[30 Pa.B. 5363]
[Continued from previous Web Page]
Subchapter H. ADDITIONAL REQUIREMENTS FOR THE COUNCIL § 1001.141. Duties and purpose.
The Council shall advise the Department on emergency health services issues that relate to manpower and training, communications, ambulance services, special care units, the content of EMS patient care reports, the content of rules and regulations, standards and policies promulgated by the Department and other subjects as required by the act or deemed appropriate by the Depart-ment or the Council. The Council shall also advise the Department on the content of the Statewide EMS development plan, and proposed revisions to it.
Subchapter I. RESEARCH IN
PREHOSPITAL CARE§ 1001.161. Research.
(a) Clinical investigations or studies that relate to direct patient care may not be conducted by providers of EMS unless the investigation or study is proposed to and approved by the Department.
(b) A proposal for clinical investigation or study shall be presented to the Department. If the Department concludes that the proposal may have merit, it shall refer the proposal to the Council, and to the regional EMS council having responsibilities in the region where the investigation or study would be undertaken. The Council and the regional EMS council shall have the proposal reviewed by their medical advisory committees and consider the comments of those committees, and shall forward their recommendations to the Department within 60 days after receiving from the Department a request to review the proposal.
(c) The Department will approve or disapprove the proposal within 30 days after receiving the recommendations of the Council and the regional EMS council. If the proposal is approved, the prehospital personnel identified in the proposal may function in accordance with the proposal and under conditions specified by the Department during the term of the clinical investigation or study.
(d) A proposal shall include and address the following considerations and items in a format specified by the Department:
(1) A specific statement of the hypothesis to be investigated and the clinical significance of the hypothesis.
(2) A specific description of the methodology to be used in the investigations.
(3) An estimated duration of the investigation.
(4) Consideration of complications or side effects that may be encountered and how they shall be treated.
(5) Consideration of how to assure patient confidentiality.
(6) Consideration of obtaining informed consent of the patient.
(7) Institutional review board approval when required by law.
(8) A letter from the researcher who identifies himself as the lead investigator and assumes clinical responsibility for the investigation.
(9) A letter from the physician who assumes clinical responsibility for the investigation.
(10) A plan for providing the Department with progress reports and a final report on the investigation or study.
(e) The Department may direct that the investigation or study be terminated prematurely for its failure to satisfy conditions of approval.
CHAPTER 1003. PERSONNEL
Subchapter A. ADMINISTRATIVE AND SUPERVISORY EMS PERSONNEL § 1003.1. Commonwealth Emergency Medical Director.
(a) Roles and responsibilities. The Commonwealth Emergency Medical Director is responsible for the following:
(1) Providing medical advice and recommendations to the Department regarding the EMS system.
(2) Assisting in the development and implementation of a Statewide EMS quality improvement program.
(3) Assisting the Department in revising or modifying the scope of practice of ALS and BLS prehospital personnel.
(4) Providing advice and guidance to the Department on investigations and the pursuit of disciplinary actions against prehospital personnel and providers of EMS.
(5) Reviewing, evaluating and making recommendations regarding regional transfer and medical treatment protocols.
(6) Reviewing, evaluating and making recommendations for the Statewide BLS medical treatment protocols.
(7) Reviewing, evaluating and making recommendations for protocols to get acutely ill and injured patients to the most appropriate facility, including criteria for the evaluation, triage, treatment, transport and referral, as well as bypass protocols.
(8) Evaluating regional EMS quality improvement programs.
(9) Providing direction and guidance to the regional EMS medical directors for training and quality improvement monitoring and assistance.
(10) Meeting with representatives and committees of regional EMS councils and the Council as necessary and as directed by the Department to provide guidance and direction.
(11) Reviewing, evaluating and making recommendations to the Department on clinical research proposals.
(12) Providing other services relating to the Department's administration of the act as assigned by the Department.
(b) Equivalent qualifications. If the Commonwealth Emergency Medical Director is not a medical command physician, the Commonwealth Emergency Medical Director shall possess the following qualifications:
(1) The minimum qualifications for a medical command physician in § 1003.4(b)(1)--(3) and (5) (relating to medical command physician).
