Advanced EMT
A Clinical-Reasoning Approach
CHAPTER 1
Introduction to Advanced
Emergency Medical
Technician Practice
Advanced EMT
Education Standard
• Applies fundamental knowledge of the
EMS system, safety/well-being of the
AEMT, and medical/legal and ethical
issues to the provision of emergency
care.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Objectives
1. Define key terms introduced in this
chapter.
2. Describe the competencies, roles,
responsibilities, and professional
characteristics of the Advanced
Emergency Medical Technician (AEMT).
16-17, 31-37
3. Describe the scope of practice of the
AEMT. 5-9
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Objectives
4. Place the roles and responsibilities of the
AEMT in the larger contexts of emergency
medical services (EMS), health care, and
public health. 21-29
5. Discuss key issues in the contemporary
practice of the AEMT, including
professionalism, the focus on patient
safety, research, and evidence-based
practice. 10, 20, 30, 38
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Introduction
• AEMTs are a critical part of the
emergency medical services (EMS).
• They provide comfort, emergency
medical care, and transportation.
• AEMTs provide a link between patients
and the health care and public health
systems.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
EMS and EMS Providers
• EMS systems developed to provide life-
saving care and emergency
transportation to critically ill and
injured patients.
• EMS providers engage in community
health education and promotion efforts
and work in a variety of settings.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
The Contemporary
EMS Profession
• EMS knowledge defined in documents
published by NHTSA.
– National EMS Core Content
– National EMS Scope of Practice
– National EMS Education Standards
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
EMS and EMS Providers
Figure 1–1 AEMTs work in a variety of settings.
(© Craig Jackson/In the Dark Photography)
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
The Contemporary EMS Profession
• EMT Oath and EMT Code of Ethics
describe the professional conduct
expected of EMS personnel.
• EMS providers must be aware of
activities and agendas of major EMS
state and national professional agencies
and organizations.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Think About It
• While on a call you see a coworker
photograph a patient. Later, when you
ask them about it, they tell you they
are going to post the photo online
because it was unusual.
• What role do rules of professional
conduct play in this situation?
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
EMS Provider Levels
• Four nationally recognized levels of
EMS providers
– Emergency medical responder (EMR)
– Emergency medical technician (EMT)
– Advanced emergency medical technician
(AEMT)
– Paramedic
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
EMS Provider Levels
• Emergency Medical Responders (EMRs)
– Trained in very basic skills.
– Use minimal equipment.
– Provide basic first-aid measures to less
critically ill and injured patients.
– Can perform simple assessments to
identify and manage life threats.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
EMS Provider Levels
• Emergency Medical Responders (EMRs)
– Use basic airway management and
ventilation skills, CPR, AED, simple
methods to control bleeding.
– Trained to recognize injuries that
require immobilization.
– Training completed in 48 to 60 hours.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
EMS Provider Levels
• Emergency Medical Technicians (EMTs)
– Provide emergency medical care and
transportation.
– Use basic equipment supplied on an
ambulance.
– Play a variety of roles in EMS systems.
– Act in a first-response capacity.
– Provide immediately life-saving care.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
EMS Provider Levels
• Emergency Medical Technicians (EMTs)
– May provide primary transporting EMS
service in a community or work for
ambulance services.
– May work with partner at same level or
may work with an AEMT or paramedic
partner.
– Trained to assess patients.
– Training completed in 150 to 190 hours.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
EMS Provider Levels
• Advanced EMT
– Training includes all knowledge and
skills of EMRs and EMTs.
– Able to provide limited number of
advanced life support (ALS)
interventions.
– Must practice within the Scope of
Practice approved by state and EMS
service physician medical director.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
EMS Provider Levels
• Advanced EMT
– Must either have completed EMT
training or it must be incorporated into
program.
– Training requires 150 to 250 hours
beyond time required to complete EMT
training.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
EMS Provider Levels
• Paramedics
– Allied health care professionals who
provide complex assessments and
interventions for critical and emergent
patients.
