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EMT & Paramedic Certification

New Certification Levels

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What are all these rumors about new levels of EMS providers?
The National Highway Traffic Safety Administration (NTHSA) has developed new 2009 National EMS Education Standards. The State of Utah has adopted these guidelines. The Education Standards list four levels of certification that the State of Utah is adopting. They are Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced Emergency Medical Technician (A-EMT), and Paramedic. EMR certification level was adopted by the BEMS&P in January 2009. EMT will replace EMT-Basic, and A-EMT will replace EMT-Intermediate.
What's the difference between an EMT-Basic and the new EMT?
There are quite a few changes from EMT-B to EMT, but none are significant. Patient care hasn't changed. According to the EMS Gap Analysis Template, the following skills are new:
  • Use of oxygen humidifiers
  • Use of partial rebreather masks
  • Use of simple face masks
  • Use of Venturi masks
  • Obtaining a pulse oximetry value
  • Use of automated transport ventilators
  • Use of mechanical CPR devices
  • Application of mechanical patient restraint
  • Assisting a patient with his/her prescribed medications nebulized/aerosolized
  • Administration of aspirin by mouth
  • Use of an auto-injector (self or peer)
Patient Assessment includes new terminology that more closely mimics other health care professionals, i.e.:
  • Primary Assessment
  • History taking
  • Secondary Assessment
  • Monitoring Devices
  • Reassessment
I'm an EMT-Basic now. What do I need to do to become an EMT?
When you come up for recertification you will take the new EMT written exam, and upon completion of all recertification requirements you will receive an EMT certification and badge.
When will I as an EMT-Basic have to transition to EMT?
The new EMT written exam begins January 1, 2012. When you come up for recertification after that date you are given the EMT exam as part of the recertification process and will have transitioned to the new EMT level.
As an EMT-B, are there new skills I'll have to learn to be an EMT?
Yes, note the list above from the Gap Analysis. New skills include using humidified O2 or transport ventilators, O2 masks other than non-rebreather, administration of aspirin, etc.
As an EMT-B, will I have to take a test to become an EMT?
Yes, when you recertify after on or after January 1, 2012, your recertification test will include the new EMT level questions. Your new ID badge will be for the EMT level of certification.
What do I need to study to prepare for my EMT recertification exam?
Most new EMT text books will have the material you will need. Most of the information will come via your Training Officer through CME. The EMS Gap Analysis Template highlights content you will want to study as well.
What's the difference between an EMT-Intermediate and the new Advanced EMT? As an EMT-I, are there new skills I'll have to learn to be an A-EMT?
The EMS Gap Analysis Template states that for a current 1985 EMT-I transitioning to 2009 A-EMT, the following skills are new:
  • Insertion of supraglottic airways; airways not intended for insertion into the trachea
  • Use of oxygen humidifiers
  • Use of tracheostomy mask
  • Tracheobronchial suctioning (already-intubated patient)
  • Use of mechanical CPR devices (requires additional specialty training and device approval)
  • Application of mechanical patient restraint (not a new skill, but new information)
  • Insertion of intraosseous infusion in children
  • Administration of aerosolized or nebulized beta agonists (I-85s could previously only assist a patient with his or her own prescription medication and now they administer it as an EMS medication)
  • Allow self-administered nitrous oxide
  • Administer intramuscular epinephrine and glucagon
  • Administration of intranasal naloxone
  • Administer intravenous naloxone or 50% dextrose
  • Administration of subcutaneous epinephrine
  • Blood glucose monitoring
You will notice that Utah EMT-I already do some of these skills.
I'm an EMT-I now. What do I need to do to become an Advanced EMT?
An EMT-I wishing to become an A-EMT should get ready through self-study, CME, or other means to take the transition exam.
When will I as an EMT-I have to transition to A-EMT?
The A-EMT certification and transition exams are available beginning October 1, 2011. An existing EMT-I will have a period of two years from October 1, 2011, to September 30, 2013, to certify as an A-EMT.
What will happen if I don't transition by the deadline?
At the end of the two year period (October 1, 2013) any EMT-I who has not transitioned to A-EMT will automatically be certified as an EMT and from that time forward will recertify at the EMT level.
