105 Scope of practice for emergency medical service providers; update to 2014 notice

Scope of Practice for Emergency Medical Service Providers; Update to 2014 Notice

[45 Pa.B. 377]
[Saturday, January 17, 2015]

In the notice published at 44 Pa.B. 7487 (November 29, 2014), the Department of Health (Department) published the scope of practice for emergency medical service (EMS) providers under 35 Pa.C.S. §§ 8101—8157 (relating to Emergency Medical Services System Act). This notice updates the notice published at 44 Pa.B. 7487. Changes to the scope of practice for EMS providers follow.

Under 28 Pa. Code §§ 1023.24(d)(1), 1023.25(d)(1), 1023.26(d)(1), 1023.27(d)(1), 1023.28(d), 1023.29(d) and 1023.30(e), the Department of Health is publishing the scope of practice for emergency medical responders (EMR), emergency medical technicians (EMT), advanced emergency medical technicians (AEMT), paramedics (P), prehospital registered nurses (PHRN), prehospital physician extenders (PHPE) and prehospital physicians (PHP) under 35 Pa.C.S. §§ 8101—8157.

Skills identified may be performed by an EMS provider at the provider's level of certification or registration only if the provider has successfully completed the approved education (cognitive, affective and psychomotor) on the specified skill, which includes training to perform the skill on adults, children and infants, as appropriate. EMRs, EMTs, AEMTs and Ps may only perform the skills identified, through either Statewide or other Department-approved protocols, or skills that may be ordered online by a medical command physician.

As the following chart indicates, a PHRN, PHPE and PHP may perform all skills identified as within a P's scope of practice. Each of these EMS providers may perform additional skills as outlined as follows.

A PHRN who is appropriately credentialed by the EMS agency medical director may perform other services authorized by The Professional Nursing Law (63 P. S. §§ 211—225.5), when authorized by a medical command physician through either online medical command or through the applicable Statewide or Department-approved EMS protocols.

A PHPE who is appropriately credentialed by the EMS agency medical director may perform services within the scope of practice of a physician assistant under the Medical Practice Act of 1985 (63 P. S. §§ 422.1—422.51a) or the Osteopathic Medical Practice Act (63 P. S. §§ 271.1—271.18), when authorized by a medical command physician through either online medical command or through applicable Statewide or Department-approved EMS protocols. When a PHPE functions as an EMS provider, the physician supervision requirements applicable to a physician assistant under the Medical Practice Act of 1985 and the Osteopathic Medical Practice Act do not apply.

A PHP who is appropriately credentialed by the EMS agency medical director may perform skills within a P's scope of practice and other skills within the practice of medicine or osteopathic medicine. A PHP may not perform a skill that the PHP has not been educated and trained to perform.

Under 28 Pa. Code § 1023.1(a)(1)(vi) and (vii) (relating to EMS agency medical director), the EMS agency medical director must make an initial assessment of each EMS provider at or above the AEMT level, and then within 12 months of each prior assessment, to determine whether the EMS provider has the knowledge and skills to competently perform the skills within the EMS provider's scope of practice, and a commitment to adequately perform other functions relevant to the EMS provider providing EMS at that level. EMS providers at or above the AEMT level may only perform skills that the EMS agency medical director has credentialed them to perform.

The Department highlights the following changes to the skills listed since this notice was last published at 44 Pa.B. 7487. The Department is phasing-in changes for some of the skills listed as indicated with a footnote added to those skills now being phased-in. Additionally, the following skills, which have been numbered in the same manner as on the skills list that follows, have been revised as described:

8—The description of the skill (chest tube thoracostomy, monitoring of existing tube in a closed system) was expanded to provide examples of types of closed systems.

11 and 12—The applicable scope of practice for the skill (Biphasic positive airway pressure (BiPAP)) has been revised to distinguish between patients chronically on BiPAP for more than 48 hours and patients acutely on BiPAP for less than 48 hours.

48 and 49—The applicable scope of practice for the skill (ventilators, transport) was revised to distinguish between types of patients for whom the skill is being provided based upon the patient's ultimate destination.

109—This skill now contains a new footnote relating to the administration of Naloxone and clarifies the specific training that is required before this skill can be performed by EMRs and EMTs.

Persons with a disability who require an alternate format of this notice (for example, large print, audiotape, Braille) should contact Richard Gibbons, Department of Health, Bureau of Emergency Medical Services, Room 606, Health and Welfare Building, 625 Forster Street, Harrisburg, PA 17120-0710, (717) 787-8740. Speech or hearing impaired persons may call by using V/TT (717) 783-6154 or the Pennsylvania AT&T Relay Service at (800) 654-5984 (TT).

