Advanced EMT for Preppers, by R.S.

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 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.

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.

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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  1. Another middle certification that is easier to find and accomplish is the ‘Wilderness Advanced First Aid’ certification. Its focus on up to multi-day management of medical emergencies or injuries and longer term wound management makes it more appropriate to the prepper mindset and situation.

    When I took it in the mid-90’s it was 80+ hours and was called ‘Mountaineering Oriented, Advanced First Aid’. I’m told the Red Cross doesn’t do it anymore. It took a couple months going two nights a week. The depth of study and complexity was amazing- I ended up having a 5 inch thick 3-ring notebook of handouts at completion, the course included several practical (i.e. outdoors simulated emergency) exercises, including one at night, a 2 hr final exam and 8 hours of observation duty at a local trauma center. Needless to say, my level of confidence with any medical emergency was greatly enhanced. As I tell people, it was the most challenging and rewarding class I have ever taken.

  2. A good article. My wife is/was an EMT some years ago. Although she still has the skills, she can no longer run squad because of physical issues.
    We still have most of her training supplies, and she keeps her bag in the truck.

  3. More medical training is always better!!! Emergencies happen every day, not just WTSHTF. Knowing what to do, and how to do so CALMLY are important for your safety, as well as the people you are helping during an emergency.

    As a medical director for multiple fire departments, both paid and volunteer, here are a few additional hints to consider:

    1.) In the post-9/11 and “active shooter” era, there has been a recognition that having more laypeople medically trained benefits all of society, especially in the event of a mass casualty event/natural disaster/terrorist attack.
    There are programs offered (usually from state Emergency Management Agency/state DHS) to provide free or very low-cost medical training to members of the public, usually with no service obligation expected in return. In our region, our state EMA District offers free EMR and EMT-Basic classes, as well as Fire I&II. The major investment you would have is your time, as well as the cost of course materials and a uniform (a total of about $100).

    2.) Many of these same EMR/EMT-B courses are also being taught to high school students who elect a Public Safety vocational tract. If you have young people in school, you might encourage them to participate in this offering. This tract may also lead to a secure profession as a firefighter/medic upon completion.

    3.) Many paid fire departments will show hiring preference or exclusivity to candidates who apply with EMT-B and Fire I/II certifications already. Once an applicant has been hired, many departments will sponsor a firefighter to go on to EMT-A, or more likely, EMT-P (paramedic) school. So, if you have ambitions about applying for this position, having basic or advanced certifications help your candidacy. An EMT-A will likely be shown hiring preference over an EMT-B if their applications and interviews are otherwise similar.

    4.) Unfortunately, R.S. was correct that many departments do not have specific protocols for EMT-A’s because they are rare and fall into a “no-man’s land” between EMT-B’s and EMT-P’s. I believe this is much more common in urban/suburban areas that rely on paid Fire/EMS services, and can also afford to put all of their firefighters through EMT-P school.
    Many rural departments/VFD’s have more need for folks with an advanced EMT skill set, but who have not had the opportunity to complete EMT-P school. These departments are more likely to make protocol exceptions which allow their EMT-A’s to practice at the full scope of their training.

    5.) Being involved in Fire/EMS will provide you with a plethora of skills which will be useful as a prepper. You learn to contend with austere situations and think on your feet. The fire and medical knowledge you gain may save many lives one day, and both of these emergencies (medical and fire) will frequently occur in a WTSHTF scenario. The free training that comes with part of the volunteer or paid work on a department will further your knowledge base and, more importantly, provide you with hands-on training that can’t be obtained by reading textbooks or blogs.

    6.) I suggest all laypeople take a CPR and Stop the Bleed course, regardless of interest in pursuing advanced EMS training. (Editorial: I would also suggest these be made mandatory content in all HS curricula, along with a personal finance course…much more useful than a lot of the liberal drivel being pushed in HS these days!) These two courses can be completed in an evening apiece, and literally could make a life-and-death difference for someone you love. This should be a critical portion of anyone’s prep plans. It is far more likely you’ll need these skills than your 25 year supply of freeze dried foods, or your 20,000 rounds of 5.56 ammo!

    Many community organizations offer CPR (either Red Cross or American Heart Association). The American College of Surgeons sponsors the Stop the Bleed course. Here are the links to find training in your area. Many are free. Some are taught at a reasonable fee to cover the costs of putting on the class:

    7.) Likeminded folks who happen to have medical training may make valuable members of your preparedness group.

    Stay Safe Out There!
    -Doctor Dan

  4. One of our children wanted to go into law enforcement. Our local police department requires all applicants to have associate’s degrees or 5 years experience. They also must be 21. Since he was 17 when he graduated high school, we offered pay for him to go to school to become a paramedic, which is a two year degree at our local technical college. We now have a medic in our group, plus it fulfilled his need of a associate degree to pursue his desired career. He is currently employed with a local hospital, is getting to meet many in our local law enforcement community and is self supporting until he is able to get into a future police academy. Also, our a local volunteer fire department has an EMT class every fall. Two others in our group are planning taking the course this year. It is a once a week class from Sept thru mid Dec. It qualifies the student to take the testing to be a licensed EMT in our state. Neither one in our group is planning on taking the test, they just want the skill set.

  5. I too went to EMT school just for the skills and I will say this, unless you plan on working out of an ambulance, EMT-B is probably not the prepper way to go. Far too many skills and the equipment you are taught to use are not man-packable and are for use in the back of the truck. I would recommend first responder and some of the shorter wilderness first aid courses that are out there. NOLS, REI Coop and some rural schools offer enhancement courses that will compliment or enhance your skills. Disclosure; an EMT license as well as a first responder License has to be renewed every two years and each come with a documentable training requirement. Some states further regulate in addition to the NREMT requirements.

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