Prehospital Practitioners Scope of Practice [33 Pa.B. 2713] Under 28 Pa. Code §§ 1003.21(c)(13), 1003.22(e)(3), 1003.23(f), 1003.24(e) and 1003.25b(c), the Department of Health (Department) is publishing the scope of practice for ambulance attendants, first responders, emergency medical technicians (EMTs), EMT-paramedics and prehospital registered nurses (PHRNs) under the Emergency Medical Services Act (35 P. S. §§ 6921--6938).
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-paramedic's 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 supersedes the list of skills in the scope of practice of prehospital personnel published at 33 Pa.B. 834 (February 8, 2003). Changes made are: (1) an addition to the legend that describes the conditions under which certain skills may be performed; (2) addition of the use of a cardiac magnet to alter the mode of an AICD or pacemaker; (3) addition of auto-injectors as a route for medication administration; and (4) addition of primary use epinephrine auto-injectors by EMTs.
Persons with a disability who require an alternate format of this notice (for example, large print, audiotape, Braille) should contact Barb Seifert, Department of Health, Emergency Medical Services Office, Room 1032, Health and Welfare Building, Harrisburg, PA 17120, (717) 787-8740. Speech or hearing impaired persons may use V/TT: (717) 783-6154 or the Pennsylvania AT&T Relay Service at (800) 654-5984 [TT].
CALVIN B. JOHNSON, M.D., M.P.H.,
Acting SecretaryYes--The skill is in the scope of practice for the level of certification AA--ambulance attendant No--The skill is not in the scope of practice for the level of certification FR--first responder 1--May assist higher level practitioner only when in the physical presence and under the direct supervision of the ALS practitioner EMT--emergency medical technician
EMT-P--emergency medical technician2--Additional training and approval by service medical director required paramedic 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 requirements for performing this skill Topic Skill AA FR EMT EMT-P Airway/ventilation/oxygenation Airway--esophageal tracheal--dual lumen
CombiTube®No No No Yes Airway/ventilation/oxygenation Airway--oral and nasal Yes Yes Yes Yes Airway/ventilation/oxygenation Airway--pharyngeal tracheal lumen (PTL) No No No No4 Airway/ventilation/oxygenation Bag-valve-ETT/CombiTube® ventilation No Yes1 Yes1 Yes Airway/ventilation/oxygenation Bag-valve mask--with in-line small-volume
nebulizerNo Yes1 Yes1 Yes Airway/ventilation/oxygenation Bag-valve mask ventilation Yes Yes Yes Yes Airway/ventilation/oxygenation Chest decompression--needle No No No Yes Airway/ventilation/oxygenation CPAP/BiPAP5--demonstrate application of No No No Yes Airway/ventilation/oxygenation Cricoid pressure (Sellick maneuver) No Yes Yes Yes Airway/ventilation/oxygenation Cricothyrotomy--needle No No No Yes Airway/ventilation/oxygenation Cricothyrotomy--open/surgical No No No Yes Airway/ventilation/oxygenation Cricothyrotomy--overwire (Seldinger)
techniqueNo No No Yes Airway/ventilation/oxygenation End tidal CO2 monitoring/capnography No Yes1 Yes1 Yes Airway/ventilation/oxygenation Esophageal obturator airway
(EOA)/esophageal gastric tube airwayNo No No No4 Airway/ventilation/oxygenation Extubation No No No Yes Airway/ventilation/oxygenation Flow restricted oxygen powered ventilation
device (demand valve)No Yes Yes Yes Airway/ventilation/oxygenation Gastric decompression--OG5 and NG5 tube
(suction)No No No Yes Airway/ventilation/oxygenation Gastric tube insertion--nasal and oral No No No Yes Airway/ventilation/oxygenation Head-tilt/chin-lift Yes Yes Yes Yes Airway/ventilation/oxygenation Intubation--digital and lighted stylet No No No Yes Airway/ventilation/oxygenation Intubation--endotracheal tube No No No Yes Airway/ventilation/oxygenation Intubation--medication paralytics assisted
(RSI5)No No No No4 Airway/ventilation/oxygenation Intubation--nasotracheal and orotracheal No No No4 Yes Airway/ventilation/oxygenation Intubation--retrograde No No No No4 Airway/ventilation/oxygenation Intubation--transillumination/lighted stylet No No No Yes Airway/ventilation/oxygenation Jaw thrust and modified jaw thrust (trauma) Yes Yes Yes Yes Airway/ventilation/oxygenation Laryngeal mask airway (LMA) No No No No4 Airway/ventilation/oxygenation Mouth-to-mouth, nose, stoma, barrier and