MICHAEL WOLF,
Secretary

Category Skill EMR EMT AEMT P*

1 Airway/Ventilation/Oxygenation Airway—Nonsurgical Alternative/Rescue Airway—CombiTube^TM, King LT-D Airway^TM, or King LTS-D Airway^TM No No Yes Yes

2 Airway/Ventilation/Oxygenation Airway—Oropharyngeal (OPA) & Nasopharyngeal (NPA) Yes Yes Yes Yes

3 Airway/Ventilation/Oxygenation Airway—Pharyngeal tracheal lumen (PTL) No No No No

4 Airway/Ventilation/Oxygenation Bag-valve-ETT/Nonsurgical alternative airway ventilation Yes² Yes² Yes Yes

5 Airway/Ventilation/Oxygenation Bag-valve-ventilation—with in-line small-volume nebulizer No Yes² Yes Yes

6 Airway/Ventilation/Oxygenation Bag-valve-mask (BVM) ventilation Yes Yes Yes Yes

7 Airway/Ventilation/Oxygenation Chest decompression—needle No No No Yes

8 Airway/Ventilation/ Oxygenation Chest tube thoracostomy, monitoring of existing tube in a closed system (for example water seal or suction) No No No No

9 Airway/Ventilation/Oxygenation Chest tube thoracostomy, acute insertion No No No No

10 Airway/Ventilation/Oxygenation Continuous positive airway pressure (CPAP) No Yes¹ Yes Yes

11 Airway/Ventilation/Oxygenation Biphasic positive airway pressure (BiPAP) for patients chronically on BiPAP for >48 hours No No No Yes

12 Airway/Ventilation/Oxygenation Biphasic positive airway pressure (BiPAP) for patients acutely on BiPAP for <48 hours No No No No

13 Airway/Ventilation/Oxygenation Cricothyrotomy—needle No No No Yes

14 Airway/Ventilation/Oxygenation Cricothyrotomy—open/surgical No No No Yes

15 Airway/Ventilation/Oxygenation Cricothyrotomy—overwire (Seldinger) technique No No No Yes

16 Airway/Ventilation/Oxygenation End tidal CO₂ monitoring/capnography No No Yes Yes

17 Airway/Ventilation/Oxygenation Esophageal obturator airway (EOA)/esophageal gastric tube airway (EGTA) No No No No

18 Airway/Ventilation/Oxygenation Extubation—removal of ETT No No No Yes

19 Airway/Ventilation/Oxygenation Gastric decompressions—Orogastric or nasogastric tube insertion No No No Yes

20 Airway/Ventilation/Oxygenation Gastric decompression by means of alternative/rescue airway (CombiTube^TM or King LTS-D^TM) No No Yes Yes

21 Airway/Ventilation/Oxygenation Head-tilt/chin lift Yes Yes Yes Yes

22 Airway/Ventilation/Oxygenation Inspiratory Impedance Threshold Device (ITD) No No Yes¹ Yes

23 Airway/Ventilation/Oxygenation Endotracheal Intubation—by direct laryngoscopy (including video intubation devices), nasotracheal, digital, and transillumination/lighted stylet techniques No No No Yes

24 Airway/Ventilation/Oxygenation Endotracheal Intubation—paralytic assisted, rapid sequence induction (RSI) No No No No

25 Airway/Ventilation/Oxygenation Ventilation—maintenance of previously initiated neuromuscular blockade No No No No

26 Airway/Ventilation/Oxygenation Endotracheal Intubation—retrograde technique No No No No

27 Airway/Ventilation/Oxygenation Jaw thrust and modified jaw thrust (trauma) Yes Yes Yes Yes

28 Airway/Ventilation/Oxygenation Laryngeal mask airway (LMA) No No No No

29 Airway/Ventilation/Oxygenation Mouth-to-mouth, nose, stoma, barrier and pocket mask Yes Yes Yes Yes

30 Airway/Ventilation/Oxygenation Obstruction—direct laryngoscopy (remove with forceps) No No No Yes

31 Airway/Ventilation/Oxygenation Obstruction—manual (abdominal thrusts, finger sweep, chest thrusts) upper airway Yes Yes Yes Yes

