Louisville Metro EMS utilizes two levels of care providers. EMT-Basics (referred to as technicians or EMTs) and EMT-Paramedics (usually just called paramedics) have drastically different scopes of practice but all exist to provide care and transportation to the sick and injured. A technician specializes in ambulance operation and basic care as well assistance to advanced providers. Most technicians have an initial six months of training. Paramedics use complex diagnostics, perform medical procedures, and administer medications and additional advanced care that would otherwise only be provided by an emergency physician. Paramedics in Kentucky generally have three years of initial training including at least 750 hours of internship and clinical instruction in addition to about 1200 hours of formal, classroom instruction. An increasing number of paramedics possess at least an associates degree, many have bachelor's degrees.
Technicians are trained to operate independent of a paramedic and when such situations arise they are capable of caring for and transporting any medical emergency to the hospital on their own.
Although the Kentucky Board of Emergency Medical Services allows for the use of EMT-Intermediate providers, LMEMS does not utilize this mid-level of care provider.
|Treatment issue||EMT-B skills (technician)||EMT-P skills (paramedic)|
|Airway management||Assessment, manual repositioning, oro- and nasopharyngeal airway adjuncts, manual removal of obstructions, suctioning, King LT-D blind insertion airway device (BIAD)||tracheal intubation (oral and nasal), advanced airway management for endotracheal tube, tracheostomy. Deep suctioning, use of Magill forceps, surgical airways (including needle cricothyrotomy)|
|Breathing||Assessment (rate, effort, symmetry, skin color), obstructed airway maneuver, passive oxygen administration by nasal canula, rebreathing and non-rebreathing mask, active oxygen administration by Bag-Valve-Mask (BVM) device, pulse oximetry||Active oxygen administration by endotracheal tube or other device using BVM, colometric, side stream, or inline end tidal carbon dioxide (EtCO2) capnography. Use of mechanical transport ventilators (rare), active oxygen administration by surgical airway, decompression of chest cavity using needle/valve device (needle thoracostomy)|
|Circulation||Assessment of pulse (rate, rhythm, volume), blood pressure, skin color, and capillary refill, patient positioning to enhance circulation, recognition and control of hemorrhage of all types using direct and indirect pressure and tourniquets||Ability to interpret assessment findings in terms of levels of perfusion, obtaining intravenous access (IV), intravenous fluid replacement, vasoconstricting drugs, intraosseous (IO) cannulation (placement of needle into marrow space of a large bone). Access central venous catheters or peripherally inserted central catheters (PICC).|
|Cardiac arrest||Cardiopulmonary resuscitation, airway management, manual ventilation with BVM, automatic external defibrillator, ResQPod thoracic impedance device||Dynamic resuscitation including intubation, drug administration (includes anti-arrhythmics), 12-lead ECG interpretation, manual defibrillation, synchronized electrical or chemical cardioversion, and external cardiac pacing|
|Cardiac Monitoring||None||12-lead ECG monitoring and interpretation including modified chest leads, right-sided leads, and posterior adjunctive leads.|
|Drug administration||Oral, nebulized, auto-injector||Intramuscular and subcutaneous injection, intravenous and intraosseous boluses and infusions, endotracheal tube drug administration, rectal tube, and umbilical venous access.|
|Drug types permitted||Low-risk/immediate requirements e.g. oxygen (hypoxia), aspirin (chest pain), oral glucose (low blood sugar), epinephrine auto-injector (allergic reaction), albuterol (asthma)||Analgesics for pain, antiarrhythmics (irregularities in heartbeat), cardiac resuscitation drugs, bronchodilators (for breathing), vasoconstrictors (to improve circulation, e.g. dopamine, Pitressin, epinephrine), atropine for slow heart rates, anticonvulsives (for prolonged seizures), antidotes (naloxone for opiate overdose), dextrose 50% in water (low blood sugar), sodium bicarbonate (acidosis)|
|Patient assessment||Basic physical assessment, 'vital' signs, history of general and current condition, pulse oximetry||More detailed physical assessment and history, auscultation, interpretation of assessment findings, ECG interpretation, glucometry, capnography|
|Wound management||Assessment, control of bleeding, application of pressure dressings and other types of dressings, splinting and immobilization||Pain management|
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