(2) Experience in the prehospital and emergency department care of the acutely ill and injured patient.
(3) Knowledge regarding the medical command direction of prehospital personnel and the operation of emergency dispatch.
(4) Knowledge of the capabilities and limitations of ambulances, including air ambulances and prehospital personnel.
(5) Knowledge of potential medical complications which may arise during transport of a patient by an ambulance service.
(c) Disclosure. The Commonwealth Emergency Medical Director shall disclose to the Department all financial or other interest in providers of EMS and in other matters which present a potential conflict of interest.
§ 1003.2. Regional EMS medical director.
(a) Roles and responsibilities. Each regional EMS council shall have a regional EMS medical director who shall carry out the following duties:
(1) Assist the regional EMS council to approve or reject applications for medical command physicians received from medical command facility medical directors.
(2) Maintain liaison with the Commonwealth Emergency Medical Director.
(3) Assist the regional EMS council, after consultation with the regional medical advisory committee, to establish and revise transfer and medical treatment protocols for the regional EMS system.
(4) Assist the regional EMS council to establish field treatment protocols for determining when a patient will not be transported to a treatment facility and establish procedures for documenting the reasons for a nontransport decision.
(5) Assist the regional EMS council to establish field protocols to govern situations in which a patient may be transported without consent, in accordance with Pennsylvania law. The protocols shall cover appropriate documentation and review procedures.
(6) Assist the regional EMS council to establish criteria for level of care and type of transportation to be provided in various medical emergencies, such as ALS versus BLS, and ground versus air ambulance, and distribute approved criteria to PSAPs.
(7) Conduct quality improvement audits of the regional EMS system including reviewing the quality improvement activities conducted by the ALS service medical directors within the region.
(8) Serve on the State EMS Quality Improvement Committee.
(9) Serve as chairperson of the regional EMS council medical advisory committee.
(10) Facilitate continuity of patient care during inter-regional transport.
(11) Recommend to the Department suspension, revocation or restriction of prehospital personnel certifications and recognitions.
(12) Conduct hearings in accordance with § 1003.28 (relating to medical command authorization) upon appeal of an individual whose medical command authorization is denied or restricted by the ALS service medical director and issue written decisions.
(13) Review regional plans, procedures and processes for compliance with State standards of emergency medical care.
(b) Minimum qualifications. A regional EMS council medical director shall have the following qualifications:
(1) Licensure as a physician.
(2) Experience in prehospital and emergency department care of the acutely ill or injured patient.
(3) Experience in medical command direction of prehospital personnel.
(4) Experience in emergency department management of the acutely ill or injured patient.
(5) Have completed 3 years in a residency program in emergency medicine or have served as a medical command physician in this Commonwealth prior to October 14, 2000.
(6) Experience in the training of basic and advanced prehospital personnel.
(7) Experience in the medical audit, review and critique of BLS and ALS prehospital personnel.
(c) Disclosure. A regional EMS medical director shall disclose to a regional EMS council all financial or other interest in providers of EMS and in other matters which present a potential conflict of interest.
§ 1003.3. Medical command facility medical director.
(a) Roles and responsibilities. A medical command facility shall have a medical command facility medical director. A medical command facility medical director is responsible for the following:
(1) Medical command.
(2) Quality improvement.
(3) Liaison with regional EMS council medical director.
(4) Participation in prehospital training activities.
(5) Clinical and continuing education training of prehospital personnel.
(6) Recommendations to the regional EMS medical director regarding medical command physician applications from the medical command facility.
(b) Minimum qualifications. To qualify and continue to function as a medical command facility medical director, an individual shall have the following qualifications:
(1) Be currently serving as a medical command physician.
(2) Satisfy one of the following:
(i) Have completed 3 years in a residency program in emergency medicine.
(ii) Have served as a medical command physician in this Commonwealth prior to October 14, 2000.
(iii) Have secured board certification in surgery, internal medicine, family medicine, pediatrics or anesthesiology. If the physician has board certification in one of these medical specialties, the physician shall also have successfully completed or taught the ACLS course within the preceding 2 years and have completed, at least once, the ATLS course, and either an APLS or PALS course, or other programs determined by the Department to meet or exceed the standards of theses programs.
