NOTICES
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/
oxygenationAirway--Nonsurgical Alternative/Rescue Airway--CombiTubeTM, King LT-D AirwayTM or King LTS-D Airway No No No Yes Airway/ventilation/
oxygenationAirway--oral & nasal Yes Yes Yes Yes Airway/ventilation/
oxygenationAirway--pharyngeal tracheal lumen (PTL) No No No No4 Airway/ventilation/
oxygenationBag-valve--ETT/Non surgical alternative airway ventilation No Yes1 Yes1 Yes Airway/ventilation/
oxygenationBag-valve-mask--with in-line small-volume nebulizer No Yes1 Yes1 Yes Airway/ventilation/
oxygenationBag-valve-mask (BVM) ventilation Yes Yes Yes Yes Airway/ventilation/
oxygenationChest decompression--needle No No No Yes Airway/ventilation/
oxygenationCPAP/BiPAP5--demonstrate application of No No Yes2,3,6 Yes Airway/ventilation/
oxygenationCricoid pressure (Sellick maneuver) No Yes Yes Yes Airway/ventilation/
oxygenationCricothyrotomy--needle No No No Yes Airway/ventilation/
oxygenationCricothyrotomy--open/surgical No No No Yes Airway/ventilation/
oxygenationCricothyrotomy--overwire (Seldinger) technique No No No Yes Airway/ventilation/
oxygenationEnd tidal CO2 monitoring/capnography No Yes1 Yes1 Yes Airway/ventilation/
oxygenationEsophageal obturator airway (EOA)/esophageal gastric tube airway (EGTA) No No No No4 Airway/ventilation/
oxygenationExtubation No No No Yes Airway/ventilation/
oxygenationFlow restricted oxygen powered ventilation device (demand valve) No Yes Yes Yes Airway/ventilation/
oxygenationGastric decompression--OG5 & NG5 tube (suction) No No No Yes Airway/ventilation/
oxygenationGastric tube insertion--nasal & oral No No No Yes Airway/ventilation/
oxygenationHead-tilt/chin-lift Yes Yes Yes Yes Airway/ventilation/
oxygenationInspiratory Impedance Threshold Device (ITD) No No No Yes2 Airway/ventilation/
oxygenationIntubation--digital & lighted stylet No No No Yes Airway/ventilation/
oxygenationIntubation--endotracheal tube No No No Yes Airway/ventilation/
oxygenationIntubation--medication paralytics assisted (RSI5) No No No No4 Airway/ventilation/
oxygenationIntubation--nasotracheal & orotracheal No No No4 Yes Airway/ventilation/
oxygenationIntubation--retrograde No No No No4 Airway/ventilation/
oxygenationIntubation--transillumination/lighted stylet No No No Yes Airway/ventilation/
oxygenationJaw thrust & modified jaw thrust (trauma) Yes Yes Yes Yes Airway/ventilation/
oxygenationLaryngeal mask airway (LMA) No No No No4 Airway/ventilation/
oxygenationMouth-to-mouth, nose, stoma, barrier & pocket mask Yes Yes Yes Yes Airway/ventilation/
oxygenationObstruction--direct laryngoscopy (remove with forceps) No No No Yes Airway/ventilation/
oxygenationObstruction--manual (Heimlich, finger sweep, chest thrusts) upper airway Yes Yes Yes Yes Airway/ventilation/
oxygenationOxygen therapy--blow-by delivery Yes Yes Yes Yes Airway/ventilation/
oxygenationOxygen therapy--humidifiers No Yes Yes Yes Airway/ventilation/
oxygenationOxygen therapy--nasal cannula Yes Yes Yes Yes Airway/ventilation/
oxygenationOxygen therapy--nonrebreather mask Yes Yes Yes Yes Airway/ventilation/
oxygenationOxygen therapy--partial rebreather No Yes Yes Yes Airway/ventilation/
oxygenationOxygen therapy--regulators Yes Yes Yes Yes Airway/ventilation/
oxygenationOxygen therapy--simple face mask Yes Yes Yes Yes Airway/ventilation/
oxygenationOxygen therapy--Venturi mask No No No Yes Airway/ventilation/
oxygenationPeak expiratory flow assessment No No No Yes Airway/ventilation/
oxygenationPulse oximetry Yes1 Yes2 Yes2 Yes Airway/ventilation/
oxygenationSuctioning--meconium aspiration No No No Yes Airway/ventilation/
oxygenationSuctioning--stoma/tracheostomy No No Yes Yes Airway/ventilation/
oxygenationSuctioning--tracheobronchial No No No Yes Airway/ventilation/
oxygenationSuctioning--upper airway (nasal) No Yes Yes Yes Airway/ventilation/
oxygenationSuctioning--upper airway (oral) Yes Yes Yes Yes Airway/ventilation/
oxygenationTranstracheal jet ventilation No No No Yes Airway/ventilation/
oxygenationVentilators--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/
circulationBlood pressure--auscultation Yes Yes Yes Yes Cardiovascular/
circulationBlood pressure--electronic noninvasive Yes Yes Yes Yes Cardiovascular/
circulationBlood pressure--palpation Yes Yes Yes Yes Cardiovascular/
circulationCardiac monitoring--apply electrodes No Yes1 Yes1 Yes Cardiovascular/
circulationCardiac monitoring--multi-lead No No No Yes Cardiovascular/
circulationCardiac monitoring--single-lead (interpretive) No No No Yes Cardiovascular/
circulationCardiopulmonary resuscitation (CPR) adult, infant, child, one & two person Yes Yes Yes Yes Cardiovascular/
