Advanced emergency medical technician

 ( Emergency Medical Responders ) 

• Non-medicated intravenous fluids (e.g. 0.9% normal saline)
• Sublingual nitroglycerin (service-supplied without needing medical direction)
• Epinephrine 1:1,000 for anaphylaxis and epinephrine 1:10,000 for cardiac arrest
• Dextrose 50%, dextrose 25%, and glucagon for hypoglycemia
• Naloxone for opioid overdoses
• Nitrous oxide for pain management
• Inhaled beta agonist medications (e.g. albuterol and ipratropium) for respiratory emergencies caused by asthma, COPD, etc.

Other states may use different names for the above and often have a scope of practice beyond the minimal national standards. The EMT-I/99 had a total of three recertification cycles to meet the requirements to transition to the paramedic level, while the EMT-I/85 had two recertification cycles to transition to the AEMT.

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, AEMTs in Arkansas can start Intraosseous infusions in adults and provide CPAP to patients with pulmonary edema. AEMTs in Arkansas are becoming more commonplace, especially in areas where 911 service has been traditionally provided by BLS-level services. AEMTs 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.

Connecticut recognizes the four levels of EMS provider, EMR, EMT, AEMT and paramedic. All four level of EMS provider are required to enter based on NREMT exams. In 2017, all "AEMTs" (which were essentially EMT intermediate 85s) were required to either complete current AEMT training and obtain NREMT certification at that level, or revert to the EMT 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 IVs 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 decompressions, manual defibrillations and medication administrations. 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-basic, advanced EMT, and paramedic. EMT-intermediates in Massachusetts followed the same protocols as the EMT-basics, but were allowed to start IVs, perform fluid resuscitation, perform an ALS assessment, and insert advanced airways such as endotracheal tubes, , and laryngeal mask airways. The EMT-intermediate level in Massachusetts has been phased out and replaced by the advanced EMT; 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 (however, an EMT-paramedic must interpret the cardiac rhythm), 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 being Nassau County (located on Long Island). Nassau recognized this level in mid-2017. In 2018, NYS began a 10-year phase-out of its unique AEMT-CC level of certification. However, no advanced EMT certifications are recognized in New York City except at volunteer agencies such as Hatzalah EMS and Central Park Ambulance. One either functions as an EMT-B or a paramedic within FDNY and affiliated services.

North Carolina has had an expansive scope for AEMTs since 2023. AEMTs are permitted, based upon local protocol adoption (as the protocols are optional), to intubate, insert supraglottic airways, start IVs and IOs, manually defibrillate in cardiac arrest, perform chest needle decompressions in traumatic arrests, and use a range of medications such as Epinephrine, Albuterol, Atrovent, Famotidine, Toradol, Magnesium Sulfate, IV Steroids, Antibiotics, Antipsychotics like Haldol, Dextrose, Glucagon, TXA, and Antiemetics like Zofran and Reglan. Adoption of these protocols are scattered with some agencies no longer recognizing AEMTs (Like Wake County EMS in Raleigh or MEDIC Mecklenberg in Charlotte), others adopting only some of the updated scope, and some adopting the entire updated scope.

Oklahoma recognized an EMT-cardiac level until recently. However, that level has been phased out and providers in Oklahoma at the EMT-cardiac level have since been trained and certified to the paramedic level or downgraded to EMT-I.

Oregon Recognizes both the National standard AEMT as well as an EMT INTERMEDIATE level. The Oregon EMT-I practices under a heavily modified I-99 Scope and is allowed to give a number of additional meds by standing order including opioids such as morphine and fentanyl, Antiemetics like Zofran and a limited range of cardiac anti-dysrythmics including Epinephrine 1:10000, Atropine, Amiodarone and Lidocaine. They can also operate a cardiac defibrillator in manual mode, provide basic interpretation of 4 and 12 lead ECGs and use nasogastric and orogastric tubes. EMT-I certifications are still actively offered at several of the states Community Colleges.

