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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.
490:
administration of nebulized and aerosolized beta-2 agonists such as
Xopenex and albuterol, administration of D50W and D25W, IV therapy and access, and trauma life support including the use of MAST trousers. EMT-IVs can also administer nitroglycerin and aspirin in the event of cardiac emergencies, and can give glucagon. EMT-IVs can also administer the Mark 1 auto injector kit for organophosphate poisoning and suspected nerve gas exposure. The State of Tennessee Board of EMS is currently evaluating allowing EMT-IVs to administer naloxone, nitrous oxide as well as intraosseous infusions (IOs). The board has accepted the 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 four years for the EMT-IV to transition to EMT-advanced by way of an eight-hour course, choosing to let all EMT-IVs and paramedics under the current standard be renewed as usual for this cycle.
504:, the first level of ALS is advanced EMT. The AEMT certification replaced the EMT-enhanced, unique to Virginia, starting in 2013 and fully replaced in the EMT-E certification in 2016. The EMT-E was essentially equivalent to the EMT-I/85 and could start IV lines, perform dual-lumen airway insertion, and administer some medications such as D50W, glucagon, albuterol, epinephrine, and sometimes narcotics, but could not administer any cardiac medications. The next level of ALS is EMT-intermediate, which replaced the EMT-cardiac technician beginning in 2002, and is equivalent to the I/99 level of certification. In most jurisdictions, the EMT-I operates under the same protocols as a paramedic. There are a few procedures that only EMT-intermediates cannot perform, including
434:(advanced EMT - critical care) certification, which is unique to New York, and is more advanced than a nationally recognized AEMT. In addition to the national scope of practice, New York also authorizes its AEMT-CCs to intubate patients and do three lead ecg monitoring as well as twelve lead in certain counties, in addition to providing certain cardiac medications and cardiac care, including cardioversion. In more recent years, New York has expanded its AEMT-CC level to include the administration of certain narcotics and some additional skills. In order to transition to the national standard, NYS has introduced an additional
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1:1000, and
Albuterol. This level of training is often used in rural areas where hospitals may be sparse and advanced life support intercepts or aeromedical transports can take a great deal of time. Additionally, some private ambulance companies employ advanced EMTs for interfacility transports which only require IV therapy and do not necessitate the specialized advanced care of a paramedic.
33:
482:
first-level ALS provider is EMT-cardiac, which is unique to Rhode Island. The EMT-C is a certification between the EMT-I and EMT-P, allowing the use of more cardiac drugs than the EMT-I, but fewer than the EMT-P. The time and cost of an EMT-C program is generally less than one third that of an EMT-P
219:
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
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has an EMT-II, which is very similar to the I/85 standard, and the EMT-III, which is closer to the I/99 standard. A sponsoring physician can broaden the scope of an EMT-III beyond state-defined protocols by providing additional training and quality control measures. This means that additional drugs
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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,
380:
EMT-basics can administer EpiPen per protocol, insert a combitube, and set up and maintain (but not start) an IV that is non-medicated as well as all other basic skills. EMT-Intermediates can establish IVs in addition to the EMT-basic skills. An Iowa paramedic is a NREMT-intermediate/99 and is not
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EMTs are licensed at either the EMT-IV (intravenous therapy) level or the EMT-paramedic level. EMT-IVs are trained to the NREMT-B standard in accordance with DOT regulations, as well as receive additional training in advanced airway management, administration of epinephrine 1:1000 in anaphylaxis,
352:
licenses EMS providers at the levels of EMT, AEMT, and paramedic, following the NREMT guidelines for these levels. In addition to the
National Scope of Practice, AEMTs in Arkansas can start Intraosseous infusions in adults and provide CPAP to patients with pulmonary edema. AEMTs in Arkansas are
322:
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
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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. 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
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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. Certification as an AEMT involves a class lasting from three to six months, the curriculum for which is largely
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uses the
National Registry AEMT examination, but does not require continued national registration when an AEMT renews. The Pennsylvania scope of practice for AEMTs is similar to the national scope except Pennsylvania adds: diphenhydramine (IV/IO/PO only), epinephrine 1:10,000 (for cardiac arrest
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offers licensure at the advanced EMT level. This allows providers to start peripheral IV lines, pediatric and adult IO lines, treat for hypovolemic shock, and administer naloxone, D50, D25, normal saline, D5W, D10W, D15W, Narcan, Tordol, Zofran, Tylenol, aspirin, glucose, glucagon, epinephrine
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recognizes the DOT levels of: EMT-basic, advanced EMT, and paramedic. EMT-intermediates in
Massachusetts followed the same protocols as the EMT-basics, but were allowed to start IVs, perform fluid resuscitation, perform an ALS assessment, and insert advanced airways such as endotracheal tubes,
228:
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
191:(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
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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
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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
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recognizes the four levels of EMS provider, EMR, EMT, AEMT and paramedic. All four level of EMS provider are required to enter based on NREMT exams. In 2017, all "AEMTs" (which were essentially EMT intermediate 85s) were required to either complete current AEMT training and obtain NREMT
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the highest level of care in Iowa. This allows them to insert ET tubes and perform needle decompressions, manual defibrillations and medication administrations. The Iowa paramedic specialist is the NREMT-paramedic. Iowa also has a critical care endorsement for paramedic specialists.
