
EMT-I/85 is a level of EMT-I training formulated by the National Registry of Emergency Medical Technicians in 1985. This training level includes more invasive procedures than are covered at the EMT-Basic level, including IV therapy, the use of advanced airway devices, and provides for advanced assessment skills. The EMT-I/85 typically administered the same medications as an EMT-B (oxygen, oral glucose, activated charcoal, epinephrine auto-injectors (EpiPens), nitroglycerin, and metered-dose inhalers such as albuterol). However, in some states they were also allowed to administer naloxone, D50, and glucagon. Like all other EMT levels, their scope of practice was governed by the state or their medical director.
EMT-I/99[edit]
The EMT-I/99 level was the closest level of certification to paramedic, and allowed many techniques not available to the EMT-I/85 or EMT-basic. These techniques included needle decompression of a tension pneumothorax, endotracheal intubation, nasogastric tube placement, use of cardiac event monitors/ECGs, and administering medication to control certain cardiac arrhythmias.
The advanced EMT or AEMT is the new mid-level EMS provider that has been introduced at the national level according to the new national EMS scope of practice model.[3] The AEMT replaced the EMT-I/85 and EMT-I/99, however some states have continued to teach similar levels, but they are not nationally recognized. The new scope consists of all EMT level skills, basic airway management and the insertion of supraglottic airways, suctioning of an already intubated patient, usage of a CPAP device, initiation of peripheral intravenous therapy, pediatric and adult intraosseous placement and several pharmacological interventions beyond the EMT level.[3] These pharmacological interventions include administering
Other states may use different names for the above and often have a scope of practice beyond the minimal national standards. The EMT-I/99 had a total of three recertification cycles to meet the requirements to transition to the paramedic level, while the EMT-I/85 had two recertification cycles to transition to the AEMT.[4]