pocket maskYes Yes Yes Yes Airway/ventilation/oxygenation Obstruction--direct laryngoscopy (remove
with forceps)No No No Yes Airway/ventilation/oxygenation Obstruction--manual (Heimlich, finger
sweep, chest thrusts) upper airwayYes Yes Yes Yes Airway/ventilation/oxygenation Oxygen therapy--blow-by delivery Yes Yes Yes Yes Airway/ventilation/oxygenation Oxygen therapy--humidifiers No Yes Yes Yes Airway/ventilation/oxygenation Oxygen therapy--nasal cannula Yes Yes Yes Yes Airway/ventilation/oxygenation Oxygen therapy--nonrebreather mask Yes Yes Yes Yes Airway/ventilation/oxygenation Oxygen therapy--partial rebreather No Yes Yes Yes Airway/ventilation/oxygenation Oxygen therapy--regulators Yes Yes Yes Yes Airway/ventilation/oxygenation Oxygen therapy--simple face mask Yes Yes Yes Yes Airway/ventilation/oxygenation Oxygen therapy--Venturi mask No No No Yes Airway/ventilation/oxygenation Peak expiratory flow assessment No No No Yes Airway/ventilation/oxygenation Pulse oximetry Yes1 Yes2 Yes2 Yes Airway/ventilation/oxygenation Suctioning--meconium aspiration No No No Yes Airway/ventilation/oxygenation Suctioning--stoma No No Yes Yes Airway/ventilation/oxygenation Suctioning--tracheobronchial No No No Yes Airway/ventilation/oxygenation Suctioning--upper airway (nasal) No Yes Yes Yes Airway/ventilation/oxygenation Suctioning--upper airway (oral) Yes Yes Yes Yes Airway/ventilation/oxygenation Transtracheal jet ventilation No No No Yes Airway/ventilation/oxygenation Ventilators--automated transport (ATV) Yes1 Yes2 Yes2 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
NSC5Yes 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 and
condition (CTC)Yes Yes Yes Yes Cardiovascular/circulation Blood pressure--auscultation Yes Yes Yes Yes Cardiovascular/circulation Blood pressure--electronic noninvasive Yes Yes Yes Yes Cardiovascular/circulation Blood pressure--palpation Yes Yes Yes Yes Cardiovascular/circulation Cardiac monitoring--apply electrodes No Yes1 Yes1 Yes Cardiovascular/circulation Cardiac monitoring--multilead No No No Yes Cardiovascular/circulation Cardiac monitoring--single lead
(interpretive)No No No Yes Cardiovascular/circulation Cardiopulmonary resuscitation (CPR) adult,
infant, child, one and two personYes Yes Yes Yes Cardiovascular/circulation Cardioversion--synchronized No No No Yes Cardiovascular/circulation Carotid massage (vagal maneuvers) No No No Yes Cardiovascular/circulation Defibrillation--counter shock--manual No No No Yes Cardiovascular/circulation Defibrillation--automated external
defibrillator (AED)Yes2 Yes2 Yes2 Yes Cardiovascular/circulation Hemodynamic monitoring/assist (Swan Ganz, arterial, central venous lines) No No No No4 Cardiovascular/circulation Intra-aortic balloon pump monitoring/assist No No No No4 Cardiovascular/circulation Mechanical CPR device No No No Yes Cardiovascular/circulation Military/Pneumatic Anti-Shock
Trousers/Garment PASG/MAST5No No Yes Yes Cardiovascular/circulation Thrombolytic therapy--initiation No No No No4 Cardiovascular/circulation Thrombolytic therapy--monitoring No No No No4 Cardiovascular/circulation Transcutaneous pacing No No No Yes Cardiovascular/circulation Use a (cardiac) magnet to alter the mode of
an AICD5 or pacemakerNo No No Yes Communications Verbal patient report to receiving personnel No Yes Yes Yes Communications Communications with PSAPs5, hospitals,
medical command facilitiesYes Yes Yes Yes Documentation Out-of-Hospital Do-Not-Resuscitate (DNR)
orders (Act 59)Yes Yes Yes Yes Documentation Patient Care Report completion No Yes Yes Yes Hazardous materials Contaminated equipment disposal (sharps
and PPE5)Yes Yes Yes Yes Hazardous materials Decontamination Yes Yes Yes Yes Hazardous materials Disinfection Yes Yes Yes Yes Hazardous materials PPE5 use Yes Yes Yes Yes Immobilization PASG/MAST5--pelvic stabilization No No Yes Yes Immobilization Spinal immobilization--helmet stabilization
or removalNo No Yes Yes Immobilization Spinal immobilization--long board w/pt
supine and standingYes Yes Yes Yes Immobilization Spinal immobilization--manual