145:, which have somewhat less training, 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
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certification that meets national standard as of 2013. It still must be recognized by its regional EMS councils in order for those regions to begin implementing its use. However, progress has been steady, with the most recent county to accept the new level of certification being
523:, EMT-basic protocols are similar to those in Iowa. Certified EMT-B personnel can administer EpiPen per state protocols and can insert a combitube. The Washington EMT-B can set up and maintain an IV that is non-medicated, but EMT-I certification is required to start the IV.
516:. In 2020, Virginia began phasing out the EMT-I. Existing EMT-intermediates may continue to practice and maintain their certifications indefinitely, but no new certifications are issued. ALS certifications are now limited to either AEMT or paramedic.
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becoming more commonplace, especially in areas where 911 service has been traditionally provided by BLS-level services. AEMTs and paramedics in
Arkansas are allowed to provide advanced interventions when off-duty, if in their normal coverage area.
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Some county protocols (such as
Jefferson) accept an EMT/ILS tech which, in addition to all EMT-I and EMT-B skills, can administer D50W, naloxone, albuterol, and can now draw up epinephrine in addition to using an EpiPen.
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device, initiation of peripheral intravenous therapy, pediatric and adult intraosseous placement and several pharmacological interventions beyond the EMT level. These pharmacological interventions include administering
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and procedures (including wound suturing) can be accomplished by an appropriately trained EMT-III. The EMT-III program is a short upgrade program, and does not generally receive reciprocity with other states.
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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
447:). Nassau recognized this level in mid-2017. In 2018, NYS began a 10-year phase-out of its unique AEMT-CC level of certification. However, no advanced EMT certifications are recognized in
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uses an EMT designation which is equivalent to the national EMT-basic, and advanced EMT, which is the intermediate level or limited advanced life support, followed by paramedic, ALS level.
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392:, and laryngeal mask airways. The EMT-intermediate level in Massachusetts has been phased out and replaced by the advanced EMT; however most of the scope of practice remained the same.
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recognized an EMT-cardiac level until recently. However, that level has been phased out and providers in Oklahoma at the EMT-cardiac level have since been trained and certified to the
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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
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except at volunteer agencies such as Hatzalah EMS and Central Park Ambulance. One either functions as an EMT-B or a paramedic within FDNY and affiliated services.
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program. EMT-C or higher licensure may be required by Rhode Island fire departments, who provide emergency medical services in the majority of the state.
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recognizes three levels, EMT basic, EMT-advanced, and EMT-paramedic. EMT-advanced in the state of Maine can provide many different treatments including
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high-benefit option to provide advanced-level care when the paramedic level of care is not feasible. The AEMT is authorized to provide limited
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but can vary slightly from state to state. AEMT training is regulated at both the state and federal level. At the federal level, the
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An advanced emergency medical technician ambulance with the Lafayette County Ambulance Service in Lafayette County, Arkansas
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Inhaled beta agonist medications (e.g. albuterol and ipratropium) for respiratory emergencies caused by asthma, COPD, etc.
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has a five-tier system, consisting of emergency care attendant, EMT-basic, advanced EMT, EMT-paramedic, and paramedic.
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uses the National Registry AEMT examination, but does not require continued national registration when an AEMT renews.
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monitoring, 12 lead EKG placement (however, an EMT-paramedic must interpret the cardiac rhythm), dextrose (D50),
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241:. Like all other EMT levels, their scope of practice was governed by the state or their medical director.
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when needed. Some treatments and medications require consultation with online medical direction.
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National Highway Traffic Safety Agency, Office of Emergency Medical Services
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211:) to differentiate between the paramedic and AEMT scope of practices.
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728:"Renewal Application for Use of Additional Medications or Procedures"
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1:1,000 for anaphylaxis and epinephrine 1:10,000 for cardiac arrest
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Advanced Emergency Care and Transportation of the Sick and Injured
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253:, endotracheal intubation, nasogastric tube placement, use of
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621:(Second ed.). Jones & Bartlett Learning. p. 5.
707:"NREMT - National Registry of Emergency Medical Technicians"
525:
WA Office of Emergency Medical and Trauma System (May 2009)
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certification at that level, or revert to the EMT level.
261:, and administering medication to control certain cardiac
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860:"MDCH - Personnel Licensure & Education Requirements"
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issue licenses for more specialized levels of training.
