- Note: Massachusetts has state wide protocols which allow for some variation by individual service medical directors. The six New England states are moving towards using a standard set of protocols, but that will take some time.
Almost all states are moving towards updating the educational standards and scope of practice for all levels of EMS providers. Effective in 2019, MA will require all providers to fit into one of the three following categories. All providers will need to complete a transition course to meet the new standards. The exact dates by which the transition must be completed vary by level of provider and when they were originally certified. New or expanded skills are noted in bold text.
Massachusetts also rejoined the National Registry of EMTs in April of 2013. As a result all new EMTs and paramedics will be both nationally and state certified. Existing EMTs and paramedics who are NOT nationally registered, will continue to have Massachusetts only certifications unless they opt to challenge the National Registry psychomotor (practical) and cognitive (written) examinations.
EMT-Basic (EMT-B) will become Emergency Medical Technician
- Provides BLS: Basic Life Support
Skills include: Patient assessment, airway management with oral/nasal airways, pocket masks, B-V-M units, oral suctioning, CPR and AED, bleeding control, splinting, supplemental oxygen, childbirth, spinal immobilization, use of Epi-Pen and Aspirin, oral glucose, expanded selection of Oxygen delivery devices, pulse oximetry, mechanical CPR devices, automatic transport ventilators, albuterol via nebulizer, and assisted medications. Additionally, EMTs and most first responders in MA have been trained to administer nalaxone (Narcan) via nasal atomizer. The transition material will generally be covered during EMT Continuing Competency (refresher) training.
EMT-Intermediate (EMT-I) will become Advanced Emergency Medical Technician (AEMT)
Skills include all EMT-B skills plus: Advanced airway management, intravenous fluid administration, patient assessment/management - medical, airway ventilation and oxygenation of an infant/child in respiratory distress/failure, cardiac arrest management /AED, intravenous bolus medications, pediatric intraosseous infusion. Essentially the transition will require all existing EMT-Intermediate providers to take a course covering most of what used to be included in the paramedic curriculum. EMT-Is transitioning to AEMT will also have to take a cognitive (written) examination on the new material. EMT-Intermediates who fail to take and pass a transition course will revert to Emergency Medical Technician. The dates by which the transition must be completed vary from 2016 to 2019 depending on when and what type of original training was taken. This is the most complex transition in the plan and it is unknown how many Intermediate level providers will complete it.
EMT-Paramedic (EMT-P) will become Nationally Registered Paramedic (NRP)
- Provides ALS: Advanced Life Support
Skills include all EMT-B skills plus: IV, adult and pediatric endotracheal intubation (ET) , (LMA and Combitube can be used if regular ET Tube intubation fails) needle cricothyroidotomy ,cardiac monitoring, defibrillation, transcutaneous cardiac pacing, drug therapy, pediatric and neonatal care. New skills include BiPAP, CPAP, ETCO2 monitoring, NG/OG tube placement and monitoring, chest tube monitoring, access indwelling catheters and implanted central IV ports, placement and use of Morgan lens, administer specific physician approved medications.
Transition training can be incorporated in the Continuing Competency Requirement classes (formerly called refresher) or in stand alone transition courses. No cognitive examination is required. EMT-Paramedics who do not transition to Paramedic by 2016, will become Advanced Emergency Medical Technicians.
First Responder: Trained in Basic First aid and use of oxygen, CPR/AED, child birth. All Police Officers and Firefighters in MA are required to be trained at this level by law.