AEMT Certification: Transition or Crisis?

I've worked beside, first, EMT-Intermediates, then Advanced EMT's, for longer than many people who read my writings are alive. In my opinion, the Advanced EMT level could not die a death, fast enough. I believe the Advanced EMT model is flawed, unless, some (actively) EMS Physician Supervised (education and provision of medical care) EMS operations have been able to demonstrate a meaningful purpose and use of Advanced EMT's.

By far, nearly every Advanced EMT who I have worked with is near-useless; there is nothing "Advanced" about them, other than they have a tool chest with interventions and therapies, that, collectively, between their flawed implementation by the Advanced EMT, and the alleged merits of the interventions and therapies, that, in my opinion, serve no useful purpose. What I routinely encounter (almost all of the time), are Advanced EMT's who have awful assessment and critical decision-making skills, flawed decision making, and a sense of priority and technical skills that are equally flawed. I am yet to see an Advanced EMT perform an acceptable assessment, or history and physical. Instead, I watch these EMT Advanced "go in for the kill," by rushing to perform "Advanced" interventions. Nearly every time that I have observed this, the Advanced EMT has gone to an Advanced Intervention, before they performed an adequate assessment. In my opinion, these people are frightening, and the public and community officials have been deceived that there is something useful about Advanced EMT's, when in fact, they are “monkeys.” Clearly the "organized fire service (IAFF))," has used the Advanced EMT position to leverage additional pay. I don't know the specifics, but it seems that the private ambulance sector has found a way to bill the public and commercial payers a higher rate for an EMS encounter, in which the patient is "tended to" by an Advanced EMT. And, sadly, there are a large universe of so-called EMS Medical Directors who sign off on the deployment and operation of these Advanced EMT's, and who do not adequately (medically) supervise them.

In the state where I work, hospitals have been provided a menu by the State EMS Office, to enable them to determine what patients can be transferred between facilities by an EMT-Basic, Advanced EMT, Paramedic, or Critical Care Team, based NOT on the clinical knowledge and acumen of the crew, but by a menu of "skills that those personnel can perform." Routinely, I see patients transferred between facilities by personnel who are grossly inadequate for the position they are in, and the patient that they are responsible for caring for. In the same state, the "Sending Physician," who has responsibility for "their patient," and the medical oversight of the "transferring ambulance crew," do not care about the patient between facilities, and are not the least bit concerned about "their patient," or the responsibility that they accept as the "Transferring Physician." Finally, in the same state that I work, there is a fire department that has decided to replay the TV show "Emergency" in their wet dreams; their firefighter personnel race to the scene, to quickly perform Advanced EMT treatments, before they've even assessed their patient; rumor has it that there is a "financial bounty" for those non-transport fire personnel, for the Advanced EMT treatments that they perform. Those non-transport fire personnel are not medically supervised; they operate in No Man's Land, in terms of medical oversight, or the (medical) efficacy of what they do or don't do.

Then there is the case of a former State EMS Director, turned politician, who advanced the EMT-Intermediate model, turned Advanced EMT model, under the false premise that these people do some good to patients. Any day, I'd take a competent, skilled EMT-Basic, over an Advanced EMT.

As I said above, in my opinion, the Advanced EMT level of certification/licensure, could not die a death, quickly enough (hopefully, before the patients that these EMS "TECHNICIANS, " NOT CLINICIANS, kill them (their patients)).

Dan, I agree with most of your comments. I'm a Program Director of a CAAHEP accredited Paramedic program. I also think we need a voluntary accreditation of EMT as well, but that that's another debate. I have never been a fan of a mid-level provider. I believe the AEMT was flawed from the beginning. If we want to make a change, we should consider the AEMT becoming the EMT level. But back to the subject. I've seen a draft NASEMSO SMC. I think the most difficult part of the SMC is the clinical and field internship portion. I already have difficulty placing my Paramedic students in clinical experience. The internship is problematic because at a Paramedic ambulance provider, the AEMT student will never truly be able to be the Team Leader because in many cases the Paramedic will need to take over care so they can provide Paramedic level of care. So the AEMT student is stuck "assisting" the Paramedic. I totally agree with your last statement in the article that there is an education/expectation mismatch. The current AEMT level lacks proper anatomy & physiology, pathophysiology, and pharmacology in the 2021 National EMS Education Standards (NES). The NES are mismatched to the skills listed in the 2019 Scope of Practice Model. Finally, the NREMT should not allow states to create standards that are less than a national SMC. The states are subject to the whims of politicians who think they know how to solve the workforce problems. I believe our workforce problems are rooted in the educational system that can potentially have 50 different iterations and no mandated national standard. Thanks for listening to my rant. :)