That's interesting, In Arizona we had 3 EMT levels basic, advanced and Paramedic . First responders I do not think are a State certification, and we essentially got rid of "advanced" because they added so many skills it was just a matter of getting signed off on paramedic meds. EMTs can start IVs maintain IVs, administer all the common patient assisted meds , defib, and intubate with a King Airway or similar device. However all those skills require extra training and a required number of "field Sticks" and your Medical Director has to sign off. So depending where you are in the state or who you medical director is, you can do none, some or all. Some agencies have contracted to medical Directors and Base Hospitals out of their area so they can get the extra skills. A big debate in Az right now is Ketoimine and RSI. RSI allowed in Phoenix not in Yuma. Ketoimine allowed in Yuma, not so much every where else.
And then there is California, we work with them alot. Southern California regulates by County, you are certified statewide on national level curriculum but every county Medical Director can change protocol. AMR hired a bunch of California medics for Az, and they did not know what "off line" direction even was. They had to call in everything including IV starts.
One question, where would you find EMRs, can they work on a ambulance?
BTW Great Discussion!