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Expanded Scope of Practice for Emergency Medical Services Providers of Air Ambulance Services

[45 Pa.B. 5559]
[Saturday, September 5, 2015]

 Under 28 Pa. Code § 1027.40(f) (relating to air ambulance service), the Department of Health (Department) is publishing the expanded scope of practice for authorized paramedics (P), prehospital registered nurses (PHRN), prehospital physician extenders (PHPE) and prehospital emergency medical services physicians (PHP) when functioning for an emergency medical services (EMS) agency that has been licensed as an air ambulance service under 35 Pa.C.S. § 8129 (relating to emergency medical services agencies).

 Under 28 Pa. Code § 1027.40(f), expansion of the applicable EMS providers' scopes of practice includes EMS skills in addition to those skills included in these EMS providers' general scopes of practice that were published at 45 Pa.B. 5463 (August 29, 2015). To perform these expanded skills, EMS providers must receive education to perform these skills by having successfully completed an air ambulance transport educational program approved by the Department. Minimum requirements to become an approved air ambulance transport educational program, and a list of approved air ambulance transport 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 P'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 another 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. 5463.

 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 call by using V/TT (717) 783-6154 or the Pennsylvania AT&T Relay Service at (800) 654-5984 (TT).


Category Skill Air Ambulance Provider
(P, 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) Yes
9 Airway/ventilation/oxygenation Chest tube thoracostomy, acute insertion Yes1
12 Airway/ventilation/oxygenation Biphasic positive airway pressure (BiPAP) for patients acutely on BiPAP for <48 hoursYes
24Airway/ventilation/oxygenationEndotracheal Intubation—paralytic assisted, rapid sequence induction (RSI)Yes1
25Airway/ventilation/oxygenationVentilation—Maintenance of previously initiated neuromuscular blockadeYes
28Airway/ventilation/oxygenationLaryngeal mask airway (LMA)Yes
49Airway/ventilation/oxygenationVentilators that are portable and capable of being transported with a patient and are multi-modal, with a blender, that are used on patients requiring pressure control, pressure support or other advanced setting, or when there is an anticipated need by a healthcare provider involved with the care of the patient to actively titrate ventilator settings during transport, regardless of ventilation mode.Yes1
62Cardiovascular/circulationTransvenous or Epicardial pacing, Management of Yes1
64Cardiovascular/circulationHemodynamic monitoring/assist (pulmonary artery catheter, central venous pressure)Yes1
65Cardiovascular/circulationIntra-aortic balloon pump or invasive cardiac assist device or extracorporeal membrane oxygenation—monitoring/assistYes1
67Cardiovascular/circulationThrombolytic therapy—initiationYes1
68Cardiovascular/circulationThrombolytic therapy—monitoringYes1
75IV Initiation/maintenance/fluidsSub-cutaneous indwelling catheters—access of existing cathetersYes
77IV Initiation/maintenance/fluidsVenous central line (blood sampling)—obtainingYes
79IV Initiation/maintenance/fluidsArterial line—monitoring/assistYes
80IV Initiation/maintenance/fluidsBlood/Blood-by-products
products administration (initiation and continuation)
Yes1
92Medication administration routesEnteral Feeding Devices, Management of Yes1
101MedicationsMedications for air ambulance providers as published in Pennsylvania Bulletin by the DepartmentYes
103MedicationsOver-the-counter (OTC) medications (Note: aspirin and glucose covered elsewhere)Yes
110Patient Assessment/managementPortable blood analysis devices, use of (glucometer covered elsewhere)Yes
119Patient Assessment/managementIntracranial monitoring/assistYes1
124Patient Assessment/managementUrinary catheterizationYes

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

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

KAREN M. MURPHY, PhD, RN, 
Secretary

[Pa.B. Doc. No. 15-1626. Filed for public inspection September 4, 2015, 9:00 a.m.]



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