Prehospital Practitioner Scope of Practice [43 Pa.B. 3187]
[Saturday, June 8, 2013]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, emergency medical 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 or 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-P'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 also must have received approval to do so by the advanced life support service (ALS) medical director of the ALS 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 41 Pa.B. 2090 (April 16, 2011). One change has been made. The change is as follows:
• EMTs are permitted to use mechanical CPR devices.
Persons with a disability who require an alternate format of this notice (for example, large print, audiotape, Braille) should contact Robert D. Cooney, Bureau of Emergency Medical Services, Department of Health, 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,
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 presence and under the direct supervision of the ALS practitioner.
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 Quick Response Service (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
EMR—Emergency Medical Responder
EMT—Emergency Medical Technician
EMT-P—Emergency Medical Technician-Paramedic
TOPIC SKILL AA EMR EMT EMT-P Airway / ventilation / oxygenation Airway—Nonsurgical Alternative/Rescue Airway—CombiTubeTM, King LT-D AirwayTM or King LTS-D Airway No No No Yes Airway / ventilation / oxygenation Airway—oral & nasal Yes Yes Yes Yes Airway / ventilation / oxygenation Airway—pharyngeal tracheal lumen (PTL) No No No No4 Airway / ventilation / oxygenation Bag-valve-ETT/Non-surgical alternative airway ventilation No Yes1 Yes1 Yes Airway / ventilation / oxygenation Bag-valve-mask—with in-line small-volume nebulizer No Yes1 Yes1 Yes Airway / ventilation / oxygenation Bag-valve-mask (BVM) 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 Yes2,3,6 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) technique No 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 airway (EGTA) No 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 & NG5 tube (suction) No No No Yes Airway / ventilation / oxygenation Gastric tube insertion—nasal & oral No No No Yes Airway / ventilation / oxygenation Head-tilt/chin-lift Yes Yes Yes Yes Airway / ventilation / oxygenation Inspiratory Impedance Threshold Device (ITD) No No No Yes2 Airway / ventilation / oxygenation Intubation—digital & 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 & 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 & 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 & pocket mask Yes 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 airway Yes 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—non-rebreather 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/tracheostomy 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 Airway / ventilation / oxygenation Ventilators—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 / circulation Blood pressure—auscultation Yes Yes Yes Yes Cardiovascular / circulation Blood pressure—electronic non-invasive 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—multi lead No No No Yes Cardiovascular / circulation Cardiac monitoring—single lead (interpretive) No No No Yes Cardiovascular / circulation Cardiopulmonary resuscitation (CPR) adult, infant, child, one & two person Yes 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 Yes2 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 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 / fluids Central venous cannulation (femoral vein only) No No No Yes IV Initiation / maintenance / fluids Central venous line—access of existing catheters No 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 28 Pa. Code § 1003.23(e)(2) No No Yes Yes IV Initiation / maintenance / fluids Intraosseous—needle placement & infusion—tibia, femur and humerus No No No Yes IV Initiation / maintenance / fluids Peripheral venous—initiation (cannulation) No No No Yes IV Initiation / maintenance / fluids Sub-cutaneous indwelling catheters—access of existing catheters No No No Yes IV Initiation / maintenance / fluids Vascular access devices in home healthcare—access of existing catheters No No No Yes IV Initiation / maintenance / fluids Venous (blood sampling)—obtaining No No No Yes IV Initiation / maintenance / fluids Venous central line (blood sampling)—obtaining No 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 & 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 Pennsylvania Bulletin by PA DOH 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 / 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, thermal Yes 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 Carbon Monoxide CO—oximetry monitoring Yes1 Yes2 Yes2 Yes2 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, bandaging, hemostatic agents8 Yes Yes Yes Yes Patient assessment / management Intracranial monitoring/assist No No No No4 Patient assessment / management As outlined in DOH approved regional & statewide tx5 & transport protocols Yes 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 & 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. 13-1050. Filed for public inspection June 7, 2013, 9:00 a.m.]