(3) Experience in prehospital and emergency department care of the acutely ill or injured patient.
(4) Experience in providing medical command direction to prehospital personnel.
(5) Experience in the training of BLS and ALS prehospital personnel.
(6) Experience in the medical audit, review and critique of BLS and ALS prehospital personnel.
§ 1003.4. Medical command physician.
(a) Roles and responsibilities. A medical command physician shall provide medical command to prehospital personnel. This includes providing online medical command to prehospital personnel whenever they seek direction.
(b) Minimum qualifications. To qualify and continue to function as a medical command physician, an individual shall:
(1) Be a physician.
(2) Satisfy one of the following:
(i) Have completed 3 years in a residency program in emergency medicine.
(ii) Have served as a medical command physician in this Commonwealth prior to October 14, 2000.
(iii) Have successfully completed or taught the ACLS course within the preceding 2 years and have completed, at least once, the ATLS course, and either an APLS or PALS course, or other programs determined by the Department to meet or exceed the standards of these programs.
(3) Have completed the continuing medical education credits required for membership in the American Medical Association, or its equivalent, or be serving a graduate year III in a residency program in emergency medicine or a graduate year II in a residency program in emergency medicine, with concurrent online supervision by an approved medical command physician.
(4) Be a full-time emergency physician or practice emergency medicine for at least half-time of a full-time medical practice.
(5) Possess a valid Drug Enforcement Agency (DEA) number.
(6) Have completed the Medical Command Course.
(c) Approval of medical command physician.
(1) A physician may function as a medical command physician if approved to do so by a regional EMS council.
(2) A regional EMS council shall approve a physician as a medical command physician if the physician demonstrates that the physician will function under the auspices of a medical command facility and establishes one of the following:
(i) That the physician satisfies the qualifications for a medical command physician in subsection (b).
(ii) That the physician has received certification as a medical command physician from the Department upon successfully completing the voluntary medical command physician certification program administered by the Department.
(3) A regional EMS council shall conclude that the physician will be operating under the auspices of a medical command facility if the physician establishes that the physician has an arrangement with the medical command facility to provide medical command on its behalf while on duty for the medical command facility, under the direction of the medical command facility medical director and under the policies and procedures of the medical command facility, and further establishes one of the following:
(i) That the facility meets the requirements for a medical command facility prescribed in § 1009.1 (relating to operational criteria).
(ii) That the facility has received recognition as a medical command facility from the Department under § 1009.2 (relating to recognition process).
(d) Notice requirements for medical command facility and regional EMS council.
(1) A medical command facility shall give notice to each regional EMS council having responsibility for an EMS region in which the medical command facility anticipates medical command physicians functioning under its auspices will be providing medical command, and shall explain the circumstances under which medical command will be given in that region.
(2) A regional EMS council that has approved a physician as a medical command physician shall give notice of the approval to the Department.
(e) Transfer and medical treatment protocols. A medical command physician shall provide medical command to prehospital personnel in ground ambulances and QRSs consistent with the transfer and medical treatment protocols which are in effect in either the region in which treatment originates or the region in which the prehospital personnel begin receiving online medical command from the medical command physician.
§ 1003.5. ALS service medical director.
(a) Roles and responsibilities. An ALS service medical director is responsible for the following:
(1) Providing medical guidance and advice to the ALS ambulance service, including:
(i) Reviewing the Statewide BLS medical treatment protocols and the regional transfer and medical treatment protocols, and ensuring that the ALS ambulance service's prehospital personnel are familiar with them, and amendments and revisions thereto.
(ii) Providing guidance to the ALS ambulance service with respect to the ordering, stocking and replacement of drugs, and compliance with laws and regulations impacting upon the ALS ambulance service's acquisition, storage and use of those drugs.
(iii) Participating in the regional and Statewide quality improvement plans, including continuous quality improvement reviews of patient care and its interaction with the regional EMS system.
(iv) Recommending to the relevant regional EMS council, when appropriate, specific transfer and medical treatment protocols for inclusion in the regional transfer and medical treatment protocols.
