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Advanced Emergency Medical Technician (AEMT)

Among the most valuable skills for any prepper to possess is the ability to deal with medical issues. Advanced training such as Medical Doctor, Physician’s Assistant, or Nurse are certainly wonderful assets, but they typically require a vocational commitment. This begs the question “what about the rest of us”?

Several years ago I requested a trauma kit from my family as a birthday present. Being the loving family that they are, they dutifully provided. However, once I opened the kit to review the supplies and tools inside I suddenly realized: ”I have no idea how to use this!” It was at this point that I began to explore options for gaining some medical knowledge that would enable me to assist my family, friends and community in an emergency.

Of course, I had heard of the “Paramedic” and “Emergency Medical Technician” qualifications, but I had no idea of the capabilities and limitations of each. I have since learned that there are four nationally recognized levels of pre-hospital care. Emergency Medical Responder (EMR) is very basic training designed for police and others who may be expected to arrive first at a serious medical event. This training is intended to enable them to manage the emergency for the first five minutes until more advanced providers arrive.

At the other end of the spectrum is the Paramedic. This training is typically the equivalent of three college semesters and provides the knowledge and skills to manage a wide variety of medical and traumatic emergencies from the scene to the hospital.

EMR certification is certainly better than no training; however, it is very limited in scope. If advanced care is not forthcoming, the EMR capabilities will soon be exhausted. Paramedic training is highly desirable as it begins to include a foundation in anatomy, physiology, and pathophysiology that enables a more advanced understanding of the problem as well as techniques to provide more extensive care. The problem, of course, is finding the time to obtain Paramedic certification unless one can make it a career.

EMT Certification

Between these extremes are two intermediate levels of training: EMT and Advanced EMT. EMT certification is very obtainable and highly recommended, even for someone committed to a non-medical vocation. It is a gateway to regular pre-hospital care through an ambulance service, provides for a second income source, and (most importantly) allows regular interaction in the health care system. EMT training is considered “BLS” (Basic Life Support) and teaches non-invasive techniques, but the EMT functions regularly with Paramedics as well as Emergency Room Doctors and Nurses. Knowledge beyond the level of EMT is hard to avoid when regularly functioning in this world. Volunteer Fire Departments will often reimburse the successful trainee for the cost of the training and provide a place to volunteer to find real-world opportunities to use that training.

While the three levels of pre-hospital certification described above are often unclear to the general public, there is a fourth level located between EMT and Paramedic that is almost entirely unknown: it is the Advanced Emergency Medical Technician (AEMT). This position is designed primarily for use in rural areas where the more advanced care of Paramedics is largely unavailable and transport times from scene to hospital tend to be longer. This, in itself, lends itself to prepper applications.

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Advanced Emergency Medical Technician (AEMT)

AEMT training builds on the BLS skills of the EMT with additional anatomy, physiology, and pathophysiology, a small but critical selection of medications not available to EMTs, and the Advanced Life Support (ALS) skills to administer those medications

The AEMT is trained and certified to put in IVs to obtain venous access for the administration of fluids such as saline (critical, for example, to care for severe blood loss) and dextrose (for use in correcting a diabetic low blood sugar emergency), IOs (similar to IV except access through the bone marrow to administer the same fluids and medications), nebulized breathing treatments such as Albuterol for asthma, the administration of nitroglycerin for the relief of chest pain (and, more importantly, the lack of blood flow to the heart muscle) caused by angina, the intra-muscular injection of epinephrine for severe allergic reaction or glucagon for low blood sugar and the insertion of a supraglottic (not past the larynx as opposed to the endotracheal airway inserted by a Paramedic) airway to improve ventilation .

A Career Change

As my career as an Electrical Engineer began to wind down, I found an opportunity to pursue EMT certification through a local community college. Three evenings a week at four hours an evening for three months plus several Saturdays, skills certification testing, and a cognitive exam later I was certified. Upon joining a local fire department that also runs ambulance calls I was able to begin to learn the practice of pre-hospital care.

After two years of functioning as an EMT the opportunity arose for me to seek AEMT training. This included three months of training in a hybrid format: every other Monday we would meet for skills training and testing while classroom work was completed on-line. Unlike EMT certification that required minimal patient interaction, AEMT certification required 150 hours of clinical time split between hospital and ambulance calls. Since this included various tasks to be performed in the course of the clinical hours, I ultimately invested approximately 220 hours of clinical time.

This was followed by skills testing and then a cognitive exam: once both were successfully completed I was certified, but the journey was not yet complete. In order to be authorized to perform the advanced interventions under the license of the physician who oversees our ambulance service I was required to complete 10 additional calls under the oversight of a Paramedic and then meet with the physician for a “command interview”. He was satisfied with my certification and conduct; I was granted command authorization to practice the higher level of care. From start to finish the process took 8 months, but it was feasible for me to continue to meet the obligations of my engineering business, work part-time taking ambulance calls, and continue with my family and church obligations.

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Some Drawbacks

There are certainly drawbacks to AEMT. Chief among them is the relative lack of AEMTs in the largely suburban region where I practice: there are 7,000 EMTs, 2,000 Paramedics, and less than 50 AEMTs. AS a result, there is not a great incentive to create a place for us in the ALS (Paramedic)/BLS (EMT) structure that presently exists. Furthermore, pre-hospital providers (at least in my area) are notoriously underpaid: in my service Paramedics are paid $18 per hour and EMTs are paid $13 per hour. As I am the only AEMT at my service, I continue to function (on paper and for the purposes of payroll) as an EMT.

However, for the purposes of prepper training AEMT is a level of training that is achievable without requiring a career commitment. AEMT may be described as the civilian equivalent of a Combat Medic. As a resource for your family and community when ready access to advanced medical care is not available, this training can be life-saving. I have assembled a bag of AEMT tools including IV supplies, saline, dextrose, and other tools and supplies to enable me to provide care for my family, friends, neighbors, or church family. This available for immediately care, if necessary. The alternative is waiting 10 minutes for an ambulance to arrive, and this could be the difference in saving a life.

This has also enabled me to develop relationships with critical care providers in my area. As the volunteer fire department where I live is strictly an EMT level license, they have facilitated a relationship with the municipal ambulance service so that I can perform advanced care under their ALS license. Consequently, I am working with an entirely new group of medical professionals. It has even saved me a $140 traffic ticket after a questionable maneuver when the officer who pulled me over recognized me from a variety of emergency calls and gave me a break.

While my interest in acquiring medical training began as strictly another form of preparation, I have found that I very much enjoy it. The part-time income I receive is a bonus: I would do the work as a volunteer and do so regularly. I have been able to help family members, neighbors, and church friends a number of times before the ambulance arrived. While functioning as an EMT was an excellent introduction to this world, certification as an AEMT opened doors to provide greater care while continuing to carry on the rest of my life.

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