Pediatric emergency medicine trisk 4602 4602
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (108.66 KB, 1 trang )
(AEMTs), and ALS providers (paramedics). Some states and regions use their own notations for the skill levels of
providers, but their personnel typically fit into one of the categories described here. BLS care is provided by
EMRs and EMTs, while ALS care is provided by AEMTs and paramedics. Approximately 57% of U.S. EMS
providers are EMTs and 31% are paramedics. The EMS National Scope of Practice model was most recently
revised in 2019, and retained the four levels of providers.
Training standards and requirements for certification exist for all of these groups, established by the DOT and
NHTSA ( ). The National EMS Core Content published in 2005
describes the full body of EMS knowledge and skills. The National EMS Scope of Practice Model establishes
minimum competencies for each level of provider. The National EMS Education Standards , published in 2009,
define the minimal entry-level educational competencies (knowledge, clinical behavior, and judgment) for each
EMS personnel level ( Table 134.1 ). The DOT provides these guidelines only, but does not conduct training or
issue licenses or certifications to EMTs.
Training for EMS personnel occurs at community colleges, technical schools, and other health profession
universities. Training programs are accredited by the Committee on Accreditation of Educational Programs for
the Emergency Medical Services Professions (CoAEMSP). A general outline of the training and skills
competencies for each level of provider is discussed below. While the National Scope of Practice Model guides
the skills that each level of provider should be capable of, each EMS medical director overseeing the providers
within his or her jurisdiction may credential any level of provider to perform skills that may be traditionally
reserved for a higher level, as long as that provider is given special training and competencies are maintained.
An EMR is a person who is certified in limited but significant lifesaving capabilities. A certified EMR course
includes a 40- to 60-hour curriculum, and providers can be registered by NREMT. The role of the EMR is vital in
rural and wilderness areas where extended response times are common, and skills such as hemorrhage control,
airway positioning, and early defibrillation with an AED can be truly lifesaving. In suburban and urban EMS
areas, this level of provider is prevalent in the police and non-EMS fire services, as well as in some rural areas.
EMTs have skills that exceed those of EMRs. They are trained to recognize and treat pulselessness, apnea,
upper airway obstruction, and extremity deformity, as well as recognize respiratory distress, altered mental status,
shock, mechanisms of injury, and obvious death. EMTs are capable of patient assessment, spinal immobilization,
noninvasive ventilatory assistance, and defibrillation with AEDs. EMT training typically requires 100 or more
hours as well as observation time in an ED. This level is prevalent with volunteer fire department members and
others who provide EMS on a volunteer basis. It is also the standard level of training for private industry EMTs
who perform the interfacility and discharge transport of medically stable patients from a medical facility. The
EMT curriculum typically involves one educational module on infants and children, representing a relatively
small percentage of the total training exposures. They learn basic resuscitation skills and external airway
management as well as some of the nuances of injury that apply to children and infants.
AEMTs possess additional clinical skill beyond that of the EMT, but less than those of a paramedic. This
frequently includes the ability to acquire vascular access (including intraosseous access) and to perform advanced
airway management; however, the midlevel provider’s advanced airway management capabilities typically are
limited to a dual-lumen airway device. In some systems, the AEMT scope of practice also includes administering
medications. AEMT training requires 300 to 400 hours, including clinical preceptorship and internship. The
benefits of performing intermediate level procedures in the field are and have been a topic of much debate. It is
important that AEMTs are expert providers of BLS skills and not overly reliant on rarely performed advanced
interventions, especially in children. It is important to consider that, although this level of training may be ideal
for someone who is paired with an EMT-P, it is rarely an acceptable alternative to paramedic-level services except
when the EMS system would otherwise not be able to operate beyond the BLS level.
Paramedics have 1,000 to 2,000 hours of training, internship, and clinical hospital time, and they are capable
of administering a high level of medical care in the field. Their capabilities include advanced diagnostic skills,
recognition, and treatment of arrhythmias, and advanced airway management, including ETI and in some areas
emergent surgical airways and medication-enhanced intubation using sedatives and paralytics. In addition, they
can administer lifesaving medications and fluids in the field. Their ability to use diagnostic tools and diagnose
suspected cardiac disease, stroke, and trauma in the field can lead to the diversion of eligible patients to medical
centers that can provide the most appropriate care. Paramedics have formal didactic training in the emergency
care of children, which may include the American Academy of Pediatrics (AAP), Pediatric Education for
Prehospital Professionals (PEPP), or American Heart Association (AHA), Pediatric Advanced Life Support