(2) Granting, denying or restricting medical command authorization to members of the ALS ambulance service's prehospital personnel who require this authorization, and participating in appeals from decisions to deny or restrict medical command authorization in accordance with § 1003.28 (relating to medical command authorization).
(3) Performing medical audits of patient care provided by the ALS ambulance service's prehospital personnel.
(b) Equivalent qualifications. If the ALS service medical director is not a medical command physician, the ALS service medical director shall:
(1) Possess the minimum qualifications for a medical command physician in § 1003.4(b)(1)--(5) (relating to medical command physician).
(2) Have experience in the medical command direction of prehospital personnel.
(3) Have knowledge of the capabilities and limitations of ambulances, including air ambulances, and prehospital personnel.
(4) Have knowledge of potential medical complications which may arise during transport of the patient by an ambulance service.
(5) Successfully complete the Medical Command Course.
Subchapter B. PREHOSPITAL AND
OTHER PERSONNEL§ 1003.21. Ambulance attendant.
(a) Roles and responsibilities. An ambulance attendant, as part of the crew of an ambulance or a QRS, may perform BLS activities within the ambulance attendant's scope of practice, as set forth in subsection (c), at the scene of an emergency or enroute to a facility. This section does not prohibit an ambulance attendant from providing BLS services as a good Samaritan.
(b) Qualifications. To qualify as an ambulance attendant an individual shall satisfy the age requirement under the Child Labor Law (43 P. S. §§ 41--71) and one of the following:
(1) Possess a current certificate evidencing successful completion of an advanced first aid course sponsored by the American Red Cross and a certificate issued within the last 2 years evidencing successful completion of a CPR course.
(2) Possess a current certificate evidencing successful completion of a course determined by the Department to be equivalent to the requirements in paragraph (1).
(c) Scope of practice. An ambulance attendant shall have the authority to provide the following BLS services if trained to do so:
(1) Patient assessment--including vital signs--and ongoing evaluation.
(2) Pulmonary or cardiopulmonary resuscitation and foreign body airway obstruction management.
(3) Administration of oxygen.
(4) Insertion of oropharyngeal or nasopharyngeal airways.
(5) Oropharyngeal suctioning.
(6) Assessment and management of cardiac, respiratory, diabetic shock, behavioral and heat/cold emergencies, as prescribed within an advanced first aid course meeting the requirements in subsection (b)(1) or (2).
(7) Emergency treatment for bleeding, burns, poisoning, seizures, soft tissue injuries, chest-abdominal-pelvic injuries, muscle and bone injuries, eye injuries and childbirth (including care of the newborn), as prescribed within an advanced first aid course meeting the requirements in subsection (b)(1) or (2).
(8) Application of spinal immobilization devices and splinting materials, including traction splints.
(9) Basic triage and basic maneuvers to gain access to the patient.
(10) Patient lifting and moving techniques.
(11) Use of an automated external defibrillator when approved by a physician who serves as the medical director of the ambulance service with respect to its use of automated external defibrillators.
(12) Assist a prehospital practitioner who is above the level of first responder in the use of Department-approved automatic ventilators and pulse oximetry when approved by the medical director of the ambulance service.
(13) Other BLS skills taught in a course in advanced first aid sponsored by the American Red Cross, provided the ambulance attendant has received training to perform those skills in a course or in an equivalent training program approved by the Department, and is able to document having received the training. The Department will identify these skills as follows:
(i) The Department will publish in the Pennsylvania Bulletin, at least annually, a list of the skills taught in the most recent course in advanced first aid sponsored by the American Red Cross.
(ii) If the course sponsored by the American Red Cross teaches skills in addition to advanced first aid, the Department will exclude those skills from the published list. An ambulance attendant may not perform a skill taught in a course approved under this paragraph if the Department does not include the skill in the list it publishes under subparagraph (i).
§ 1003.22. First responder.