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Dextrose 50%, dextrose 25%, and glucagon for hypoglycemia
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760:"Emergency Medical Services Unit Forms and Applications"
706:
1068:
1063:
786:"RULES AND REGULATIONS FOR EMERGENCY MEDICAL SERVICES"
410:, and other medications. Advanced EMTs can also place
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National Association of Emergency Medical Technicians
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National Association of Emergency Medical Technicians
137:) is a provider of emergency medical services in the
294:(service-supplied without needing medical direction)
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283:Non-medicated intravenous fluids (e.g. 0.9% normal
196:cognitive assessment before they can be certified.
57:. Unsourced material may be challenged and removed.
1064:National Registry of Emergency Medical Technicians
550:National Registry of Emergency Medical Technicians
141:. A transition to this level of training from the
1096:EMT City, large community for EMTs and Paramedics
617:American Academy of Orthopaedic Surgeons (2011).
331:In addition to the standards established by the
1879:Emergency medical services in the United States
1673:International Federation for Emergency Medicine
560:Emergency Medical Services in the United States
1677:International Conference on Emergency Medicine
612:
610:
189:National Highway Traffic Safety Administration
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1084:The Difference Between an EMT and a Paramedic
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1693:Canadian Association of Emergency Physicians
1799:Care of the Critically Ill Surgical Patient
1688:Australasian College for Emergency Medicine
545:Emergency medical responder levels by state
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333:United States Department of Transportation
157:; however they are also commonly found in
839:"Emergency Medical Technician - Advanced"
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668:
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143:emergency medical technician-intermediate
117:Learn how and when to remove this message
1683:American College of Emergency Physicians
881:"FDNY How to become an EMT or Paramedic"
1703:European Society for Emergency Medicine
1026:Wisconsin Department of Health Services
606:
565:Wilderness emergency medical technician
66:"Advanced emergency medical technician"
1713:American Academy of Emergency Medicine
149:services, working in conjunction with
1201:Advanced emergency medical technician
1008:"Certification/Licensure Information"
814:"OEMS COMMUNICATIONS STATEMENT 18-06"
131:advanced emergency medical technician
7:
1708:Asian Society for Emergency Medicine
982:. Health.state.tn.us. Archived from
55:adding citations to reliable sources
1793:Advanced Life Support in Obstetrics
1698:Royal College of Emergency Medicine
952:"Official Web Site of Tiverton, RI"
472:, naloxone (IN/IM/IV/IO only), and
170:, which is beyond the scope of an
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1022:"Wisconsin EMS Scope of Practice"
1884:Emergency medical certifications
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1490:International emergency medicine
826:from the original on 2021-08-29.
676:"National EMS Scope of Practice"
31:
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1787:Pediatric Advanced Life Support
1500:Pre-hospital emergency medicine
203:.Some states use terms such as
42:needs additional citations for
1775:Acute Care of at-Risk Newborns
1769:Neonatal Resuscitation Program
461:level or downgraded to EMT-I.
1:
1757:Advanced cardiac life support
1740:Cardiopulmonary resuscitation
1074:National EMS Memorial Service
205:limited advanced life support
199:AEMTs are trained to provide
1874:Emergency medical responders
1781:Pediatric basic life support
1763:Advanced trauma life support
1746:Mouth-to-mouth resuscitation
1495:Pediatric emergency medicine
1196:Emergency medical technician
1186:Emergency medical dispatcher
1384:Critical emergency medicine
1302:Kendrick extrication device
1274:Nontransporting EMS vehicle
1264:Light horse field ambulance
1191:Emergency medical responder
1047:"קורס עזרה ראשונה באינטרנט"
1900:
1465:Emergency medical services
1132:Emergency medical services
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1171:Certified first responder
1138:
910:www.pacodeandbulletin.gov
883:. Nyc.gov. Archived from
681:. Ems.gov. Archived from
506:rapid sequence intubation
201:Intermediate Life Support
1640:Epinephrine / Adrenaline
1181:Emergency care assistant
793:www.healthy.arkansas.gov
323:transition to the AEMT.
163:law enforcement agencies
906:"Pennsylvania Bulletin"
932:. Barringtonrifire.com
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255:cardiac event monitors
178:Education and training
1821:Injury Severity Score
1592:Nasopharyngeal airway
1565:Intraosseous infusion
1153:Advanced life support
412:laryngeal mask airway
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168:advanced life support
1598:Oropharyngeal airway
1475:Emergency psychiatry
1460:Emergency department
1269:Motorcycle ambulance
1232:Air medical services
309:for opioid overdoses
251:tension pneumothorax
51:improve this article
1577:Tracheal intubation
1571:Intravenous therapy
1404:Wilderness medicine
1211:Emergency physician
819:. 10 October 2018.