Pennsylvania uses the National Registry AEMT examination, but does not require continued national registration when an AEMT renews. The Pennsylvania scope of practice for AEMTs is similar to the national scope except Pennsylvania adds: diphenhydramine (IV/IO/PO only), epinephrine 1:10,000 (for cardiac arrest only), ketorolac, naloxone (IN/IM/IV/IO only), and ondansetron.

Rhode Island first-level ALS provider is EMT-cardiac, which is unique to Rhode Island. 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. EMT-C or higher licensure may be 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 nitroglycerin and aspirin in the event of cardiac emergencies, and can give glucagon. EMT-IVs can also administer the Mark 1 auto injector kit for organophosphate poisoning and suspected nerve gas exposure. The State of Tennessee Board of EMS is currently evaluating allowing EMT-IVs to administer naloxone, nitrous oxide as well as intraosseous infusions (IOs). 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 four years for the EMT-IV to transition to EMT-advanced by way of an eight-hour course, choosing to let all EMT-IVs and paramedics under the current standard be renewed as usual for this cycle.

Texas has a five-tier system, consisting of emergency care attendant, EMT-basic, advanced EMT, EMT-paramedic, and paramedic.

In Virginia, the first level of ALS is advanced EMT. The AEMT certification replaced the EMT-enhanced, unique to Virginia, starting in 2013 and fully replaced in the EMT-E certification in 2016. The EMT-E was essentially equivalent to the EMT-I/85 and could start IV lines, perform dual-lumen airway insertion, and administer some medications such as D50W, glucagon, albuterol, epinephrine, and sometimes narcotics, but could not administer any cardiac medications. The next level of ALS is EMT-intermediate, which replaced the EMT-cardiac technician beginning in 2002, and is equivalent to the I/99 level of certification. In most jurisdictions, the EMT-I operates under the same protocols as a paramedic. There are a few procedures that only EMT-intermediates cannot perform, including rapid sequence intubation, surgical cricothyrotomy, and needle cricothyrotomy. In 2020, Virginia began phasing out the EMT-I. Existing EMT-intermediates may continue to practice and maintain their certifications indefinitely, but no new certifications are issued. ALS certifications are now limited to either AEMT or paramedic.

In the state of Washington, EMT-basic protocols are similar to those in Iowa. Certified EMT-B personnel can administer EpiPen per state protocols and can insert a combitube. The Washington EMT-B can set up and maintain an IV that is non-medicated, but EMT-I certification is required to start the IV. 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 EMT-B skills, can administer D50W, naloxone, albuterol, and can now draw up epinephrine in addition to using an EpiPen.

Wisconsin offers licensure at the advanced EMT level. This allows providers to start peripheral IV lines, pediatric and adult IO lines, treat for hypovolemic shock, and administer naloxone, D50, D25, normal saline, D5W, D10W, D15W, Narcan, Tordol, Zofran, Tylenol, aspirin, glucose, glucagon, epinephrine 1:1000, and Albuterol. This level of training is often used in rural areas where hospitals may be sparse and advanced life support intercepts or aeromedical transports can take a great deal of time. Additionally, some private ambulance companies employ advanced EMTs for interfacility transports which only require IV therapy and do not necessitate the specialized advanced care of a paramedic.

• Emergency medical responder levels by state
• National Registry of Emergency Medical Technicians
• National Association of Emergency Medical Technicians
• Emergency Medical Services in the United States
• Wilderness emergency medical technician
• Medic
• Combat medic
• Corpsman
• 68W
• Rescue squad
• Pararescue

• National Registry of Emergency Medical Technicians
• National Association of Emergency Medical Technicians
• National EMS Memorial Service
• National Highway Traffic Safety Agency, Office of Emergency Medical Services
• The Difference Between an EMT and a Paramedic
• EMT City, large community for EMTs and Paramedics