(a) Roles and responsibilities. A first responder may perform, at the scene of an emergency, enroute to a facility, or in an emergency setting in a facility, the BLS services in subsection (e) to stabilize and improve a patient's condition until more highly trained personnel arrive. Following the arrival of more highly trained personnel, a first responder may continue to perform the BLS services within a first responder's scope of practice as set forth in subsection (e) under the direction of more highly trained personnel. This section does not prohibit a first responder from providing BLS services as a good Samaritan.
(b) Certification.
(1) The Department will certify as a first responder an individual who meets the following qualifications:
(i) Completes an application on a form prescribed by the Department.
(ii) Is 16 years of age or older.
(iii) Has successfully completed a first responder training course approved by the Department. The Department will publish annually in the Pennsylvania Bulletin a list of courses leading to first responder certification.
(iv) Has passed a written examination for first responder certification prescribed by the Department, or has passed an examination which the Department has determined to be equivalent in both content and manner of administration.
(v) Has passed a practical test of first responder skills prescribed by the Department, or has passed an examination which the Department has determined to be equivalent in both content and manner of administration.
(2) A first responder's certification is valid for 3 years, subject to disciplinary action under section 11(j.1) of the act (35 P. S. § 6931(j.1)) and § 1003.27 (relating to disciplinary and corrective action).
(c) Recertification. A first responder shall apply for recertification between 1 year and 60 days prior to expiration of the first responder's certification from the Department. Failure to apply for recertification in a timely manner may result in the individual not being recertified before the prior certification expires. The Department will recertify as a first responder an individual who meets the following qualifications:
(1) Completes an application on a form prescribed by the Department.
(2) Is or was previously certified as a first responder.
(3) Has successfully completed one of the following:
(i) The first responder practical skills and written knowledge examination prescribed by the Department.
(ii) The continuing education requirements applicable to first responders in § 1003.29(a) (relating to continuing education requirements).
(d) Certification by endorsement.
(1) For an individual who is 16 years of age or older and who is currently certified in another state as a first responder or as a person with similar responsibilities, the Department will endorse the following qualifications as equivalent to those in subsection (b):
(i) Successful completion of training curriculum which meets or exceeds the standards for the training course prescribed by the Department in subsection (b)(1)(iii).
(ii) Successful completion of a written examination for first responder certification, or an equivalent certification, which is determined by the Department to meet or exceed the standards of the written examination prescribed by the Department under subsection (b)(1)(iv).
(iii) Successful completion of a practical skills examination for first responder certification, or an equivalent certification, which is determined by the Department to meet or exceed the standards of the practical skills examination prescribed by the Department under subsection (b)(1)(v).
(2) An individual whose first responder certification or equivalent certification in another state is expired at the time of application may seek to have the satisfaction of paragraph (1)(i) endorsed as equivalent to the satisfaction of subsection (b)(1)(iii), but will not be considered by the Department for endorsement of qualifications under paragraph (1)(ii) or (iii), and shall successfully complete the first responder practical skills and written knowledge examinations prescribed by the Department after applying for certification through examination.
(3) Certification under this subsection is valid for 3 years. Upon expiration of that certification, the individual shall meet the requirements for recertification in subsection (c).
(e) Scope of practice.
(1) A first responder's scope of practice includes the BLS services which may be performed by an ambulance attendant as set forth in § 1003.21(c) (relating to ambulance attendant), if the first responder has been trained to perform those services.
(2) A first responder's scope of practice also includes other BLS services taught in a first responder training course approved by the Department, if the first responder has received training to perform those services, and is able to document having received the training, in one of the following:
(i) A first responder training course approved by the Department.
(ii) A course which is determined by the Department to meet or exceed the standards or a first responder training course preapproved by the Department.
(iii) A course for which the first responder may receive continuing education credit towards recertification.
(3) The Department will publish in the Pennsylvania Bulletin, at least annually, a list of the skills taught in first responder training courses most recently approved by the Department.
(4) If the approved course is not offered by the Department, the Department may exclude from the published list, skills taught which the Department determines are not appropriate services to be performed by a first responder. A first responder may not perform a skill taught in a course under paragraph (2)(ii) or (iii) if the Department does not include the skill in the list it publishes under paragraph (3).
§ 1003.23. EMT.
