Effective: 02-28-25
Supersedes: 12-20-20
Purpose:
It is a recognized challenge in the EMS industry to provide extended experiential training to new EMTs. Paid apprenticeships and residencies are a proven, successful pathway to professional development in other facets of healthcare and other industries. As the contracted EMS provider for several area hospitals and municipalities, Brewster/EasCare Ambulance Service must maintain adequate minimum staffing levels at the BLS and ALS levels.
Policy:
Efforts will be made to fill vacant positions with EMTs as much as possible. When staffing needs outpace capacity to fill open positions with EMTs, an ATS may be utilized as a partner to a fully licensed EMT in the IFT setting to supplement available resources in accordance with applicable state regulations and waivers.
Definition(s):
Ambulance Transport Specialist (ATS) is an individual who been trained to the first responder level and meets all other requisite training requirements and has been authorized by the Chief Medical Officer to work as the partner to an EMT on a BLS level ambulance.
Procedure:
1. ATSs that are approved by the Chief Medical Officer may be partnered on a BLS IFT ambulance. When in this staffing configuration, the EMT is responsible for all patient care and documentation. The ATS shall assist with patient care within their training under the direction of the EMT. When transporting a patient, the ATS shall drive while the EMT provides patient care. Under no circumstance shall an ATS provide direct patient care when an EMT is available to do so.
2. Upon completing transport, the ATS is expected to clean and restock the vehicle while the EMT is primarily responsible for completing documentation.
3. BLS units staffed with an ATS should not be used for emergency work when BLS units staffed with dual EMTs are available. As a last resort, ambulances staffed with an ATS may respond to emergencies or provide back-up 911 coverage. A supervisor should respond with these units when available.
Minimum Experience Level and Competencies of EMT assigned to work with ATS
The ambulance service, in accordance with its affiliate hospital medical director(s) has established the following minimum experience levels and skill competencies for each of its EMT-Basics working in an EMT-Basic / ATS level staffing configuration. Brewster Ambulance Service has developed a “scoring” system within its scheduling software to assist schedulers in ensuring ambulance units are staffed appropriately. Each employee is assigned a number of “points” based on their training and experience level. At a minimum, each BLS level ambulance must be staffed with a crew configuration equaling 5 points. Skill competency and protocol compliance is reviewed as part of our ongoing quality assurance program, and Field Supervisors play a critical role in coaching, mentoring and evaluation. Upon Supervisor recommendation, team members with at least four (4) months of EMT experience and consistent skill competence are awarded an additional point and noted as category “3” in the scheduling software which allows them to be paired with a less experienced EMT or ATS. Any deviations from these minimum staffing requirements for extraordinary situations must be authorized by an area manager.
Points |
Description |
1 |
New Employee |
2 |
Completed Orientation and all training requirements. ATS, or EMT with < 4 months experience or not yet cleared by Supervisor to work independently |
3 |
EMT with at least 4 months experience, cleared by Supervisor to work with junior EMT or ATS. |
4 |
Educator, Field Supervisor, FTO, Manager |
Minimum Standards for First Responder Training / Scope of Practice
|
First Responder/ATS |
EMT |
Patient Assessment and Movement |
|
|
Primary Survey |
X |
X |
Secondary Survey, including vital sign (BP,HR,RR) |
X |
X |
Patient Movement (long board, scoop, stair chair, draw sheet, power and manual stretcher operation) |
X |
X |
Patient Restraint (ATS may assist the EMT) |
X |
X |
Airway / Ventilation / Oxygenation |
|
|
Airway-nasal |
X |
X |
Airway-oral |
X |
X |
Bag valve mask (BVM) |
X |
X |
Head tilt- chin lift |
X |
X |
Jaw thrust |
X |
X |
Airway obstruction- dislodgement techniques |
X |
X |
Oxygen therapy- nasal cannula |
X |
X |
Oxygen therapy- non rebreather mask |
X |
X |
Pulse oximetry |
X |
X |
Suctioning- upper airway |
X |
X |
Cardiovascular / Circulation |
|
|
Cardiopulmonary resuscitation (CPR) |
X |
X |
Defibrillation- AED |
X |
X |
Hemorrhage control- direct pressure |
X |
X |
Hemorrhage control- tourniquet |
X |
X |
Hemorrhage control- wound packing |
X |
X |
Splinting / Spinal Motion Restriction / Restraint |
X |
X |
Cervical Collar |
X |
X |
Long spine board |
X |
X |
Manual cervical stabilization |
X |
X |
KED |
X |
X |
Extremity stabilization / splinting |
X |
X |
Traction splint |
X |
X |
Emergency Moves for endangered patient |
X |
X |
Medication Administration |
|
|
Epi-Pen |
|
X |
Check and Inject Epinephrine |
|
X |
Nasal Narcan |
X |
X |
Oral Aspirin |
|
X |
Oral Glucose for suspected hypoglycemia |
|
X |
Notes:
Massachusetts EMS System regulations were updated on January 6, 2023, including changes in staffing requirements for EMS Units. 105 CMR 170.305 (Staffing) now includes language permitting the EMT / First Responder staffing configuration.
Massachusetts Administrative Requirement AR 2-100: Minimum Standards for First Responder Training in First Aid, Epinephrine Auto-Injector and Naloxone Use. Available at: https://www.mass.gov/doc/ar-2-100-minimum-standards-for-first-responder-training-in-first-aid-epinephrine-auto-injector-and-naloxone-use/download
Rhode Island permits an EMT to work with a First Responder or “driver”. See Statewide Treatment Protocol #6.05 “Interfacility and Non-Emergent Transport”
New Hampshire requires a minimum of two licensed providers, at least one of whom is an EMT. The other provider may be licensed at the Emergency Medical Responder (EMR) level.
*Note: originally referred to as “Emergency Transport Specialist” or “ETS”, but title was subsequently updated to ATS to better reflect role.