Prehospital Practitioner Scope of Practice [41 Pa.B. 1976]
[Saturday, April 9, 2011]Under 28 Pa. Code §§ 1003.21(c)(13), 1003.22(e)(3), 1003.23(f), 1003.24(e) and 1003.25(b) and (c), the Department of Health (Department) is publishing the scope of practice for ambulance attendants, first responders, emergency medical technicians (EMTs), EMT—paramedics (EMT-Ps) and prehospital registered nurses (PHRNs) under 35 Pa.C.S. §§ 8101—8157 (relating to Emergency Medical Services System Act).
Skills identified may be performed by a prehospital practitioner at the practitioner's level of certification/recognition only if the practitioner has successfully completed training (cognitive, affective and psychomotor) on the specified skill, which includes training to perform the skill on adults, children and infants, as appropriate.
A PHRN with medical command authorization may perform, in addition to those services within an EMT-Ps scope of practice, 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 standing medical treatment protocols. To administer drugs in addition to those permitted by applicable medical treatment protocols, a PHRN must also have received approval to do so by the advanced life support service medical director of the advanced life support ambulance service under which the PHRN is functioning.
This list supercedes the list of skills in the scope of practice of prehospital personnel published at 38 Pa.B. 6565 (November 29, 2008). Two changes have been made. The changes are as follows:
Removing MAST as an approved treatment.
Adding Transport Ventilators for use by ALS providers and Carbon Monoxide Co-oximetry monitoring.
Persons with a disability who require an alternate format of this notice (for example, large print, audiotape, Braille) should contact Robert Cooney, Emergency Medical Services System Act, 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).
ELI N. AVILA, MD, JD, MPH, FCLM,
Acting SecretaryYes—The skill is in the scope of practice for the level of certification
No—The skill is not in the scope of practice for the level of certification
1. May assist higher level practitioner only when in the physical
2. Additional training and approval by service medical director required
3. The skill may be performed by BLS personnel in accordance with Statewide BLS protocols or medical command order
4. The skill is not approved for the level of certification regardless if taught in a course approved for that level of certification
5. The acronym is explained following the table.
6. Skill may only be used when functioning with a licensed ambulance service or QRS that complies with Department requirement for performing this skill.
7. May only be done as a physician extender under the Medical Practice Act.
8. FDA Approved Hemostatic Agents enclosed in self contained package during treatment
AA—Ambulance Attendant
FR—First Responder
EMT—Emergency Medical Technician presence and under the direct supervision of the ALS practitioner
EMT-P—Emergency Medical Technician—Paramedic
TOPIC SKILL AA FR EMT EMT-P Airway/ventilation/
oxygenationAirway—Nonsurgical Alternative/Rescue Airway—CombiTubeTM, King LT-D AirwayTM or King LTS-D Airway No No No Yes Airway/ventilation/
oxygenationAirway—oral & nasal Yes Yes Yes Yes Airway/ventilation/
oxygenationAirway—pharyngeal tracheal lumen (PTL) No No No No4 Airway/ventilation/
oxygenationBag-valve-ETT/Non surgical alternative airway ventilation No Yes1 Yes1 Yes Airway/ventilation/
oxygenationBag-valve-mask—with in-line small-volume nebulizer No Yes1 Yes1 Yes Airway/ventilation/
oxygenationBag-valve-mask (BVM) ventilation Yes Yes Yes Yes Airway/ventilation/
oxygenationChest decompression—needle No No No Yes Airway/ventilation/
oxygenationCPAP/BiPAP5—demonstrate application of No No Yes2,3,6 Yes Airway/ventilation/
