Advanced EMT (AEMT) vs EMT and Paramedic: Scope, Training and Certification
What an Advanced EMT is, what an AEMT can do beyond an EMT, how the level differs from a paramedic, how to become one, and why not every state uses the AEMT level the same way.
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An Advanced EMT (AEMT) is the third of the four national EMS licensure levels, between the EMT and the Paramedic. An AEMT does everything an EMT is trained to do and adds a limited set of advanced skills, most notably starting IV and intraosseous (IO) lines and giving a limited set of additional medications. It is a smaller step up from the EMT than the paramedic is, and not every state uses it.
What is an AEMT?
The National EMS Scope of Practice Model, published by the NHTSA Office of EMS, describes four licensure levels: Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced EMT (AEMT) and Paramedic. Each builds on the one below it. The AEMT level is basic life support plus a limited set of advanced skills: enough to start a line and give a few more medications, without the cardiac monitor interpretation, endotracheal intubation and broad formulary that make up a paramedic's advanced life support.
EMT vs AEMT: what the Advanced EMT adds
In broad strokes, the national model adds the following to the EMT's scope at the AEMT level. Your state may narrow or widen the list, and your medical director decides what you actually do.
- Vascular access: starting a peripheral IV, and intraosseous (IO) access, a line placed into the bone when a vein cannot be found.
- IV fluids, given through that access.
- A limited set of additional medications beyond the EMT's short list, including some given by routes the EMT level does not use. The national model lists them, and your state and your protocols set which ones you carry.
Everything else an EMT does, the AEMT does too: the full patient assessment, airway care, CPR and an AED, bleeding control, splinting and spinal motion restriction, and transport. The difference in practice is that an AEMT can begin some of the treatments that need a line before a paramedic is on scene, or where none is available.
| Area | EMT | AEMT | Paramedic |
|---|---|---|---|
| Level of care | Basic life support | Basic life support plus limited advanced skills | Advanced life support |
| Vascular access | None in the national model | IV and IO access | IV and IO access |
| Medications | A short list, such as aspirin, oral glucose, an epinephrine auto-injector and naloxone | The EMT's list plus a limited set of additional medications | A broad formulary, including drugs given IV, IO, IM, inhaled and by other routes |
| Cardiac | CPR and an AED | CPR and an AED | Cardiac monitoring, 12-lead ECG interpretation, manual defibrillation, cardioversion and pacing |
| Advanced airways | Not in the national model | A supraglottic airway in the national model; not endotracheal intubation; check your state's scope | Advanced airways including endotracheal intubation |
AEMT vs paramedic
The AEMT and the paramedic both start IV and IO lines and share some medications, but the paramedic's scope goes much further: a paramedic provides advanced life support: cardiac monitoring and 12-lead interpretation, manual defibrillation, cardioversion and pacing, advanced airways including intubation, and a much broader range of medications, with the clinical decision-making to use them. The EMT vs Paramedic section in this library compares the two ends of that range side by side.
The training differs as much as the scope. An AEMT course is commonly longer than an EMT course and much shorter than a paramedic program, which commonly runs a year or more with hospital clinical rotations and a field internship. At the paramedic level, graduating from a program accredited by CAAHEP (on the recommendation of CoAEMSP), or one holding a CoAEMSP Letter of Review, is part of National Registry eligibility. Your state and your program set the exact length and requirements of each.
How to become an AEMT
- Become an EMT first. AEMT programs commonly require a current EMT certification or license before you start. The How to Become an EMT section in this library walks through that step.
- Confirm that your state licenses the AEMT level, and how it uses it, before you enroll. Your state EMS office is the place to ask.
- Complete a state-approved AEMT course. Courses are taught to the National EMS Education Standards and combine classroom work with a skills lab, and commonly some clinical or field time where you start IVs on real patients under supervision.
- Meet the certification requirements. Where your state uses the National Registry, that is a psychomotor requirement and the National Registry's AEMT cognitive exam, the same shape as at every other level. The Getting certified section in this library covers the process, and the current exam format, fees and attempt limits are on the Registry's own pages.
- Apply for a state license. National certification is not a license to practice; your state EMS office licenses you, and you may also need credentialing with the agency you join.
Not every state uses the AEMT level the same way
The national model is a reference, and states adopt it differently. Some states license AEMTs with the national scope; some license the level with a narrower or wider scope; some do not license it at all; and some have intermediate levels of their own, with their own names and scopes, between the EMT and the Paramedic. Older national material also used an intermediate level that the current model replaced with the AEMT, so you may still see that older name.
So a certification that is useful in one state may not transfer cleanly to another. If you might move, check how the state you are moving to treats the level before you rely on it. The state licensure section in this library lists every state and its EMS office where verified.
Is becoming an AEMT worth it?
That depends on where you are and where you are going. Some questions worth answering before you sign up:
- Does your state license the AEMT level, and do the services you want to work for staff it? In some areas, often where paramedics are scarce, the AEMT may be the highest level a service staffs, and in others the level is rarely used.
- Are you headed to paramedic school anyway? Paramedic programs commonly require an EMT certification, not an AEMT one, so the AEMT is an optional step rather than a required one. Some students take it for the IV practice and the patient contact; others go straight from EMT to paramedic.
- What will the extra course cost you in time and money, and would that time be better spent working as an EMT or starting a paramedic program?
- Does your agency or employer support the level, through its protocols, its equipment and its pay structure? Ask them rather than assuming.
None of those has a single right answer, and the people best placed to help you weigh them are your state EMS office, the services you want to work for, and the programs you are considering.
Related sections
The EMR vs EMT section covers the first two levels, the EMT vs Paramedic section compares the levels above them, How to Become an EMT and How to Become a Paramedic walk through each path, and the Getting certified section covers the National Registry process at every level, including the AEMT.
NHTSA Office of EMS: NHTSA Office of EMS: the National EMS Scope of Practice Model and the National EMS Education Standards
National Registry of Emergency Medical Technicians: National Registry of EMTs: certification requirements and exams at the AEMT level
CoAEMSP: CoAEMSP: paramedic program accreditation, and how to check a program's status