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Scope of Practice for Critical Care Transport Emergency Medical Service Providers

[45 Pa.B. 2678]
[Saturday, May 30, 2015]

 Under 28 Pa. Code § 1027.39(d) (relating to critical care transport ambulance service), the Department of Health (Department) is publishing the expanded scope of practice for authorized paramedics, prehospital registered nurses (PHRN), prehospital physician extenders (PHPE) and prehospital emergency medical services physicians (PHP) when functioning for an emergency medical service (EMS) agency that has been licensed as a critical care transport (CCT) ambulance service under 35 Pa.C.S. § 8129 (relating to emergency medical services agencies).

 Under 28 Pa. Code § 1027.39(d), expansion of the applicable EMS providers' scopes of practice include EMS skills in addition to those skills included in these EMS providers' general scopes of practice that were published at 44 Pa.B. 7487 (November 29, 2014) and 45 Pa.B. 377 (January 17, 2015). To perform these expanded skills, EMS providers must receive education to perform these skills by having successfully completed a critical care transport educational program approved by the Department. Minimum requirements to become an approved CCT educational program, and a list of approved CCT educational programs, will be continuously updated on the Bureau of Emergency Medical Services' web site.

 Skills identified may be performed by these EMS providers only if the provider 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. These providers may only perform skills that are indicated through either Statewide or other Department-approved protocols or that are ordered online by a medical command physician.

 A PHRN who is appropriately credentialed by the EMS agency medical director may perform 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 through the applicable Statewide or Department-approved EMS protocols.

 A PHPE who is appropriately credentialed by the EMS agency medical director may perform services within the scope of practice of a physician assistant under the Medical Practice Act of 1985 (63 P. S. §§ 422.1—422.51a) or the Osteopathic Medical Practice Act (63 P. S. §§ 271.1—271.18), whichever applies to the physician assistant, when authorized by a medical command physician through either online medical command or through applicable Statewide or Department-approved EMS protocols. When a PHPE functions in this capacity, the physician supervision requirements applicable to a physician assistant under the Medical Practice Act of 1985 or the Osteopathic Medical Practice Act do not apply.

 A PHP who is appropriately credentialed by the EMS agency medical director may perform skills within a paramedic's scope of practice and other skills within the practice of medicine or osteopathic medicine, whichever applies to the physician. A PHP may not perform a skill that the PHP has not been educated and trained to perform.

 To administer medications in addition to those permitted by applicable medical treatment protocols, PHRNs, PHPEs and PHPs must also receive approval to do so by the EMS agency medical director of the advanced life support ambulance service under which they are functioning.

 Under 28 Pa. Code § 1023.1(a)(1)(vi) and (vii) (relating to EMS agency medical director), the EMS agency medical director must make an initial assessment of each EMS provider at or above the advanced emergency medical technician (AEMT) level, and then within 12 months of each prior assessment, to determine whether the EMS provider has the knowledge and skills to competently perform the skills within the EMS provider's scope of practice, and a commitment to adequately perform other functions relevant to the EMS provider providing EMS at that level. EMS providers at or above the AEMT level may only perform skills that the EMS agency medical director has credentialed them to perform.

 The number listed in the first column in the following chart matches the number of the skill listed in the notice published for the scope of practice for EMS providers at 45 Pa.B. 377.

 Persons with a disability who require an alternate format of this notice (for example, large print, audiotape, Braille) should contact Richard L. Gibbons, Bureau Director, 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 use V/TT (717) 783-6154 or the Pennsylvania AT&T Relay Service at (800) 654-5984 (TT).

KAREN M. MURPHY, PhD, RN, 
Secretary


Category Skill Critical Care Transport Provider (Paramedic, PHRN, PHPE or PHP)
8 Airway/ventilation/oxygenation Chest tube thoracostomy, monitoring of existing tube in a closed system (for example water seal or suction) Yes1
9 Airway/ventilation/oxygenation Chest tube thoracostomy, acute insertion Yes2
12 Airway/ventilation/oxygenation Biphasic positive airway pressure (BiPAP) for patients acutely on BiPAP for <48 hoursYes1
24Airway/ventilation/oxygenationEndotracheal Intubation—paralytic assisted, rapid sequence induction (RSI)Yes2
25Airway/ventilation/oxygenationVentilation—Maintenance of previously initiated neuromuscular blockadeYes1
28Airway/ventilation/oxygenationLaryngeal mask airway (LMA)Yes1
49Airway/ventilation/oxygenationVentilators, transport—single or multi-modal, with or without blender, using volume control mode only, on patients >1 year of age with no anticipated need to actively titrate ventilator settings during transport. Yes1
64 Cardiovascular/circulation Transvenous or Epicardial pacing, Management of Yes2
66 Cardiovascular/circulation Hemodynamic monitoring/assist (pulmonary artery catheter, central venous pressure) Yes2
67 Cardiovascular/circulation Intra-aortic balloon pump or invasive cardiac assist device or extracorporeal membrane oxygenation—monitoring/assist Yes2
69 Cardiovascular/circulation Thrombolytic therapy—initiation Yes2
70 Cardiovascular/circulation Thrombolytic therapy—monitoring Yes2
77 IV Initiation/maintenance/fluids Sub-cutaneous indwelling catheters—access of existing catheters Yes1
79 IV Initiation/maintenance/fluids Venous central line (blood sampling)—obtaining Yes1
81 IV Initiation/maintenance/fluids Arterial line—monitoring Yes1
82 IV Initiation/maintenance/fluids Blood products—initiation and continued administration Yes2
94 Medication administration routes Enteral Feeding Devices, Management of Yes1
103 Medications Medications for Critical Care Transport Providers as published in Pennsylvania Bulletin by the Department Yes1
105 Medications Over-the-counter (OTC) medications (Note: aspirin and glucose covered elsewhere) Yes1
112 Patient Assessment/management Portable blood analysis devices, use of (glucometer covered elsewhere) Yes1
121 Patient Assessment/management Intracranial pressure monitoring/assist Yes2
126 Patient Assessment/management Urinary catheterization Yes1

 Yes—The skill is in the scope of practice for paramedics, PHRNs, PHPEs and PHPs who are authorized to function for an EMS agency that has been licensed as a CCT ambulance service.

 1. Paramedics, PHRNs, PHPEs and PHPs who are authorized to function for an EMS agency that has been licensed as a CCT ambulance service may only perform or assist with these skills during interfacility transport with a CCT ambulance.

 2. Paramedics who are authorized to function for an EMS agency that has been licensed as a CCT ambulance service may assist a PHRN, PHPE or PHP with this skill only during interfacility transport with a CCT ambulance and when in the direct physical presence of, and supervised by, the higher level provider.

[Pa.B. Doc. No. 15-1022. Filed for public inspection May 29, 2015, 9:00 a.m.]



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