Advanced emergency medical technician (AEMT) Paramedic Some states also recognize the advanced practice paramedic or critical care paramedic level as a state-specific licensure above that of paramedic. These critical care paramedics generally perform high acuity transports that require skills outside the scope of a standard paramedic (such as mechanical ventilation and management of cardiac assist devices). In addition, EMTs can seek out specialty certifications such as wilderness EMT, wilderness paramedic, tactical EMT, and flight paramedic. In 2009, the NREMT posted information about a transition to a new system of levels for emergency care providers developed by NHTSA with the National EMS Scope of Practice Project. By 2014, these new levels replaced the fragmented system found around the United States. The new classification includes emergency medical responder (replacing first responder), emergency medical technician (replacing EMT-basic), advanced emergency medical technician (replacing EMT-intermediate/85), and paramedic (replacing EMT-intermediate/99 and EMT-paramedic). Education requirements in transitioning to the new levels are substantially similar. EMR EMR is the most basic level of training, and is considered the bare minimum certification for rescuers that respond to medical emergencies. EMRs are typically on-call volunteers in rural communities, or are primarily employed as firefighters or search and rescue personnel. EMRs typically arrive quickly and assess and stabilize the patient before the transporting ambulance arrives, and then assist the crew with patient care and packaging. EMRs provide advanced first aid-level care, CPR, semi-automatic defibrillation, basic airway management (suction/oropharyngeal airway), oxygen therapy, and administration of basic, life-saving medications such as epinephrine and naloxone. EMT EMT is the next level of EMS certification and is considered the most common entry level of training. The procedures and skills allowed at this level include bleeding control, management of burns, splinting of suspected fractures and spinal injuries, childbirth, cardiopulmonary resuscitation, semi-automatic defibrillation, oral suctioning, insertion of oropharyngeal and nasopharyngeal airways, pulse oximetry, blood glucose monitoring, auscultation of lung sounds, and administration of a limited set of medications (including oxygen, epinephrine, dextrose, naloxone, albuterol, ipratropium bromide, glucagon, nitroglycerin, nitrous oxide, and acetylsalicylic acid). Some areas may add to the scope of practice, including intravenous access, insertion of supraglottic airway devices, and CPAP. Training requirements and treatment protocols vary from area to area. Advanced EMT Advanced EMT is the level of training between EMT and paramedic. They can provide intermediate life support (ILS) care including obtaining intravenous or intraosseous access, basic cardiac monitoring, fluid resuscitation, capnography, and administration