32 Airway/Ventilation/Oxygenation Oxygen therapy—blow-by delivery Yes Yes Yes Yes

33 Airway/Ventilation/Oxygenation Oxygen therapy—humidifiers No Yes Yes Yes

34 Airway/Ventilation/Oxygenation Oxygen therapy—nasal cannula Yes Yes Yes Yes

35 Airway/Ventilation/Oxygenation Oxygen therapy—non-rebreather Yes Yes Yes Yes

36 Airway/Ventilation/Oxygenation Oxygen therapy—partial rebreather No Yes Yes Yes

37 Airway/Ventilation/Oxygenation Oxygen therapy—regulators Yes Yes Yes Yes

38 Airway/Ventilation/Oxygenation Oxygen therapy—simple face mask No Yes Yes Yes

39 Airway/Ventilation/Oxygenation Oxygen therapy—Venturi mask No Yes Yes Yes

40 Airway/Ventilation/Oxygenation Peak expiratory flow assessment No No Yes Yes

41 Airway/Ventilation/Oxygenation Suctioning—meconium aspiration No No No Yes

42 Airway/Ventilation/Oxygenation Suctioning—stoma/tracheostomy Yes Yes Yes Yes

43 Airway/Ventilation/Oxygenation Suctioning—tracheobronchial by means of advanced airway No Yes² Yes Yes

44 Airway/Ventilation/Oxygenation Suctioning—upper airway (nasal) Yes Yes Yes Yes

45 Airway/Ventilation/Oxygenation Suctioning—upper airway (oral) Yes Yes Yes Yes

46 Airway/Ventilation/Oxygenation Transtracheal jet ventilation No No No Yes

47 Airway/Ventilation/Oxygenation Single mode, volume controlled automated ventilator (without blender) No Yes Yes Yes

48 Airway/Ventilation/Oxygenation Ventilators, transport—used in multi-modal settings, blended gas transport ventilator on patients >1 year of age and ventilated >48 hours and no anticipated need to actively titrate ventilator settings in patients transported to or from residence, skilled nursing facility, rehabilitation hospital or long term acute care hospital (LTACH) No No No Yes^1,5

49 Airway/Ventilation/Oxygenation Ventilators, transport—used in multi-modal settings, blended gas transport ventilator on patients >1 year of age and ventilated >48 hours and no anticipated need to actively titrate ventilator settings in patients transported between acute care hospitals No No No No⁵

50 Airway/Ventilation/Oxygenation Ventilators, transport—used in multi-modal settings, blended gas transport ventilator on patients ventilated <48 hours or anticipated need to actively titrate ventilator settings No No No No⁵

51 Airway/Ventilation/Oxygenation Ventilators—transport No No No Yes⁴

52 Cardiovascular/Circulation Blood pressure—auscultation Yes Yes Yes Yes

53 Cardiovascular/Circulation Blood pressure—electronic non-invasive Yes Yes Yes Yes

54 Cardiovascular/Circulation Blood pressure—palpation Yes Yes Yes Yes

55 Cardiovascular/Circulation Electrocardiogram (ECG) monitoring—apply electrodes for single leads No Yes² Yes² Yes

56 Cardiovascular/Circulation Electrocardiogram (ECG) monitoring—obtain and transmit 12-lead ECG No No Yes Yes

57 Cardiovascular/Circulation Electrocardiogram (ECG) monitoring—12-lead (interpret) No No No Yes

58 Cardiovascular/Circulation Cardiac monitoring—single lead (interpret) No No No Yes

59 Cardiovascular/Circulation Manual chest compressions—adult, child, infant Yes Yes Yes Yes

60 Cardiovascular/Circulation Cardioversion—synchronized No No No Yes

61 Cardiovascular/Circulation Carotid massage (vagal maneuvers) No No No Yes

62 Cardiovascular/Circulation Defibrillation—counter shock—manual No No No Yes

63 Cardiovascular/Circulation Transcutaneous cardiac pacing No No No Yes

64 Cardiovascular/Circulation Transvenous or Epicardial pacing, Management of No No No No

65 Cardiovascular/Circulation Defibrillation—automated external defibrillator (AED) Yes Yes Yes Yes

66 Cardiovascular/Circulation Hemodynamic monitoring/assist (Swan Ganz, central venous pressure) No No No No

67 Cardiovascular/Circulation Intra-aortic balloon pump or invasive cardiac assist device monitoring/assist No No No No

68 Cardiovascular/Circulation Mechanical chest compression device use No Yes¹ Yes¹ Yes¹

69 Cardiovascular/Circulation Thrombolytic therapy—initiation No No No No

70 Cardiovascular/Circulation Thrombolytic therapy—monitoring No No No No

71 IV Initiation/Maintenance/Fluids Central venous cannulation/insertion No No No No

72 IV Initiation/Maintenance/Fluids Central venous line—access of existing catheters with external ports No No No Yes

73 IV Initiation/Maintenance/Fluids External jugular vein cannulation No No No Yes

74 IV Initiation/Maintenance/Fluids Saline lock insertions as no-flow IV No No Yes Yes

75 IV Initiation/Maintenance/Fluids Intraosseous—needle placement and infusion—tibia, femur and humerus No No Yes³ Yes

76 IV Initiation/Maintenance/Fluids IV insertion, peripheral venous—initiation (cannulation) No No Yes Yes

77 IV Initiation/Maintenance/Fluids Sub-cutaneous indwelling catheters—access of existing catheters No No No No

78 IV Initiation/Maintenance/Fluids Venous blood sampling, peripheral—for clinical diagnostic purposes only, not for legal purposes No No Yes³ Yes