315:for pain management
1751:Basic life support
1655:Sodium bicarbonate
1453:Emergency medicine
1446:Emergency medicine
1394:Emergency medicine
1322:Spinal precautions
1148:Basic life support
1089:2008-09-30 at the
795:. January 23, 2017
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1650:Magnesium sulfate
1559:Electrocardiogram
1485:Medical emergency
1470:Emergency nursing
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1399:Military medicine
1379:Aviation medicine
1363:Search and rescue
1353:Ambulance station
740:on March 24, 2012
650:content.nremt.org
327:Scope of practice
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957:
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950:Joe Shansky.
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68: –
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62:Find sources:
56:
52:
46:
45:
40:This article
38:
34:
29:
28:
19:
1845:
1833:
1727:Life support
1505:Major trauma
1358:Rescue squad
1312:Spinal board
1200:
1176:Combat medic
1143:Paramedicine
1041:
1030:. Retrieved
1028:. 2014-05-05
1025:
1016:
1002:
991:. Retrieved
984:the original
971:
960:. Retrieved
956:the original
945:
934:. Retrieved
924:
913:. Retrieved
909:
900:
889:. Retrieved
885:the original
875:
864:. Retrieved
854:
843:. Retrieved
832:
808:
797:. Retrieved
792:
780:
770:February 14,
768:. Retrieved
764:the original
754:
744:February 14,
742:. Retrieved
735:the original
722:
711:. Retrieved
701:
690:. Retrieved
683:the original
654:. Retrieved
649:
643:"Newsletter"
637:
618:
590:Rescue squad
575:Combat medic
530:
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498:
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465:Pennsylvania
463:
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443:(located on
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269:Advanced EMT
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107:October 2020
104:
94:
87:
80:
73:
61:
49:Please help
44:verification
41:
1604:Pocket mask
1480:Golden hour
841:. Maine.gov
837:Maine EMS.
709:. Nremt.org
508:, surgical
474:ondansetron
445:Long Island
371:Connecticut
337:some states
298:Epinephrine
290:Sublingual
263:arrhythmias
1868:Categories
1816:NACA score
1625:Amiodarone
1539:Chest tube
1254:Blood bike
1032:2022-01-21
993:2014-02-14
962:2014-02-14
936:2014-02-14
915:2020-08-04
891:2014-02-14
866:2014-02-14
845:2014-02-14
799:2019-07-03
713:2014-02-14
692:2014-02-14
656:2019-07-03
601:References
595:Pararescue
521:Washington
400:IV therapy
390:combitubes
365:California
215:Historical
155:paramedics
77:newspapers
1735:First aid
1620:Adenosine
1587:Combitube
1561:(ECG/EKG)
1525:Equipment
1327:Stretcher
1237:Ambulance
1206:Paramedic
977:"Minutes"
532:Wisconsin
487:Tennessee
470:ketorolac
459:paramedic
147:ambulance
1840:Category
1801:(CCrISP)
1645:Naloxone
1635:Dopamine
1630:Atropine
1337:Weevac 6
1294:movement
1225:Vehicles
1087:Archived
821:Archived
580:Corpsman
539:See also
502:Virginia
455:Oklahoma
422:Michigan
408:glucagon
350:Arkansas
307:Naloxone
245:EMT-I/99
239:glucagon
231:naloxone
224:EMT-I/85
1852:Outline
1777:(ACoRN)
1723:Courses
1242:history
468:only),
432:AEMT-CC
430:has an
335:(DOT),
91:scholar
1795:(ALSO)
1789:(PALS)
1783:(PBLS)
1765:(ATLS)
1759:(ACLS)
1515:Triage
1307:Litter
1163:People
652:. 2011
625:
343:Alaska
285:saline
237:, and
93:
86:
79:
72:
64:
1771:(NRP)
1753:(BLS)
1742:(CPR)
1613:Drugs
1600:(OPA)
1594:(NPA)
1535:(BVM)
1346:Other
987:(PDF)
980:(PDF)
930:"FAQ"
824:(PDF)
817:(PDF)
789:(PDF)
738:(PDF)
731:(PDF)
686:(PDF)
679:(PDF)
646:(PDF)
570:Medic
494:Texas
396:Maine
185:NAEMT
98:JSTOR
84:books
1573:(IV)
1567:(IO)
1292:and
772:2014
746:2014
623:ISBN
436:AEMT
416:CPAP
378:Iowa
276:CPAP
259:ECGs
209:LALS
161:and
153:and
151:EMTs
135:AEMT
70:news
1553:ICD
1548:AED
585:68W
500:In
476:.
404:EKG
235:D50
193:ALS
172:EMT
129:An
53:by
1870::
1725:/
1024:.
908:.
791:.
665:^
648:.
609:^
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265:.
233:,
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1675:(
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105:(
95:·
88:·
81:·
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47:.
20:)
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