(a) Roles and responsibilities. An EMT may perform, in a prehospital, interhospital or emergency care setting in a hospital, or during the transfer of convalescent or other nonemergency cases, the BLS services set forth in subsection (e), to prevent loss of life or aggravation of physiological or psychological illness or injury. This section does not prohibit an EMT from providing BLS services as a good Samaritan.
(b) Certification.
(1) The Department will certify as an EMT an individual who meets the following qualifications:
(i) Completes an application on a form prescribed by the Department.
(ii) Is 16 years of age or older.
(iii) Has successfully completed an EMT training course approved by the Department.
(iv) Has successfully completed a written EMT examination prescribed by the Department.
(v) Has successfully completed an EMT practical skills examination prescribed by the Department.
(2) The Department will also certify as an EMT an individual who completes an application on a form prescribed by the Department and who has one of the following:
(i) Permanent certification as an EMT-paramedic under § 1003.24(b) (relating to EMT-paramedic) but without medical command authorization under § 1003.28 (relating to medical command authorization).
(ii) Permanent recognition as a prehospital registered nurse under § 1003.25b (relating to prehospital registered nurse) but without medical command authorization under § 1003.28.
(3) Certification granted under paragraph (1) or (2) is valid for 3 years, subject to disciplinary action under section 11(j.1) of the act (35 P. S. § 6931(j.1)) and § 1003.27 (relating to disciplinary and corrective action).
(c) Certification by endorsement.
(1) For an individual who is 16 years of age or older and currently certified as an EMT in another state, the Department will endorse the following qualifications as equivalent to those in subsection (b):
(i) Successful completion of EMT training curriculum that meets or exceeds the standards of the training course prescribed by the Department under subsection (b)(1)(iii).
(ii) Successful completion of a written examination for EMT certification which is determined by the Department to meet or exceed the standards of the written examination prescribed by the Department under subsection (b)(1)(iv).
(iii) Successful completion of a practical skills examination for EMT certification which is determined by the Department to meet or exceed the standards of the practical skills examination prescribed by the Department under subsection (b)(1)(v).
(2) An individual whose EMT certification in another state is expired at the time of application may seek to have the satisfaction of paragraph (1)(i) endorsed as equivalent to the satisfaction of subsection (b)(1)(iii), but will not be considered by the Department for endorsement of qualifications under paragraph (1)(ii) or (iii), and shall successfully complete the EMT practical skills and written examinations prescribed by the Department after applying for certification through examination.
(3) Certification under this subsection is valid for 3 years. Upon expiration of that certification the individual shall meet the requirements for recertification in subsection (d).
(d) Recertification. An EMT shall apply for recertification between 1 year and 60 days prior to expiration of the EMT's certification from the Department. Failure to apply for recertification in a timely manner may result in the individual not being recertified before the prior certification expires. The Department will recertify as an EMT an individual who meets the following qualifications:
(1) Completes an application on a form prescribed by the Department.
(2) Is or was previously certified as an EMT.
(3) Has successfully completed one of the following:
(i) The written and practical EMT recertification examinations prescribed by the Department.
(ii) The continuing education requirements for EMTs in § 1003.29(b) (relating to continuing education requirements).
(e) Scope of practice. An EMT's scope of practice, under medical command direction or utilization of the Statewide BLS medical treatment protocols, includes the BLS services which may be performed by a first responder as set forth in § 1003.22(e) (relating to first responder) and the following:
(1) Administration to a patient or assisting a patient to administer drugs previously prescribed for that patient, as specified in the Statewide BLS medical treatment protocols.
(2) Transportation of a patient with an indwelling intravenous catheter without medication running, unless the medication is part of the patient's normal treatment plan and the transport of the patient with medication running is consistent with the Statewide BLS medical treatment protocols.
(3) Other BLS services taught in a basic training program for EMTs approved by the Department, if the EMT has received training to perform those services, and is able to document having received the training, in one of the following:
(i) A basic training course for EMTS approved by the Department.
(ii) A course which is determined by the Department to meet or exceed the standards of a basic training course for EMTS preapproved by the Department.
(iii) A course for which the EMT may receive continuing education credit towards recertification.