oxygenationCricoid pressure (Sellick maneuver) No Yes Yes Yes Airway/ventilation/
oxygenationCricothyrotomy—needle No No No Yes Airway/ventilation/
oxygenationCricothyrotomy—open/surgical No No No Yes Airway/ventilation/
oxygenationCricothyrotomy—overwire (Seldinger) technique No No No Yes Airway/ventilation/
oxygenationEnd tidal CO2 monitoring/capnography No Yes1 Yes1 Yes Airway/ventilation/
oxygenationEsophageal obturator airway (EOA)/esophageal gastric tube airway (EGTA) No No No No4 Airway/ventilation/
oxygenationExtubation No No No Yes Airway/ventilation/
oxygenationFlow restricted oxygen powered ventilation device (demand valve) No Yes Yes Yes Airway/ventilation/
oxygenationGastric decompression—OG5 & NG5 tube (suction) No No No Yes Airway/ventilation/
oxygenationGastric tube insertion—nasal & oral No No No Yes Airway/ventilation/
oxygenationHead-tilt/chin-lift Yes Yes Yes Yes Airway/ventilation/
oxygenationInspiratory Impedance Threshold Device (ITD) No No No Yes2 Airway/ventilation/
oxygenationIntubation—digital & lighted stylet No No No Yes Airway/ventilation/
oxygenationIntubation—endotracheal tube No No No Yes Airway/ventilation/
oxygenationIntubation—medication paralytics assisted (RSI5) No No No No4 Airway/ventilation/
oxygenationIntubation—nasotracheal & orotracheal No No No4 Yes Airway/ventilation/
oxygenationIntubation—retrograde No No No No4 Airway/ventilation/
oxygenationIntubation—transillumination/lighted stylet No No No Yes Airway/ventilation/
oxygenationJaw thrust & modified jaw thrust (trauma) Yes Yes Yes Yes Airway/ventilation/
oxygenationLaryngeal mask airway (LMA) No No No No4 Airway/ventilation/
oxygenationMouth-to-mouth, nose, stoma, barrier & pocket mask Yes Yes Yes Yes Airway/ventilation/
oxygenationObstruction—direct laryngoscopy (remove with forceps) No No No Yes Airway/ventilation/
oxygenationObstruction—manual (Heimlich, finger sweep, chest thrusts) upper airway Yes Yes Yes Yes Airway/ventilation/
oxygenationOxygen therapy—blow-by delivery Yes Yes Yes Yes Airway/ventilation/
oxygenationOxygen therapy—humidifiers No Yes Yes Yes Airway/ventilation/
oxygenationOxygen therapy—nasal cannula Yes Yes Yes Yes Airway/ventilation/
oxygenationOxygen therapy—non-rebreather mask Yes Yes Yes Yes Airway/ventilation/
oxygenationOxygen therapy—partial rebreather No Yes Yes Yes Airway/ventilation/
oxygenationOxygen therapy—regulators Yes Yes Yes Yes Airway/ventilation/
oxygenationOxygen therapy—simple face mask Yes Yes Yes Yes Airway/ventilation/
oxygenationOxygen therapy—Venturi mask No No No Yes Airway/ventilation/
oxygenationPeak expiratory flow assessment No No No Yes Airway/ventilation/
oxygenationPulse oximetry Yes1 Yes2 Yes2 Yes Airway/ventilation/
oxygenationSuctioning—meconium aspiration No No No Yes Airway/ventilation/
oxygenationSuctioning—stoma/tracheostomy No No Yes Yes Airway/ventilation/
oxygenationSuctioning—tracheobronchial No No No Yes Airway/ventilation/
oxygenationSuctioning—upper airway (nasal) No Yes Yes Yes Airway/ventilation/
oxygenationSuctioning—upper airway (oral) Yes Yes Yes Yes Airway/ventilation/
oxygenationTranstracheal jet ventilation No No No Yes Airway/ventilation/
oxygenationVentilators—automated transport (ATV) Yes1 Yes2 Yes2 Yes Airway/ventilation/
oxygenationVentilators—transport No No No Yes Assessment of Glasgow Coma Scale (GCS) Yes Yes Yes Yes Assessment of Level of consciousness (LOC) Yes Yes Yes Yes Assessment of Patient assessment skills identified in the NSC5 Yes Yes Yes Yes Assessment of Vital sign—body temperature Yes Yes Yes Yes Assessment of Vital sign—pulse Yes Yes Yes Yes Assessment of Vital sign—pupils Yes Yes Yes Yes Assessment of Vital sign—respirations Yes Yes Yes Yes Assessment of Vital sign—skin color/temperature & condition (CTC) Yes Yes Yes Yes Cardiovascular/