stabilization and cervical collarYes Yes Yes Yes Immobilization Spinal immobilization--rapid extrication No No Yes Yes Immobilization Spinal immobilization--seated patient
(KED©5, and the like)No No Yes Yes Immobilization Splinting--manual, ridged, soft, vacuum Yes Yes Yes Yes Immobilization Splinting--traction Yes Yes Yes Yes IV Initiation/maintenance/fluids Central venous cannulation (femoral vein
only)No No No Yes IV Initiation/maintenance/fluids Central venous line--access of existing
cathetersNo No No Yes IV Initiation/maintenance/fluids Clean technique No No No Yes IV Initiation/maintenance/fluids External jugular vein cannulation No No No Yes IV Initiation/maintenance/fluids Heparin/saline lock insertions as no-flow IV No No No Yes IV Initiation/maintenance/fluids Indwelling intravenous catheters as
described in 28 Pa. Code § 1003.23(e)(2)No No Yes Yes IV Initiation/maintenance/fluids Intraosseous--needle placement and
infusion--anterior tibia or distal femurNo No No Yes IV Initiation/maintenance/fluids Peripheral venous--initiation (cannulation) No No No Yes IV Initiation/maintenance/fluids Subcutaneous indwelling catheters--access
of existing cathetersNo No No Yes IV Initiation/maintenance/fluids Vascular access devices in home
healthcare--access of existing cathetersNo No No Yes IV Initiation/maintenance/fluids Venous (blood sampling)--obtaining No No No Yes IV Initiation/maintenance/fluids Venous central line (blood
sampling)--obtainingNo No No No4 IV Initiation/maintenance/fluids Arterial line--capped--transport No No Yes Yes IV Initiation/maintenance/fluids Arterial line--monitoring/assist No No No No4 IV Initiation/maintenance/fluids Blood/Blood by-products No No No No4 Lifting & moving Patient lifting, moving and transfers per
NSC5Yes 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 Intraosseous--anterior tibia or distal femur No No No Yes Medication administration routes Intravenous (IV)--bolus No No No Yes Medication administration routes Intravenous (IV) infusion, including by
intravenous pumpNo 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 Sublingual 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 DepartmentNo No No Yes Medications Immunizations No No No No4 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 prescriptionNo No Yes2,3,6 Yes Medications--Patient Assisted Auto-injected epinephrine No No Yes3 Yes Medications--Patient Assisted Metered dose inhaler
(MDI)--bronchodilatorNo No Yes3 Yes Medications--Patient Assisted Nitroglycerin No No Yes3 Yes Patient assessment/management Behavioral--restrain violent patient No No Yes Yes Patient assessment/management Blood glucose assessment No No No Yes Patient assessment/management Burns--chemical, electrical, inhalation,
radiation, thermalYes Yes Yes Yes Patient assessment/management Childbirth--umbilical cord cutting No Yes Yes Yes Patient assessment/management Childbirth (abnormal/complications) No No Yes Yes Patient assessment/management Childbirth (normal)--cephalic delivery Yes Yes Yes Yes Patient assessment/management Dislocation reduction (shoulder) No No No No4 Patient assessment/management Eye irrigation/care Yes Yes Yes Yes Patient assessment/management Hemorrhage control--diffuse, direct,
pressure point, tourniquet, bandagingYes Yes Yes Yes Patient assessment/management Intracranial monitoring/assist No No No No4 Patient assessment/management As outlined in Department-approved
regional and Statewide TX5 and
transport protocolsYes Yes Yes Yes Patient assessment/management Multiple Casualty Incident (MCI)/Incident
Command System (ICS)No Yes Yes Yes Patient assessment/management Triage (prioritizing patients)--use of tags Yes Yes Yes Yes Patient assessment/management Urinary catheterization No No No Yes Rescue Vehicle access and 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 United States Department of Transportation National Standard Curriculum OG and NG Oral gastric and nasal gastric tube PASG/MAST Pneumatic anti-shock garment/military anti-shock trousers PPE Personal protective equipment PSAP Public safety answering point RSI Rapid sequence induction TX Treatment [Pa.B. Doc. No. 03-1077. Filed for public inspection June 6, 2003, 9:00 a.m.]