(f) Publication of approved skills.
(1) The Department will publish in the Pennsylvania Bulletin, at least annually, a list of the skills taught in the EMT basic training course most recently approved by the Department.
(2) If the course is not offered by the Department, the Department may exclude, from the published list, skills taught which the Department determines are not appropriate skills to be performed by an EMT. An EMT may not perform a skill taught in a course under subsection (e)(3)(ii) or (iii) if the Department does not include the skill in the list it publishes under paragraph (1).
§ 1003.23a. EMS instructor certification.
(a) Qualifications for certification. The Department will issue an EMS instructor certification to an individual who meets all of the following requirements:
(1) Has completed an application for EMS instructor certification on a form prescribed by the Department.
(2) Is 18 years of age or older.
(3) Has successfully completed an EMS instructor course approved by the Department, or possesses a bachelor's degree in education or a teacher's certification in education.
(4) Has successfully completed an EMT-Basic transition program or update, or has completed an EMT-Basic course.
(5) Possesses current certification as an EMT or EMT-paramedic, or recognition as a health professional.
(6) Possesses current certification in CPR or current certification as a CPR instructor.
(7) Possesses at least 1 year experience functioning at the EMT, EMT-paramedic or health professional level providing prehospital care.
(b) Renewal of instructor certification. An EMS instructor certification is valid for 3 years. The Department will renew an EMS instructor certification for an individual who meets the following requirements:
(1) Has completed an application for renewal of an EMS instructor certification on a form prescribed by the Department.
(2) Has demonstrated competence in teaching the didactic and practical skills portions of the curriculum.
(3) Has provided documentation to the Department to establish that the individual conducted at least 60 hours of teaching EMS or rescue courses during the previous 3 years.
(4) Possesses current certification as an EMT, certification as an EMT-paramedic or recognition as a health professional.
(5) Possess current certification in CPR.
(6) Effective October 14, 2003, has completed an EMS instructor update program within 3 years prior to applying for renewal of certification.
§ 1003.24. EMT-paramedic.
(a) Roles and responsibilities.
(1) An EMT-paramedic who has been granted medical command authorization under § 1003.28 (relating to medical command authorization), or an individual who is a student in an approved EMT-paramedic training program under the supervision of an approved preceptor, may provide in a prehospital, interhospital or in an emergency care setting in a facility, or during the transfer of convalescent or other nonemergency cases, BLS services which may be performed by an EMT as set forth in § 1003.23(a) and (e) (relating to EMT), as well as the ALS services in subsection (d) to prevent loss of life or aggravation of physiological or psychological illness or injury. This section does not prohibit an EMT-paramedic from providing EMS as a good Samaritan.
(2) An EMT-paramedic who does not have or chooses not to maintain medical command authorization under § 1003.28 may apply to the Department for certification as an EMT. The rules applicable to certification of an EMT-paramedic as an EMT are in § 1003.23(b)(2). An EMT-paramedic without medical command authorization who is certified as an EMT may provide only the BLS services within an EMT's scope of practice as set forth in § 1003.23(a) and (e) until the EMT-paramedic has regained medical command authorization in accordance with § 1003.28. Following loss of medical command authorization, an EMT-paramedic may function as an EMT for the ALS ambulance service under which the EMT-paramedic has lost medical command authorization, for 30 days without securing EMT certification, if approval to do so is granted by the ALS service medical director for that ALS ambulance service.
(b) Certification.
(1) The Department will certify as an EMT-paramedic an individual who meets the following qualifications:
(i) Completes an application on a form prescribed by the Department.
(ii) Possesses current certification as an EMT.
(iii) Is 18 years of age or older.
(iv) Has successfully completed a training course for EMT-paramedics approved by the Department.
(v) Has successfully completed a practical examination of EMT-paramedic skills.
(vi) Has successfully completed a written examination for EMT-paramedics administered by the Department.
(2) An individual certified as an EMT-paramedic is permanently certified as an EMT-paramedic, subject to disciplinary action under section 11(j.1) of the act (35 P. S. § 6931(j.1)) and § 1003.27 (relating to disciplinary and corrective action).