79 IV Initiation/Maintenance/Fluids Venous central line (blood sampling)—obtaining No No No No

80 IV Initiation/Maintenance/Fluids Arterial line—capped—transport No Yes Yes Yes

81 IV Initiation/Maintenance/Fluids Arterial line—monitoring/assist No No No No

82 IV Initiation/Maintenance/Fluids Blood/Blood-by-products administration (initiation and continuation) No No No No

83 Lifting & Moving Patient lifting, moving and transfers Yes Yes Yes Yes

84 Lifting & Moving Patient restraints on transport devices Yes Yes Yes Yes

85 Medication administration routes Endotracheal (ET) No No No Yes

86 Medication administration routes Inhalation (aerosolized/nebulized) No No Yes Yes

87 Medication administration routes Intramuscular (IM) No No Yes Yes

88 Medication administration routes Intranasal No No Yes Yes

89 Medication administration routes Intraosseous—tibia, humerus, or femur No No No Yes

90 Medication administration routes Intravenous (IV)—fluid bolus No No Yes Yes

91 Medication administration routes Intravenous (IV)—monitoring or maintaining existing intravenous infusion (crystalloid fluid as published in the EMS medication list in the Pennsylvania Bulletin) during interfacility transport No No Yes Yes

92 Medication administration routes Intravenous (IV) infusion, with added medication, including by intravenous pump No No No Yes

93 Medication administration routes Nasogastric No No No Yes

94 Medication administration routes Enteral feeding devices, management of No No No No

95 Medication administration routes Oral—glucose and aspirin (other medications addressed elsewhere) No Yes Yes Yes

96 Medication administration routes Rectal No No No Yes

97 Medication administration routes Subcutaneous No No Yes Yes

98 Medication administration routes Sublingual (Note: EMT may only assist patient with his/her prescribed Nitroglycerin (NTG)) No Yes Yes Yes

99 Medication administration routes Topical No No No Yes

100 Medications Auto-injector benzodiazepine for seizure No No No Yes

101 Medications Auto-injector epinephrine (assist patient with his/her prescribed medication) No Yes Yes Yes

102 Medications Auto-injected epinephrine-primary use—not patient's own prescription No Yes¹ Yes Yes

103 Medications Medications as published in Pennsylvania Bulletin by the Department No No Yes Yes

104 Medications Immunizations as published in the Pennsylvania Bulletin by the Department No No Yes Yes

105 Medications Over-the-counter (OTC) medications (Note: aspirin and glucose covered elsewhere) No No No No

106 Medications Oxygen Yes¹ Yes Yes Yes

107 Medications Auto-injector nerve agent antidote—self rescue treatment No Yes³ Yes³ Yes

108 Medications Metered-dose inhaler (MDI) bronchodilator (Note: EMT may only assist patient with his/her own prescribed medication) No Yes Yes Yes

109 Medications Naloxone—Intranasal or auto-injector Yes⁶ Yes⁶ Yes Yes

110 Patient assessment/management Behavioral—Restrain violent patient Yes¹ Yes Yes Yes

111 Patient assessment/management Blood glucose assessment No No Yes Yes

112 Patient assessment/management Portable blood analysis devices, use of (glucometer covered elsewhere) No No No No

113 Patient assessment/management Childbirth—umbilical cord cutting Yes Yes Yes Yes

114 Patient assessment/management Childbirth (abnormal/complications) No Yes Yes Yes

115 Patient assessment/management Childbirth (normal)—cephalic delivery Yes Yes Yes Yes

116 Patient assessment/management Carbon Monoxide CO-oximetry monitoring No Yes¹ Yes¹ Yes¹

117 Patient assessment/management Carbon Monoxide monitoring, with environmental surveillance devices Yes Yes Yes Yes

118 Patient assessment/management Hemodynamic monitoring/assist (Swan Ganz, central venous pressure) No No No No

119 Patient assessment/management Dislocation reduction No No No No

120 Patient assessment/management Eye irrigation (Note: irrigation through corneal contact device limited to AEMT and Paramedic) Yes Yes Yes Yes

121 Patient assessment/management Intracranial monitoring/assist No No No No

122 Patient assessment/management Patient management per Statewide EMS Protocols and Department approved protocols Yes Yes Yes Yes

123 Patient assessment/management Pulse oximetry monitoring No Yes Yes Yes

124 Patient assessment/management Splinting, extremity—manual, rigid, soft, vacuum No Yes Yes Yes

125 Patient assessment/management Splinting, femur—traction No Yes Yes Yes

126 Patient assessment/management Urinary catheterization No No No No

127 Patient assessment/management Wound care, dressing, bandaging Yes Yes Yes Yes

128 Patient assessment/management Wound care, removal of Taser probe/barb No No No No

129 Patient assessment/management Wound drainage vacuum devices, monitoring No Yes Yes Yes

130 Patient assessment/management Wound care, hemorrhage control—direct pressure, tourniquet, bandaging, hemostatic agents Yes Yes Yes Yes