circulationBlood pressure—auscultation Yes Yes Yes Yes Cardiovascular/
circulationBlood pressure—electronic non-invasive Yes Yes Yes Yes Cardiovascular/
circulationBlood pressure—palpation Yes Yes Yes Yes Cardiovascular/
circulationCardiac monitoring—apply electrodes No Yes1 Yes1 Yes Cardiovascular/
circulationCardiac monitoring—multi lead No No No Yes Cardiovascular/
circulationCardiac monitoring—single lead (interpretive) No No No Yes Cardiovascular/
circulationCardiopulmonary resuscitation (CPR) adult, infant, child, one & two person Yes Yes Yes Yes Cardiovascular/
circulationCardioversion—synchronized No No No Yes Cardiovascular/
circulationCarotid massage (vagal maneuvers) No No No Yes Cardiovascular/
circulationDefibrillation—Counter shock—manual No No No Yes Cardiovascular/
circulationDefibrillation—automated external defibrillator (AED) Yes2 Yes2 Yes2 Yes Cardiovascular/
circulationHemodynamic monitoring/assist (Swan Ganz, arterial, central venous lines) No No No No4 Cardiovascular/
circulationIntra-aortic balloon pump monitoring/assist No No No No4 Cardiovascular/
circulationMechanical CPR device No No No Yes Cardiovascular/
circulationThrombolytic therapy—initiation No No No No4 Cardiovascular/
circulationThrombolytic therapy—monitoring No No No No4 Cardiovascular/
circulationTranscutaneous pacing No No No Yes Cardiovascular/
circulationUse a (cardiac) magnet to alter the mode of an AICD5 or pacemaker No No No Yes Communications Verbal patient report to receiving personnel Yes Yes Yes Yes Communications Communications with PSAPs5, hospitals, medical command facilities Yes Yes Yes Yes Documentation Out-of-Hospital Do Not Resuscitate (DNR) orders (Act #59) Yes Yes Yes Yes Documentation Patient Care Report completion Yes Yes Yes Yes Hazardous materials Contaminated equipment disposal (sharps & PPE5) Yes Yes Yes Yes Hazardous materials Decontamination Yes Yes Yes Yes Hazardous materials Disinfection Yes Yes Yes Yes Hazardous materials PPE5 (personal protection equipment) use Yes Yes Yes Yes Immobilization Spinal immobilization—helmet stabilization or removal No No Yes Yes Immobilization Spinal immobilization—long board w/pt supine & standing Yes Yes Yes Yes Immobilization Spinal immobilization—manual stabilization & cervical collar Yes Yes Yes Yes Immobilization Spinal immobilization—rapid extrication No No Yes Yes Immobilization Spinal immobilization—seated patient (KED5, etc.) No No Yes Yes Immobilization Splinting—manual, ridged, soft, vacuum Yes Yes Yes Yes Immobilization Splinting—traction Yes Yes Yes Yes IV Initiation/
maintenance/fluidsCentral venous cannulation (femoral vein only) No No No Yes IV Initiation/
maintenance/fluidsCentral venous line—access of existing catheters No No No Yes IV Initiation/
maintenance/fluidsClean technique No No No Yes IV Initiation/
maintenance/fluidsExternal jugular vein cannulation No No No Yes IV Initiation/
maintenance/fluidsHeparin/saline lock insertions as no-flow IV No No No Yes IV Initiation/
maintenance/fluidsIndwelling intravenous catheters as described 28 Pa. Code § 1003.23(e)(2) No No Yes Yes IV Initiation/
maintenance/fluidsIntraosseous—needle placement & infusion—tibia, femur and humerus No No No Yes IV Initiation/
maintenance/fluidsPeripheral venous—initiation (cannulation) No No No Yes IV Initiation/
maintenance/fluidsSub-cutaneous indwelling catheters—access of existing catheters No No No Yes IV Initiation/
maintenance/fluidsVascular access devices in home healthcare—access of existing catheters No No No Yes IV Initiation/
maintenance/fluidsVenous (blood sampling)—obtaining No No No Yes IV Initiation/
maintenance/fluidsVenous central line (blood sampling)—obtaining No No No No4 IV Initiation/
