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Emergency Medical Technician-Intermediate (EMT-I) is a mid level provider of prehospital emergency medical services in the United States. The EMT-I is not intended to deliver definitive medical care, but rather to augment prehospital critical care and provide rapid on-scene treatment. EMT-Is are most commonly employed delivering prehospital emergency care in ambulances, working in conjunction with EMT-Basics and EMT-Paramedics. As a mid level provider of prehospital emergency medical care, the EMT-Intermediate is typically authorized to provide more advanced medical treatment than the EMT-Basic and is typically authorized to provide advanced life support.
Typical Training for the EMT-I usually involves a class, which can range from a couple of months to a year. Class lengths vary depending upon what state you are taking it in. Along with the class the EMT-I is also required to complete many clocked hours of clinical time in the operating room, emergency department, as well as field experience hours on an advanced life support ambulance. During these clinical hours the EMT-I must successfully demonstrate full and practical knowledge of skills learned.
EMT-I/85 is a level of training that will typically allow several more invasive procedures than are allowed at the basic level, including IV therapy, the use of multi-lumen airway devices (even endotracheal intubation in some states), and provides for enhanced assessment skills such as 4 lead EKG interpretation. The EMT-I/85 is typically allowed only the same medications an EMT-B is allowed to use (these being oxygen administration, oral glucose, activated charcoal, epinephrine auto-injectors (Epi-Pens), nitroglycerin, and Metered-Dose Inhalers (MDIs), though in many states administration of 5 and 50% dextrose in water is also allowed (commonly referred to as D5W and D50 respectively)). Protocols for medications vary by state. For example, in some states, an EMT-I is allowed to administer Epinephrine 1:1000 and 1:10,000, Narcan, Atropine, Thiamine, nebulized Albuterol and glucagon as well as other medications in addition to the above listed medications.
The EMT-I/99 level is the closest level of certification to Paramedic, and allows many techniques not available to the EMT-I/85 or below. Some of these techniques include needle-decompression of tension pneumothorax, endotracheal intubation, nasogastric tubes, use of cardiac event monitors/ECGs, and medication administration to control certain cardiac Arrhythmias.
In addition to the United States Department of Transportation established standards, some states issue licenses for more specialized levels of training. Other states simply use different names for the above.
Alaska 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; interestingly 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 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.
California uses an EMT-I or "EMT-One" Roman numeral designation which is equivalent to the National EMT-Basic; this should not be confused with the EMT-Intermediate (hereafter EMT-I).
Iowa EMT-Basics can administer Epi-pen per protocol, insert a Combi-Tube, and set up and maintain an IV that is non-medicated as well as all other basic skills. (Not establish an IV.) EMT-Intermediates can establish an IV as well as do all of the EMT-Basic skills. An Iowa Paramedic is a NREMT-Intermediate/99 and is not the highest level of care in Iowa. This allows them to insert ET Tubes, needle decompression, Manual Defib., and administer medication. The Iowa Paramedic Specialist is the NREMT-Paramedic. Iowa also has a Critical Care endorsement for Paramedic Specialists.
Michigan recognizes the DOT levels of EMT-B, EMT-I/85, and EMT-P, however they refer to an EMT-I/85 as an EMT-S (Specialist). Since standards for EMT-Basic are nearing the EMT-Paramedic level, the EMT-Specialist is slowly being phased out.
New York State has an AEMT-CC (Advanced EMT - Critical Care) certification, which is unique to New York, but almost identical in curriculum to the national standard EMT-Intermediate/99. Part of the reason why New York possesses this level is that it also has an AEMT-I (Advanced EMT - Intermediate) certification which is at the same level as the national standard for EMT-I/85. However, no advanced EMT certifications are recognized in New York City. One is either an EMT-B or a Paramedic.
Oklahoma recognized a similar level, called EMT-Cardiac, until recently; however, that level has been phased out and EMTs certified in Oklahoma at that level have since been trained and certified to the paramedic level or downgraded to EMT-I.
Rhode Island's first-level ALS provider is EMT-Cardiac, which is unique to Rhode Island and Virginia (Virginia has recently phased out the Cardiac Tech program). 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 program, and is much more popular. EMT-C or higher licensure is generally required by Rhode Island fire departments, who provide emergency medical services in the majority of the state.
Tennessee 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, 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 nitroglycerine and aspirin in the event of cardiac emergencies, and can give Glucagon. EMT-IVs can also administer the Mark 1 Autoinjector kit for Organophospate poisoning and suspected nerve gas exposure. The State of TN Board of EMS is currently evaluating allowing EMT-IVs to administer NARCAN and Nitrous Oxide, as well. 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 4 years for the EMT-IV to transition to EMT-Advanced by way of an 8 hour course, choosing to let all EMT-IV's and Paramedics under the current standard be renewed as usual for this cycle. [1]
Vermont's first level of ALS provider is the EMT-I '03, which is unique to the state. EMT-I '03's have an expanded scope of practice which falls above an EMT-I/85 but below an EMT-I/99. In addition to providing IV therapy EMT-I '03's are allowed to administer Albuterol, ASA (Aspirin), D50, Epinephrine (1:1000), Glucagon, Naloxone (Narcan), Nitro and Thiamine in addition to EMT-B level meds.
In Virginia, the first level of ALS is EMT-Enhanced (previously Shock Trauma), which is unique to Virginia. It is essentially equivalent to the EMT-I/85. EMT-Enhanced can start IV lines, perform dual-lumen airway insertion, and administer some medications such as D50, glucagon, albuterol/atrovent, epinephrine and in some cases narcotics. The next level of ALS is EMT-Intermediate, which is equivalent to the I/99 level of certification and in most counties, operate under the same protocols as EMT-Paramedics. (Virginia has recently phased out its Cardiac Tech program and replaced it with Intermediate.)
In Washington State EMT-Basic protocols are similar to those in Iowa. Certified EMT-B personnel can administer Epi-pen per state protocols, can insert a Combi-Tube, and can set up and maintain an IV that is non-medicated. All other basic skills are also part of the protocol. EMT-Intermediates can establish an IV as well (which EMT-Basic cannot) as well as perform all EMT-Basic skills..WA Office of Emergency Medical and Trauma System (May 2009) Some county protocols ( Such as Jefferson) accept an EMT/ILS tech which in addition to all EMT I and basic skills can administer D50W, Narcan, Albuterol, and now draw up Epi in addition to the Epi-Pen
Wisconsin offers an EMT-IV-Technician certification for the EMT-Basic, allowing them to start basic IV lines, treat for hypovolemic shock, administer Narcan, D5, and a limited number of other medications. This level of training is often used in non-urban areas where hospitals may be sparse and Advanced Life Support intercepts or aero-medical transports can take a great deal of time. Additionally, some private ambulance companies employ EMT-IV Technicians for interfacility transports which only require IV therapy and do not necessitate the specialized advanced care of a paramedic.
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