131 Patient assessment/management Wound care, irrigation and skin closure with tape or adhesive glue No No No No

132 Spine Care Restrict spinal motion—Cervical collar application No Yes Yes Yes

133 Spine Care Restrict spinal motion—Helmet removal or stabilization No Yes Yes Yes

134 Spine Care Restrict spinal motion—manual cervical spine stabilization Yes Yes Yes Yes

135 Spine Care Restrict spinal motion—rapid extrication with precautions to restrict spinal movement No Yes Yes Yes

136 Spine Care Devices to restrict spinal motion—for example—vacuum mattress, extrication devices, scoop stretcher and spine board) No Yes Yes Yes

EMR—Emergency Medical Responder

EMT—Emergency Medical Technician

AEMT—Advanced Emergency Medical Technician

P*—Paramedic (*includes-PHRN/PHPE/PHP)

No—The skill is not in the scope of practice for the level of certification.

Yes—The skill is in the scope of practice for the level of certification.

1. Additional training and authorization by EMS agency medical director is required, and this skill may only be used when functioning with a licensed EMS agency that complies with Department requirements for providing this skill.

2. May assist a P, PHRN, PHPE or PHP with this skill only when in the physical presence of and under the direct supervision of the higher level provider.

3. May perform this skill only in the physical presence of and under the direct supervision of a P, PHRN, PHPE or PHP.

4. After July 1, 2015, Statewide ALS Protocols will include any restrictions placed upon the use of this skill.

5. This revision becomes effective July 1, 2015.

6. Department-approved Act 139 training required and approval of the EMS medical director, and this skill may only be used when functioning with a licensed EMS agency that complies with Department requirements for providing this skill.

[Pa.B. Doc. No. 15-105. Filed for public inspection January 16, 2015, 9:00 a.m.]

105 Scope of practice for emergency medical service providers; update to 2014 notice

Scope of Practice for Emergency Medical Service Providers; Update to 2014 Notice

[45 Pa.B. 377]
[Saturday, January 17, 2015]

[Pa.B. Doc. No. 15-105. Filed for public inspection January 16, 2015, 9:00 a.m.]

