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NOTICES

Prehospital Practitioner Scope of Practice

[34 Pa.B. 3988]

   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 (EMT), EMT-paramedics and prehospital registered nurses (PHRN) 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 on-line 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 33 Pa.B. 2713 (June 7, 2003). Changes made are:  (1) clarification related to immunizations. Immunizations may only be done when the practitioner is functioning as a physician extender under the Medical Practice Act of 1985 (act) (63 P. S. §§ 422.1--422.51a) and Osteopathic Medical Practice Act (63 P. S. §§ 271.1--271.18).

   Persons with a disability who require an alternate format of this notice (for example, large print, audiotape or Braille) should contact Bob Gaumer, Department of Health, Emergency Medical Services Office, Room 1032, Health and Welfare Building, Harrisburg, PA 17120, (717) 787-8740. Speech or hearing impaired persons should call by using 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.,   
Secretary

   Yes--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.

   AA--Ambulance attendant.

   FR--First responder.

   EMT--Emergency medical technician.

   EMT-P--Emergency medical technician paramedic.

   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 QRS that complies with Department requirements for performing this skill.

   7--May only be done as a physician extender under the act.


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 No No No No4
Airway/ventilation/oxygenation Bag-valve-ETT/CombiTube® ventilation No Yes1 Yes1 Yes
Airway/ventilation/oxygenation Bag-valve-mask (BVM)--with in-line small-volume nebulizer No Yes1 Yes1 Yes
Airway/ventilation/oxygenation 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 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) technique No No No Yes
Airway/ventilation/oxygenation End tidal CO2 monitoring/capnography No Yes1 Yes1 Yes
Airway/ventilation/oxygenation Esophageal obturator airway/esophageal gastric tube airway 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 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 No No No No4
Airway/ventilation/oxygenation Mouth-to-mouth, nose, stoma, barrier and 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--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 Yes Yes Yes Yes
Assessment of Level of consciousness 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 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 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 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 antishock trousers/garment (MAST5) No 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 pacemaker No No No Yes
Communications Verbal patient report to receiving personnel No 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 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 removal No No Yes Yes
Immobilization Spinal immobilization--long board w/pt supine and standing Yes Yes Yes Yes
Immobilization Spinal immobilization--manual stabilization and cervical collar Yes 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 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 intravenous (IV) No No No Yes
IV initiation/maintenance/fluids Indwelling IV catheters as described in 28 Pa. Code § 1003.23(e)(2) (relating to EMT) No No Yes Yes
IV initiation/maintenance/fluids Intraosseous--needle placement and infusion--anterior tibia or distal femur No 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 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 and moving Patient lifting, moving and transfers per NSC5 Yes Yes Yes Yes
Lifting and moving Patient restraints on transport devices Yes Yes Yes Yes
Medication administration routes Endotracheal tube No No No Yes
Medication administration routes Inhalation (aerosolized/nebulized) No No No Yes
Medication administration routes Intramuscular No No No Yes
Medication administration routes Intraosseous--anterior tibia or distal femur No No No Yes
Medication administration routes IV--bolus No No No Yes
Medication administration routes IV infusion, including by IV 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 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 Department No No No Yes
Medications Immunizations No No No Yes7
Medications Oral glucose No No Yes3 Yes
Medications Over-the-counter medications No No No No4
Medications Oxygen Yes Yes Yes Yes
Medications Autoinjected epinephrine--primary use--not patient's prescription No No Yes2, 3, 6 Yes
Medications--patient assisted Autoinjected epinephrine No No Yes3 Yes
Medications--patient assisted Metered dose inhaler--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 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 Yes 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 protocols Yes Yes Yes Yes
Patient assessment/management Multiple casualty incident/incident command system 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 antishock garment/military antishock trousers    
      PPE Personal protective equipment    
      PSAP Public safety answering point    
      RSI Rapid sequence induction    
      TX Treatment
[Pa.B. Doc. No. 04-1372. Filed for public inspection July 23, 2004, 9:00 a.m.]



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