Are there some skills and medications that I have now as an EMT-I that I will not be able to use as an A-EMT?
The answer is a qualified yes. Many of the following skills and medications were taught and approved by local medical control but were not part of the Utah EMT-I curriculum, e.g.:
  • Insertion of nasogastric and orogastric tubes
  • Tracheobronchial suctioning (Utah EMT-I were permitted to intubate and suction; now AEMTs will only able to perform suctioning in already-intubated patients)
  • Interpret single lead electrocardiograms
  • Perform manual defibrillation attempts
  • Apply ECG to monitor internal cardiac pacing
  • Perform transcutaneous cardiac pacing
  • Administer morphine or other narcotic analgesics
Others were part of the curriculum or were added by variance and optional drugs but will no longer be taught at the A-EMT level:
  • Lidocaine (ONLY for pulseless v-tach/v-fib after administration of epinephrine)
  • Rectal medication administration
  • Performing direct laryngoscopy
  • Insertion of an orotracheal tube
  • Pressure points and extremity elevation for hemorrhage control
  • Fentanyl
  • Acetaminophen elixir
  • Midazolam
  • Nubain
  • Promethazine
  • Zofran
  • CyanoKit
There are EMT-I skills and drugs that are not in the A-EMT scope of practice. Does this transition mean I can't use those skills or administer those drugs anymore?
Yes; however, BEMS&P will allow, through agency Medical Directors, A-EMTs within their agency to administer optional drugs and perform skills outside of their scope of practice through approved waivers and an intra-agency training and credentialing process.
I'm a Training Officer. What do I need to do to help my EMT-Is prepare for the A-EMT transition exam?
Our suggestion is to prepare them with CME training focusing on the Education Standards. A look at the EMS Gap Analysis Template might be helpful, too. An evaluation of the National EMS Education Standards and the Instructional Guidelines can help with content material. An Advanced EMT Textbook and Instructor's material should be the basis of all future CME.
As a Training Officer, what can I do to help my EMT-Basics prepare for the EMT certification exam?
You can prepare them through CME training focusing on the National EMS Education Standards and the Instructional Guidelines for EMT, EMT Textbooks, and Instructor's material.
I'm a Training Officer. My agency's Medical Director is electing to allow A-EMTs to continue to do functions and administer drugs that were in the Utah EMT-I scope of practice but are not in the A-EMT Education Standards. What do I do with the new A-EMTs coming out of schools that are not trained to do those things?
Train them in the skills that are outside of the A-EMT Education Standards. An outline of training is part of the variance process. You and your Medical Director should have in place training modules for every variance and optional medication approved by the Bureau.
I'm a Course Coordinator. I teach EMT-Basic and EMT-Intermediate courses. When will I no longer be able to teach these courses?
When can I start to teach the new Standards material for EMT and A-EMT?
If your course will end after the implementation date (e.g. A-EMT October 1, 2011, and EMT January 1, 2012) it will need to be respectively an A-EMT course and not an EMT-I course, or an EMT course and not an EMT-Basic course.
I'm a Course Coordinator. What about the 120 days my EMT-I students have to complete their certification? Will they be able to take their EMT-B or EMT-I test after the deadline?
Yes, for students who took an EMT-B or EMT-I course, the tests will be available for a full 120 days after the end of the course. If your course will end after the implementation date then it should be an EMT or an A-EMT course and not an EMT-B or an EMT-I course.
With this transition process, what are the responsibilities and roles of the Course Coordinator, Training Officer, and Medical Director with regards to their agency's waivers and variances?
The course coordinator is responsible to develop and teach a course to the 2009 Advanced EMT Instructional guidelines. This has been referred to as the "floor." The Training Officer and Medical Director have to decide what elements and skills over and above that level they wish to allow the Advanced EMT in their agency to perform. All applications for waivers above the standard will have to include a description of what initial and ongoing training will include and how it will be accomplished. Training Officers must recognize that newly certified A-EMTs will not have the knowledge and skills to perform the agency's waivered skills without additional training.

Questions? Contact the James Hansen at jwhansen@utah.gov or 801-273-6628.

Updated July 16, 2014