Advanced EMTs - lost in the crowd?

Note: not a bitch session, just something that's been percolating in my forebrain for awhile

To the general public, there are consciously aware of two types of emergency medical service professionals: emergency medical technicians (EMT), and paramedics.  According to the National Registry of Emergency Medical Technicians (NREMT), the organization responsible for maintaining the standards for training and certification, there are actually 4 levels of EMS certification.  These are, in ascending order:

• Emergency Medical Responder (EMR)
• Emergency Medical Technician (EMT)
• Advanced Emergency Medical Technician (AEMT)
• Paramedic

EMRs are first responders, trained in essentially advanced first aid techniques.  They are not very common here in the US, but most police and some industrial workers are usually trained to this standard.

EMTs are the backbone of EMS in many communities in the US.  Most fire departments (including the departments here in the Las Vegas area), require firefighter recruits to possess EMT certification before they even start academy.  In many rural areas they are the only EMS workers that staff the ambulances to provide patient transport to the hospital.  EMTs are trained in providing basic life support (BLS) medical care, and generally do not perform any invasive procedures other than doing a finger-stick to check blood glucose levels.  They can provide oxygen, operate an automated external defibrillator (AED), assess and treat minor injuries, and transport the patient to the hospital for advanced care. 

AEMTs (like myself), can do the same level of stuff as EMTs do, but we have a little more capabilities that we can bring into play, which include:

• Starting IVs on patients.
• Use certain advanced airways (those that don't require you to see the person's throat).
• Administer some medications (e.g. nalaxone (Narcan), diphenhydramine (Benadryl), glucagon, dextrose 50% solution (D50), epinephrine 1:1000, albuterol, and Solu-Cortef. In some jurisdictions,  AEMTs can administer nitrous oxide for pain management (unfortunately not here).
• In some areas, AEMTs can do intraosseous (IO) fluid administration on pediatric patients; here in the county, they can do IOs on unconscious adult patients under certain circumstances, but not on pediatric patients. 

Paramedics are at the top of the EMS food chain, with the ability to do a wide variety of tasks including 12-lead EKGs, cardiac pacing, cricothyrotomies, intubations, administer narcotics for pain management, and other medications for cardiac and anti-seizure among others.  They have the longest course of study, which can average anywhere from 15-24 months depending on schedule, and in most instances you can earn an associates degree in paramedicine.  From there they can branch out into specializations such as flight medics, critical care transport, and community paramedicine.  Some take the plunge and become RNs or even physicians.  US Army Green Beret medics and Air Force Pararescuemen are trained to paramedic levels and beyond as part of their extensive course of study.

So yes it seems wonderful and exciting, and truth be told it is to me.  But often I wind up seeming to be a little short-changed in some ways, namely the face that the general public are not often familiar with the fact that AEMTs exist and usually get classified as either EMTs or paramedics.

Well, part of the reasons for this is that statistically AEMTs are not very numerous overall (about 4% of total certifications per the NREMT), and some states do not license them at all (Florida and California for example).  There has been some commentary that AEMTs are unnecessary and confusing to the public and should not be part of the EMS system.

My own two cents on this is that AEMTs do provide a niche service to the public, with the ability to provide limited advanced care that would often help stabilize a patient until they get to more comprehensive care at the hospital.  They are often the most advanced field care provider in many areas that do not have the financial or logistical means to provide paramedics.

I chose to be an AEMT as I felt that it would provide an extra layer of skills I can utilize to provide patient care when necessary.  About 98% of the time I usually just do the basics anyway, and it's just nice to have the extra available when needed.  Besides, to attend paramedic training and be successful requires you to be financially independent and a bit of a hermit to get through the material.

For those that want to read more about an example of the trials of becoming a paramedic, I definitely recommend that you read Kevin Grange's book 'Lights and Sirens', which describes the author's experiences of attending UCLAs paramedic training program.

Would I want to become a paramedic?  If the money and time are there, yes I probably would.  But for now I am happy with the level I am at.