(3) An EMT-paramedic shall register biennially with the Department on forms supplied by the Department prior to the biennial anniversary date of the EMT-paramedic's certification and shall supply information requested by the Department on the registration form.
(c) Certification by endorsement.
(1) For an individual who is 18 years of age or older and who is currently certified in another state as an EMT-paramedic, the Department will endorse the following qualifications as equivalent to those in subsection (b).
(i) Certification as an EMT-paramedic in the other state instead of current certification as an EMT in this Commonwealth.
(ii) Successful completion of EMT-paramedic training curriculum that meets or exceeds the standards of the training course prescribed by the Department under subsection (b)(1)(iv).
(iii) Successful completion of a written examination for EMT-paramedic certification which is determined by the Department to meet or exceed the standards of the written examination prescribed by the Department under subsection (b)(1)(vi).
(iv) Successful completion of a practical skills examination for EMT-paramedic certification which is determined by the Department to meet or exceed the standards of the practical skills examination prescribed by the Department under subsection (b)(1)(v).
(2) An individual whose EMT-paramedic certification in another state is expired at the time of application may seek to have the satisfaction of paragraph (1)(ii) endorsed as equivalent to the satisfaction of subsection (b)(1)(iv), but will not be considered by the Department for endorsement of qualifications under paragraph (1)(i), (iii) or (iv), and shall successfully complete the EMT-paramedic practical skills and written examinations prescribed by the Department after making application for certification through examination.
(d) Scope of practice. An EMT-paramedic's scope of practice includes the BLS services which may be performed by an EMT in § 1003.23(a) and (e) and the ALS services set forth in this subsection. An EMT-paramedic, with medical command authorization, following the order of a medical command physician, or use of Department approved transfer and medical treatment protocols as authorized by the ALS service medical director, may:
(1) Perform pulmonary ventilation by the use of oral, nasal, endotracheal or tracheostomy intubation.
(2) Insert, in peripheral veins, intravenous catheters, needles or other cannulae-IV lines.
(3) Obtain venous blood samples for analysis, but only for diagnostic and treatment purposes.
(4) Prepare and administer approved medication and solutions by intravenous, intramuscular, subcutaneous, intraosseous, oral, sublingual, topical, inhalation, rectal or endotracheal routes.
(5) Perform defibrillation and synchronized cardioversion.
(6) Perform gastric suction by nasogastric or orogastric intubation.
(7) Insert nasogastric or orogastric tubes.
(8) Visualize the airway by use of the laryngoscope and remove foreign bodies with forceps.
(9) Apply electrodes and monitor cardiac electrical activity including electrocardiograms.
(10) Perform Valsalva maneuvers.
(11) Use mechanical cardiopulmonary resuscitation devices.
(12) Assess and manage patients in accordance with the EMT-paramedic training curriculum approved by the Department.
(13) Perform thoracic decompression.
(14) Perform cricothyrotomy and pulmonary ventilation.
(15) Perform central venous and intraosseous cannulation.
(16) Perform external transcutaneous pacing.
(17) Perform urinary catheterization.
(18) Access central venous lines and subcutaneous indwelling catheters.
(19) Perform other ALS skills taught in a training course for EMT-paramedics approved by the Department, if the EMT-paramedic has received training to perform those services and is able to document having received the training, in one of the following:
(i) A training course for EMT-paramedics approved by the Department.
(ii) A course which is determined by the Department to meet or exceed the standards of a training course for EMT-paramedics preapproved by the Department.
(iii) A course for which the EMT-paramedic may receive continuing education credit towards qualifying for medical command authorization.
(e) Publication of approved skills.
(1) The Department will publish in the Pennsylvania Bulletin, at least annually, a list of the skills taught in the EMT-paramedic training course most recently approved by the Department.
(2) If the approved course is not offered by the Department, the Department may exclude, from the published list, skills taught which the Department determines are not appropriate skills to be performed by an EMT-paramedic. An EMT-paramedic may not perform a skill taught in a course under subsection (d)(19)(ii) or (iii) if the Department does not include the skill in the list it publishes under paragraph (1).
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