Document Information

	Category	Skill	EMR	EMT	AEMT	P*
1	Airway/Ventilation/Oxygenation	Airway—Nonsurgical Alternative/Rescue Airway—CombiTube^TM, King LT-D Airway^TM, or King LTS-D Airway^TM	No	No	Yes	Yes
2	Airway/Ventilation/Oxygenation	Airway—Oropharyngeal (OPA) & Nasopharyngeal (NPA)	Yes	Yes	Yes	Yes
3	Airway/Ventilation/Oxygenation	Airway—Pharyngeal tracheal lumen (PTL)	No	No	No	No
4	Airway/Ventilation/Oxygenation	Bag-valve-ETT/Nonsurgical alternative airway ventilation	Yes²	Yes²	Yes	Yes
5	Airway/Ventilation/Oxygenation	Bag-valve-ventilation—with in-line small-volume nebulizer	No	Yes²	Yes	Yes
6	Airway/Ventilation/Oxygenation	Bag-valve-mask (BVM) ventilation	Yes	Yes	Yes	Yes
7	Airway/Ventilation/Oxygenation	Chest decompression—needle	No	No	No	Yes
8	Airway/Ventilation/ Oxygenation	Chest tube thoracostomy, monitoring of existing tube in a closed system (for example water seal or suction)	No	No	No	No
9	Airway/Ventilation/Oxygenation	Chest tube thoracostomy, acute insertion	No	No	No	No
10	Airway/Ventilation/Oxygenation	Continuous positive airway pressure (CPAP)	No	Yes¹	Yes	Yes
11	Airway/Ventilation/Oxygenation	Biphasic positive airway pressure (BiPAP) for patients chronically on BiPAP for >48 hours	No	No	No	Yes
12	Airway/Ventilation/Oxygenation	Biphasic positive airway pressure (BiPAP) for patients acutely on BiPAP for <48 hours	No	No	No	No
13	Airway/Ventilation/Oxygenation	Cricothyrotomy—needle	No	No	No	Yes
14	Airway/Ventilation/Oxygenation	Cricothyrotomy—open/surgical	No	No	No	Yes
15	Airway/Ventilation/Oxygenation	Cricothyrotomy—overwire (Seldinger) technique	No	No	No	Yes
16	Airway/Ventilation/Oxygenation	End tidal CO₂ monitoring/capnography	No	No	Yes	Yes
17	Airway/Ventilation/Oxygenation	Esophageal obturator airway (EOA)/esophageal gastric tube airway (EGTA)	No	No	No	No
18	Airway/Ventilation/Oxygenation	Extubation—removal of ETT	No	No	No	Yes
19	Airway/Ventilation/Oxygenation	Gastric decompressions—Orogastric or nasogastric tube insertion	No	No	No	Yes
20	Airway/Ventilation/Oxygenation	Gastric decompression by means of alternative/rescue airway (CombiTube^TM or King LTS-D^TM)	No	No	Yes	Yes
21	Airway/Ventilation/Oxygenation	Head-tilt/chin lift	Yes	Yes	Yes	Yes
22	Airway/Ventilation/Oxygenation	Inspiratory Impedance Threshold Device (ITD)	No	No	Yes¹	Yes
23	Airway/Ventilation/Oxygenation	Endotracheal Intubation—by direct laryngoscopy (including video intubation devices), nasotracheal, digital, and transillumination/lighted stylet techniques	No	No	No	Yes
24	Airway/Ventilation/Oxygenation	Endotracheal Intubation—paralytic assisted, rapid sequence induction (RSI)	No	No	No	No
25	Airway/Ventilation/Oxygenation	Ventilation—maintenance of previously initiated neuromuscular blockade	No	No	No	No
26	Airway/Ventilation/Oxygenation	Endotracheal Intubation—retrograde technique	No	No	No	No
27	Airway/Ventilation/Oxygenation	Jaw thrust and modified jaw thrust (trauma)	Yes	Yes	Yes	Yes
28	Airway/Ventilation/Oxygenation	Laryngeal mask airway (LMA)	No	No	No	No
29	Airway/Ventilation/Oxygenation	Mouth-to-mouth, nose, stoma, barrier and pocket mask	Yes	Yes	Yes	Yes
30	Airway/Ventilation/Oxygenation	Obstruction—direct laryngoscopy (remove with forceps)	No	No	No	Yes
31	Airway/Ventilation/Oxygenation	Obstruction—manual (abdominal thrusts, finger sweep, chest thrusts) upper airway	Yes	Yes	Yes	Yes
32	Airway/Ventilation/Oxygenation	Oxygen therapy—blow-by delivery	Yes	Yes	Yes	Yes
33	Airway/Ventilation/Oxygenation	Oxygen therapy—humidifiers	No	Yes	Yes	Yes
34	Airway/Ventilation/Oxygenation	Oxygen therapy—nasal cannula	Yes	Yes	Yes	Yes
35	Airway/Ventilation/Oxygenation	Oxygen therapy—non-rebreather	Yes	Yes	Yes	Yes
36	Airway/Ventilation/Oxygenation	Oxygen therapy—partial rebreather	No	Yes	Yes	Yes
37	Airway/Ventilation/Oxygenation	Oxygen therapy—regulators	Yes	Yes	Yes	Yes
38	Airway/Ventilation/Oxygenation	Oxygen therapy—simple face mask	No	Yes	Yes	Yes
39	Airway/Ventilation/Oxygenation	Oxygen therapy—Venturi mask	No	Yes	Yes	Yes
40	Airway/Ventilation/Oxygenation	Peak expiratory flow assessment	No	No	Yes	Yes
41	Airway/Ventilation/Oxygenation	Suctioning—meconium aspiration	No	No	No	Yes
42	Airway/Ventilation/Oxygenation	Suctioning—stoma/tracheostomy	Yes	Yes	Yes	Yes
43	Airway/Ventilation/Oxygenation	Suctioning—tracheobronchial by means of advanced airway	No	Yes²	Yes	Yes
44	Airway/Ventilation/Oxygenation	Suctioning—upper airway (nasal)	Yes	Yes	Yes	Yes
45	Airway/Ventilation/Oxygenation	Suctioning—upper airway (oral)	Yes	Yes	Yes	Yes
46	Airway/Ventilation/Oxygenation	Transtracheal jet ventilation	No	No	No	Yes
47	Airway/Ventilation/Oxygenation	Single mode, volume controlled automated ventilator (without blender)	No	Yes	Yes	Yes
