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PA Bulletin, Doc. No. 03-1077

NOTICES


Prehospital Practitioners Scope of Practice

[33 Pa.B. 2713]

   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 and prehospital registered nurses (PHRNs) 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 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 33 Pa.B. 834 (February 8, 2003). Changes made are: (1) an addition to the legend that describes the conditions under which certain skills may be performed; (2) addition of the use of a cardiac magnet to alter the mode of an AICD or pacemaker; (3) addition of auto-injectors as a route for medication administration; and (4) addition of primary use epinephrine auto-injectors by EMTs.

   Persons with a disability who require an alternate format of this notice (for example, large print, audiotape, Braille) should contact Barb Seifert, Department of Health, Emergency Medical Services Office, Room 1032, Health and Welfare Building, Harrisburg, PA 17120, (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].

CALVIN B. JOHNSON, M.D., M.P.H.,   
Acting Secretary

Yes--The skill is in the scope of practice for the level of certification AA--ambulance attendant
No--The skill is not in the scope of practice for the level of certification FR--first responder
1--May assist higher level practitioner only when in the physical presence and under the direct supervision of the ALS practitioner EMT--emergency medical technician
EMT-P--emergency medical technician
2--Additional training and approval by service medical director required              paramedic
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
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 (PTL) No No No No4
Airway/ventilation/oxygenation Bag-valve-ETT/CombiTube® 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 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
   (EOA)/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 (LMA) 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 (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 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 (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 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 IV No No No Yes
IV Initiation/maintenance/fluids Indwelling intravenous catheters as
   described in 28 Pa. Code § 1003.23(e)(2)
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 & moving Patient lifting, moving and 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 Intraosseous--anterior tibia or distal 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 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 No4
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
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 (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 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 anti-shock garment/military anti-shock trousers
PPE Personal protective equipment
PSAP Public safety answering point
RSI Rapid sequence induction
TX Treatment
[Pa.B. Doc. No. 03-1077. Filed for public inspection June 6, 2003, 9:00 a.m.]



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