– Complex understanding of anatomy,
physiology, pathophysiology, and
treatment modalities.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
EMS Provider Levels
• Paramedics
– Education programs are often based in
institutions of higher education.
– The Commission on Accreditation of
EMS programs (CoAEMSP) accredits
paramedic education programs.
– Programs range from 1000 to 1500
hours beyond—EMT level.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Think About It
• A tour bus MVC has occurred in your
jurisdiction, resulting in multiple
injuries and possible fatalities.
• What levels of EMS responders are
likely to be on-scene?
• Responders must work together.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Advanced EMT Roles and
Responsibilities
Figure 1–5 AEMT responsibilities include making sure equipment and the emergency
vehicle are prepared to respond to emergency calls.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Advanced EMT Roles and
Responsibilities
• Each state has legislation that defines
the Scope of Practice of licensed EMS
personnel.
• Emergency vehicle readiness and
operations
– Emergency vehicle must be in good
mechanical repair and driven safely.
– Vehicle must have adequate amount of
required equipment and supplies.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Advanced EMT Roles and
Responsibilities
• Safety
– Responsibility for own safety, and safety
of coworkers, patients, and others.
– Important to adhere to the AEMT’s safe
medication administration practices.
– Awareness of safety of public while
operating emergency vehicle and safety
of others at scene of emergency.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Advanced EMT Roles and
Responsibilities
Figure 1–6 Teamwork is required to integrate the tasks of patient care and patient
transportation.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Advanced EMT Roles and
Responsibilities
• Scene leadership, management,
teamwork
– Be confident and in control.
– Be empathetic to medical and emotional
needs of patients and family members.
– Patient assessment, care, and
transportation must be integrated into a
smooth process.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Advanced EMT Roles and
Responsibilities
• Patient assessment and management
– Ability to assess and manage patients
who have variety of illnesses and
injuries from minor to critical.
– Be aware of the most current trends
and practices in EMS.
– Be willing to discard outdated
knowledge and practice to add new
ones.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Advanced EMT Roles and
Responsibilities
• Maintaining certification or licensure
– An individual professional obligation of
each health care provider, not a
responsibility of employers or
educational institutions.
– Requirements include documentation of
mandatory continuing education
activities, medical director verification of
skills, submission of CPR card, payment
of a fee.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Advanced EMT Roles and
Responsibilities
Figure 1–7 AEMTs work closely with other health care and public safety providers.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Advanced EMT Roles and
Responsibilities
• Working with other public safety and
health-care personnel
– Emergency medical services are cross-
disciplinary; both public safety and
health care personnel.
– Strive to maintain cooperative
relationships with other professionals.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Think About It
• You arrive at the emergency
department with a 9-year-old drowning
victim.
• What is the most important information
to share in the handoff?
• What could result from an incomplete
handoff?
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Advanced EMT Professional
Characteristics
• Professional characteristics defined by
– Expectations of public
– Professional group itself
– Other related professional groups
– Most visible way patients and families
can judge—professionalism is through
interactions with them
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Advanced EMT Professional
Characteristics
• Define each term listed below
– Integrity
– Empathy
– Self-motivation
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Advanced EMT Professional
Characteristics
Figure 1–8 Appearance and demeanor are critical elements of professionalism.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Advanced EMT Professional
Characteristics
• Why do EMS personnel wear uniforms?
• Define the each term listed below
– Self-confident
– Self-confidence
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Advanced EMT Professional
Characteristics
• Who do AEMTs communicate with?
• Why is good communication required?
• What does good time management
mean?
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Advanced EMT Professional
Characteristics
• Define each of the following terms
– Teamwork
– Diplomacy (tact)
– Respect
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Advanced EMT Professional
Characteristics
• Define each of the following terms
– Patient advocacy
– Careful delivery of service
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Think About It
• You and your partner respond to a
domestic violence call at a familiar
address. You arrive shortly after law
enforcement.
• How do you proceed?
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
Chapter Summary
• AEMTs are an essential part of EMS and
of the health care and public health
systems.
• AEMTs are health care professionals of
whom the public has high expectations.
Advanced EMT: A Clinical-Based Approach
Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss
