page_title: Advanced emergency medical technician
section_title: Scope of practice
hierarchical_section_title: Advanced emergency medical technician / Scope of practice
caption_attribution_description: English: An advanced emergency medical technician ambulance with the Lafayette County Ambulance Service in Lafayette County Arkansas.
context_page_description: Advanced emergency medical technician is provider of prehospital emergency medical services in the United States. A transition to this level of training from the Emergency Medical Technician-Intermediate, which had somewhat less training, began in 2013 and has been implemented by most states at this point. The AEMT is 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 most usually employed in ambulance services, working in conjunction with EMTs and paramedics, however are also commonly found in fire departments and law enforcement agencies 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, high-benefit option to provide advanced-level care when the paramedic level of care is not feasible. The AEMT is authorized to provide limited advanced life support, which is beyond the scope of an EMT.
context_section_description: In addition to the standards established by the United States Department of Transportation (DOT), some states issue licenses for more specialized levels of training. The minimal psychomotor scope of practice at the national level for an AEMT includes
  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. 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.
  Arkansas 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, AEMT's in Arkansas can start Intraosseous infusions in Adults and provide CPAP to patients with pulmonary edema.  AEMT's in Arkansas are becoming more commonplace, especially in areas where 911 service has been traditionally provided by BLS-level services.  AEMT's and Paramedics in Arkansas are allowed to provide Advanced Interventions when off-duty, if in their normal coverage area. 
  California 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.
  Iowa 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 an IV in addition to 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 and perform needle decompression, manual defibrillation and medication administration. The Iowa Paramedic Specialist is the NREMT-Paramedic. Iowa also has a Critical Care endorsement for Paramedic Specialists.
  Massachusetts recognizes the DOT levels of EMT-B, AEMT, and EMT-P. EMT-Intermediates in Massachusetts followed the same protocols as the EMT-Basic, but were allowed to start IVs, perform fluid resuscitation, perform an ALS assessment, and insert advanced airways such as endotracheal tubes, Combitubes, and laryngeal mask airways. The Intermediate level in Massachusetts has been phased out and replaced by the EMT-Advanced; however most of the scope of practice remained the same.
  Maine recognizes three levels, EMT Basic, EMT-Advanced, and EMT-Paramedic. EMT-Advanced in the state of Maine can provide many different treatments including IV therapy, EKG monitoring, 12 lead EKG placement, dextrose (D50), glucagon, and other medications. Advanced EMTs can also place laryngeal mask airway devices and use CPAP when needed. Some treatments and medications require consultation with online medical direction.
  Michigan uses the National Registry AEMT examination, but does not require continued national registration when an AEMT renews.
  New York State has an AEMT-CC (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 AEMT 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 bei
caption: An advanced emergency medical technician ambulance with the Lafayette County Ambulance Service in Lafayette County Arkansas.
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