48	Airway/Ventilation/Oxygenation	Ventilators, transport—used in multi-modal settings, blended gas transport ventilator on patients >1 year of age and ventilated >48 hours and no anticipated need to actively titrate ventilator settings in patients transported to or from residence, skilled nursing facility, rehabilitation hospital or long term acute care hospital (LTACH)	No	No	No	Yes^1,5
49	Airway/Ventilation/Oxygenation	Ventilators, transport—used in multi-modal settings, blended gas transport ventilator on patients >1 year of age and ventilated >48 hours and no anticipated need to actively titrate ventilator settings in patients transported between acute care hospitals	No	No	No	No⁵
50	Airway/Ventilation/Oxygenation	Ventilators, transport—used in multi-modal settings, blended gas transport ventilator on patients ventilated <48 hours or anticipated need to actively titrate ventilator settings	No	No	No	No⁵
51	Airway/Ventilation/Oxygenation	Ventilators—transport	No	No	No	Yes⁴
52	Cardiovascular/Circulation	Blood pressure—auscultation	Yes	Yes	Yes	Yes
53	Cardiovascular/Circulation	Blood pressure—electronic non-invasive	Yes	Yes	Yes	Yes
54	Cardiovascular/Circulation	Blood pressure—palpation	Yes	Yes	Yes	Yes
55	Cardiovascular/Circulation	Electrocardiogram (ECG) monitoring—apply electrodes for single leads	No	Yes²	Yes²	Yes
56	Cardiovascular/Circulation	Electrocardiogram (ECG) monitoring—obtain and transmit 12-lead ECG	No	No	Yes	Yes
57	Cardiovascular/Circulation	Electrocardiogram (ECG) monitoring—12-lead (interpret)	No	No	No	Yes
58	Cardiovascular/Circulation	Cardiac monitoring—single lead (interpret)	No	No	No	Yes
59	Cardiovascular/Circulation	Manual chest compressions—adult, child, infant	Yes	Yes	Yes	Yes
60	Cardiovascular/Circulation	Cardioversion—synchronized	No	No	No	Yes
61	Cardiovascular/Circulation	Carotid massage (vagal maneuvers)	No	No	No	Yes
62	Cardiovascular/Circulation	Defibrillation—counter shock—manual	No	No	No	Yes
63	Cardiovascular/Circulation	Transcutaneous cardiac pacing	No	No	No	Yes
64	Cardiovascular/Circulation	Transvenous or Epicardial pacing, Management of	No	No	No	No
65	Cardiovascular/Circulation	Defibrillation—automated external defibrillator (AED)	Yes	Yes	Yes	Yes
66	Cardiovascular/Circulation	Hemodynamic monitoring/assist (Swan Ganz, central venous pressure)	No	No	No	No
67	Cardiovascular/Circulation	Intra-aortic balloon pump or invasive cardiac assist device monitoring/assist	No	No	No	No
68	Cardiovascular/Circulation	Mechanical chest compression device use	No	Yes¹	Yes¹	Yes¹
69	Cardiovascular/Circulation	Thrombolytic therapy—initiation	No	No	No	No
70	Cardiovascular/Circulation	Thrombolytic therapy—monitoring	No	No	No	No
71	IV Initiation/Maintenance/Fluids	Central venous cannulation/insertion	No	No	No	No
72	IV Initiation/Maintenance/Fluids	Central venous line—access of existing catheters with external ports	No	No	No	Yes
73	IV Initiation/Maintenance/Fluids	External jugular vein cannulation	No	No	No	Yes
74	IV Initiation/Maintenance/Fluids	Saline lock insertions as no-flow IV	No	No	Yes	Yes
75	IV Initiation/Maintenance/Fluids	Intraosseous—needle placement and infusion—tibia, femur and humerus	No	No	Yes³	Yes
76	IV Initiation/Maintenance/Fluids	IV insertion, peripheral venous—initiation (cannulation)	No	No	Yes	Yes
77	IV Initiation/Maintenance/Fluids	Sub-cutaneous indwelling catheters—access of existing catheters	No	No	No	No
78	IV Initiation/Maintenance/Fluids	Venous blood sampling, peripheral—for clinical diagnostic purposes only, not for legal purposes	No	No	Yes³	Yes
79	IV Initiation/Maintenance/Fluids	Venous central line (blood sampling)—obtaining	No	No	No	No
80	IV Initiation/Maintenance/Fluids	Arterial line—capped—transport	No	Yes	Yes	Yes
81	IV Initiation/Maintenance/Fluids	Arterial line—monitoring/assist	No	No	No	No
82	IV Initiation/Maintenance/Fluids	Blood/Blood-by-products administration (initiation and continuation)	No	No	No	No
83	Lifting & Moving	Patient lifting, moving and transfers	Yes	Yes	Yes	Yes
84	Lifting & Moving	Patient restraints on transport devices	Yes	Yes	Yes	Yes
85	Medication administration routes	Endotracheal (ET)	No	No	No	Yes
86	Medication administration routes	Inhalation (aerosolized/nebulized)	No	No	Yes	Yes
87	Medication administration routes	Intramuscular (IM)	No	No	Yes	Yes
88	Medication administration routes	Intranasal	No	No	Yes	Yes
89	Medication administration routes	Intraosseous—tibia, humerus, or femur	No	No	No	Yes
90	Medication administration routes	Intravenous (IV)—fluid bolus	No	No	Yes	Yes
91	Medication administration routes	Intravenous (IV)—monitoring or maintaining existing intravenous infusion (crystalloid fluid as published in the EMS medication list in the Pennsylvania Bulletin) during interfacility transport	No	No	Yes	Yes