circulationCardioversion--synchronized No No No Yes Cardiovascular/
circulationCarotid massage (vagal maneuvers) No No No Yes Cardiovascular/
circulationDefibrillation--Counter shock--manual No No No Yes Cardiovascular/
circulationDefibrillation--automated external defibrillator (AED) Yes2 Yes2 Yes2 Yes Cardiovascular/
circulationHemodynamic monitoring/assist (Swan Ganz, arterial, central venous lines) No No No No4 Cardiovascular/
circulationIntra-aortic balloon pump monitoring/assist No No No No4 Cardiovascular/
circulationMechanical CPR device No No No Yes Cardiovascular/
circulationMilitary/Pneumatic Anti-Shock Trousers/Garment PASG/MAST5) No No Yes Yes Cardiovascular/
circulationThrombolytic therapy--initiation No No No No4 Cardiovascular/
circulationThrombolytic therapy--monitoring No No No No4 Cardiovascular/
circulationTranscutaneous pacing No No No Yes Cardiovascular/
circulationUse 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/fluidsCentral venous cannulation (femoral vein only) No No No Yes IV Initiation/
maintenance/fluidsCentral venous line--access of existing catheters No No No Yes IV Initiation/
maintenance/fluidsClean technique No No No Yes IV Initiation/
maintenance/fluidsExternal jugular vein cannulation No No No Yes IV Initiation/
maintenance/fluidsHeparin/saline lock insertions as no-flow IV No No No Yes IV Initiation/
maintenance/fluidsIndwelling intravenous catheters as described 28 Pa. Code § 1003.23(e)(2) No No Yes Yes IV Initiation/
maintenance/fluidsIntraosseous--needle placement & infusion--tibia, femur and humerus No No No Yes IV Initiation/
maintenance/fluidsPeripheral venous--initiation (cannulation) No No No Yes IV Initiation/
maintenance/fluidsSub-cutaneous indwelling catheters--access of existing catheters No No No Yes IV Initiation/
maintenance/fluidsVascular access devices in home healthcare--access of existing catheters No No No Yes IV Initiation/
maintenance/fluidsVenous (blood sampling)--obtaining No No No Yes IV Initiation/
maintenance/fluidsVenous central line (blood sampling)--obtaining No No No No4 IV Initiation/
maintenance/fluidsArterial line--capped--transport No No Yes Yes IV Initiation/
maintenance/fluidsArterial line--monitoring/assist No No No No4 IV Initiation/
maintenance/fluidsBlood/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 routesEndotracheal tube (ET) No No No Yes Medication
administration routesInhalation (aerosolized/nebulized) No No No Yes Medication
administration routesIntramuscular (IM) No No No Yes Medication
administration routesIntranasal No No No Yes Medication
administration routesIntraosseous--tibia, humerus or femur No No No Yes Medication
administration routesIntravenous (IV)--bolus No No No Yes Medication
administration routesIntravenous (IV) infusion, including by intravenous pump No No No Yes Medication
administration routesNasogastric No No No Yes Medication
administration routesOral No No No Yes Medication
administration routesRectal No No No Yes Medication
administration routesSubcutaneous No No No Yes Medication
administration routesSub-lingual No No No Yes Medication
administration routesTopical No No No Yes Medication
administration routesAuto-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/
managementBehavioral--Restrain violent patient No No Yes Yes Patient assessment/
managementBlood glucose assessment No No No Yes Patient assessment/
managementBurns--chemical, electrical, inhalation, radiation, thermal Yes Yes Yes Yes Patient assessment/
managementChildbirth--umbilical cord cutting No Yes Yes Yes Patient assessment/
managementChildbirth (abnormal/complications) No No Yes Yes Patient assessment/
managementChildbirth (normal)--cephalic delivery Yes Yes Yes Yes Patient assessment/
managementDislocation reduction (shoulder) No No No No4 Patient assessment/
managementEye irrigation/care Yes Yes Yes Yes Patient assessment/
managementHemorrhage control--diffuse, direct, pressure point, tourniquet, bandaging, hemostatic agents8 Yes Yes Yes Yes Patient assessment/
managementIntracranial monitoring/assist No No No No4 Patient assessment/
managementAs outlined in DOH approved regional & Statewide tx5
& transport protocolsYes Yes Yes Yes Patient assessment/
managementMultiple Casualty Incident (MCI)/Incident Command System (ICS) No Yes Yes Yes Patient assessment/
managementTriage (prioritizing patients)--use of tags Yes Yes Yes Yes Patient assessment/
managementUrinary 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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