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Prehospital Practitioner Scope of Practice

[38 Pa.B. 6565]
[Saturday, November 29, 2008]

   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 (EMT-Ps) and prehospital registered nurses (PHRNs) under the Emergency Medical Services Act (EMS 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-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 supersedes the list of skills in the scope of practice of prehospital personnel published at 36 Pa.B. 8013 (December 30, 2006). Six changes have been made. The changes are:

   Adding the King LTS-D Airway as a device to be used as a rescue airway.

   Adding CPAP/BiPAP as a skill that can be performed by EMTs.

   Listing tracheostomy suctioning as an EMT and EMT-P skill.

   Permitting ambulance attendants to make verbal patient reports to individuals receiving the patient.

   Permitting ambulance attendants to complete patient care reports.

   Adding the use of hemostatic agents to the methods that can be employed to stop bleeding.

   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

   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 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 Technician

   EMT--Emergency Medical Techician

   EMT-P--Emergency Medical Technician Paramedic


TOPIC SKILL AA FR 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--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/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
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 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--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 No Yes
Cardiovascular/
   circulation
Military/Pneumatic Anti-Shock Trousers/Garment PASG/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 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 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 & 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
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
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

   Persons with a disability who require an alternate format of this notice (for example, large print, audiotape, Braille) should contact Robert Cooney at the 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).

A. EVERETT JAMES,   
Acting Secretary

[Pa.B. Doc. No. 08-2162. Filed for public inspection November 28, 2008, 9:00 a.m.]



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