92	Medication administration routes	Intravenous (IV) infusion, with added medication, including by intravenous pump	No	No	No	Yes
93	Medication administration routes	Nasogastric	No	No	No	Yes
94	Medication administration routes	Enteral feeding devices, management of	No	No	No	No
95	Medication administration routes	Oral—glucose and aspirin (other medications addressed elsewhere)	No	Yes	Yes	Yes
96	Medication administration routes	Rectal	No	No	No	Yes
97	Medication administration routes	Subcutaneous	No	No	Yes	Yes
98	Medication administration routes	Sublingual (Note: EMT may only assist patient with his/her prescribed Nitroglycerin (NTG))	No	Yes	Yes	Yes
99	Medication administration routes	Topical	No	No	No	Yes
100	Medications	Auto-injector benzodiazepine for seizure	No	No	No	Yes
101	Medications	Auto-injector epinephrine (assist patient with his/her prescribed medication)	No	Yes	Yes	Yes
102	Medications	Auto-injected epinephrine-primary use—not patient's own prescription	No	Yes¹	Yes	Yes
103	Medications	Medications as published in Pennsylvania Bulletin by the Department	No	No	Yes	Yes
104	Medications	Immunizations as published in the Pennsylvania Bulletin by the Department	No	No	Yes	Yes
105	Medications	Over-the-counter (OTC) medications (Note: aspirin and glucose covered elsewhere)	No	No	No	No
106	Medications	Oxygen	Yes¹	Yes	Yes	Yes
107	Medications	Auto-injector nerve agent antidote—self rescue treatment	No	Yes³	Yes³	Yes
108	Medications	Metered-dose inhaler (MDI) bronchodilator (Note: EMT may only assist patient with his/her own prescribed medication)	No	Yes	Yes	Yes
109	Medications	Naloxone—Intranasal or auto-injector	Yes⁶	Yes⁶	Yes	Yes
110	Patient assessment/management	Behavioral—Restrain violent patient	Yes¹	Yes	Yes	Yes
111	Patient assessment/management	Blood glucose assessment	No	No	Yes	Yes
112	Patient assessment/management	Portable blood analysis devices, use of (glucometer covered elsewhere)	No	No	No	No
113	Patient assessment/management	Childbirth—umbilical cord cutting	Yes	Yes	Yes	Yes
114	Patient assessment/management	Childbirth (abnormal/complications)	No	Yes	Yes	Yes
115	Patient assessment/management	Childbirth (normal)—cephalic delivery	Yes	Yes	Yes	Yes
116	Patient assessment/management	Carbon Monoxide CO-oximetry monitoring	No	Yes¹	Yes¹	Yes¹
117	Patient assessment/management	Carbon Monoxide monitoring, with environmental surveillance devices	Yes	Yes	Yes	Yes
118	Patient assessment/management	Hemodynamic monitoring/assist (Swan Ganz, central venous pressure)	No	No	No	No
119	Patient assessment/management	Dislocation reduction	No	No	No	No
120	Patient assessment/management	Eye irrigation (Note: irrigation through corneal contact device limited to AEMT and Paramedic)	Yes	Yes	Yes	Yes
121	Patient assessment/management	Intracranial monitoring/assist	No	No	No	No
122	Patient assessment/management	Patient management per Statewide EMS Protocols and Department approved protocols	Yes	Yes	Yes	Yes
123	Patient assessment/management	Pulse oximetry monitoring	No	Yes	Yes	Yes
124	Patient assessment/management	Splinting, extremity—manual, rigid, soft, vacuum	No	Yes	Yes	Yes
125	Patient assessment/management	Splinting, femur—traction	No	Yes	Yes	Yes
126	Patient assessment/management	Urinary catheterization	No	No	No	No
127	Patient assessment/management	Wound care, dressing, bandaging	Yes	Yes	Yes	Yes
128	Patient assessment/management	Wound care, removal of Taser probe/barb	No	No	No	No
129	Patient assessment/management	Wound drainage vacuum devices, monitoring	No	Yes	Yes	Yes
130	Patient assessment/management	Wound care, hemorrhage control—direct pressure, tourniquet, bandaging, hemostatic agents	Yes	Yes	Yes	Yes
131	Patient assessment/management	Wound care, irrigation and skin closure with tape or adhesive glue	No	No	No	No
132	Spine Care	Restrict spinal motion—Cervical collar application	No	Yes	Yes	Yes
133	Spine Care	Restrict spinal motion—Helmet removal or stabilization	No	Yes	Yes	Yes
134	Spine Care	Restrict spinal motion—manual cervical spine stabilization	Yes	Yes	Yes	Yes
135	Spine Care	Restrict spinal motion—rapid extrication with precautions to restrict spinal movement	No	Yes	Yes	Yes
136	Spine Care	Devices to restrict spinal motion—for example—vacuum mattress, extrication devices, scoop stretcher and spine board)	No	Yes	Yes	Yes

105 Scope of practice for emergency medical service providers; update to 2014 notice

Scope of Practice for Emergency Medical Service Providers; Update to 2014 Notice

[45 Pa.B. 377][Saturday, January 17, 2015]

[Pa.B. Doc. No. 15-105. Filed for public inspection January 16, 2015, 9:00 a.m.]

Document Information

[45 Pa.B. 377]
[Saturday, January 17, 2015]