maintenance/fluidsArterial line—capped—transport No No Yes Yes IV Initiation/
maintenance/fluidsArterial line—monitoring/assist No No No No4 IV Initiation/
maintenance/fluidsBlood/Blood—by-products No No No No4 Lifting & moving Patient lifting, moving & transfers per NSC5 Yes Yes Yes Yes Lifting & moving Patient restraints on transport devices Yes Yes Yes Yes Medication administration routes Endotracheal tube (ET) No No No Yes Medication administration routes Inhalation (aerosolized/nebulized) No No No Yes Medication administration routes Intramuscular (IM) No No No Yes Medication administration routes Intranasal No No No Yes Medication administration routes Intraosseous—tibia, humerus or femur No No No Yes Medication administration routes Intravenous (IV)—bolus No No No Yes Medication administration routes Intravenous (IV) infusion, including by intravenous pump No No No Yes Medication administration routes Nasogastric No No No Yes Medication administration routes Oral No No No Yes Medication administration routes Rectal No No No Yes Medication administration routes Subcutaneous No No No Yes Medication administration routes Sub-lingual No No No Yes Medication administration routes Topical No No No Yes Medication administration routes Auto-injectors No No Yes3 Yes Medications Activated charcoal No No Yes3 Yes Medications As published in the Pennsylvania Bulletin by the Department No No No Yes Medications Immunizations No No No Yes7 Medications Oral glucose No No Yes3 Yes Medications Over-the-counter medications (OTC) No No No No4 Medications Oxygen Yes Yes Yes Yes Medications Auto-injected epinephrine-primary use-not patient's own prescription No No Yes2,3,6 Yes Medications—Patient Assisted Auto-injected epinephrine No No Yes3 Yes Medications—Patient Assisted Metered dose inhaler (MDI)—bronchodilator No No Yes3 Yes Medications—Patient Assisted Nitroglycerin No No Yes3 Yes Patient assessment/
managementBehavioral—Restrain violent patient No No Yes Yes Patient assessment/
managementBlood glucose assessment No No No Yes Patient assessment/
managementBurns—chemical, electrical, inhalation, radiation, thermal Yes Yes Yes Yes Patient assessment/
managementChildbirth—umbilical cord cutting No Yes Yes Yes Patient assessment/
managementChildbirth (abnormal/complications) No No Yes Yes Patient assessment/
managementChildbirth (normal)—cephalic delivery Yes Yes Yes Yes Patient assessment/
managementCarbon Monoxide CO—oximetry monitoring Yes1 Yes2 Yes2 Yes2 Patient assessment/
managementDislocation reduction (shoulder) No No No No4 Patient assessment/
managementEye irrigation/care Yes Yes Yes Yes Patient assessment/
managementHemorrhage control—diffuse, direct, pressure point, tourniquet, bandaging, hemostatic agents8 Yes Yes Yes Yes Patient assessment/
managementIntracranial monitoring/assist No No No No4 Patient assessment/
managementAs outlined in DOH approved regional & statewide tx5 & transport protocols Yes Yes Yes Yes Patient assessment/
managementMultiple Casualty Incident (MCI)/Incident Command System (ICS) No Yes Yes Yes Patient assessment/
managementTriage (prioritizing patients)—use of tags Yes Yes Yes Yes Patient assessment/
managementUrinary catheterization No No No Yes Rescue Vehicle access & extrication Yes Yes Yes Yes Acronym Explanation AICD Automatic Implantable Cardioverter Defibrillators CPAP/BiPAP Continuous positive airway pressure/biphasic positive airway pressure KED Kendrick Extrication Device NSC U.S. Department of Transportation National Standard Curriculum OG & NG Oral gastric & nasal gastric tube PPE Personal protective equipment PSAP Public safety answering point RSI Rapid sequence induction TX Treatment [Pa.B. Doc. No. 11-628. Filed for public inspection April 8, 2011, 9:00 a.m.]
