NOTICES
DEPARTMENT OF HEALTH
Scope of Practice for Emergency Medical Service Providers
[53 Pa.B. 8146]
[Saturday, December 30, 2023]Under 35 Pa.C.S. Chapter 81 (relating to the Emergency Medical Services System Act) and the Department of Health's (Department) regulations in 28 Pa. Code §§ 1023.24(d)(1), 1023.25(d)(1), 1023.26(d)(1), 1023.27(d)(1), 1023.28(d), 1023.29(d) and 1023.30(e), the Department is publishing the scope of practice for emergency medical responders (EMR), emergency medical technicians (EMT), advanced emergency medical technicians (AEMT), paramedics (P), prehospital registered nurses (PHRN), prehospital physician extenders (PHPE) and prehospital physicians (PHP).
Skills identified may be performed by an emergency medical service (EMS) provider at the provider's level of certification or registration only if the provider has successfully completed the approved education (cognitive, affective and psychomotor) on the specified skill, which includes training to perform the skill on adults, children and infants, as appropriate. EMRs, EMTs, AEMTs and Ps may only perform the skills identified, through either Statewide or other Department-approved protocols, or skills that may be ordered online by a medical command physician.
As the following chart indicates, a PHRN, PHPE and PHP may perform all skills identified as within a P's scope of practice. Each of these EMS providers may perform additional skills as outlined as follows.
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—422.53) or the Osteopathic Medical Practice Act (63 P.S. §§ 271.1—271.18), 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 as an EMS provider, the physician supervision requirements applicable to a physician assistant under the Medical Practice Act of 1985 and 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 Ps scope of practice and other skills within the practice of medicine or osteopathic medicine. A PHP may not perform a skill that the PHP has not been educated and trained to perform.
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 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.
Persons with a disability who require an alternate format of this notice (for example, large print, audiotape, Braille) should contact Jenni Hoffman, EMS Program Manager, Department of Health, Bureau of Emergency Medical Services, 1310 Elmerton Avenue, Harrisburg, PA 17110, (717) 787-8740. Persons with a speech or hearing impairment may call by using V/TT at (717) 783-6154 or the Pennsylvania Hamilton Relay Service at (800) 654-5984 (TT).
Category Skill EMR EMT AEMT P* 1 Airway/Ventilation/Oxygenation Nonsurgical Supraglottic Airway No No Yes Yes 2 Airway/Ventilation/Oxygenation Nasopharyngeal Yes Yes Yes Yes 3 Airway/Ventilation/Oxygenation Oropharyngeal Yes Yes Yes Yes 4 Airway/Ventilation/Oxygenation Pharyngeal Tracheal lumen No No No No 5 Airway/Ventilation/Oxygenation BVM-ETT/Nonsurgical Supraglottic Airway Yes2 Yes2 Yes Yes 6 Airway/Ventilation/Oxygenation BVM with in line small volume nebulizer No Yes2 Yes Yes 7 Airway/Ventilation/Oxygenation Bag Valve Mask (BVM) Yes Yes Yes Yes 8 Airway/Ventilation/Oxygenation Chest decompression—needle No No No Yes 9 Airway/Ventilation/Oxygenation Chest tube thoracostomy monitoring closed (clamped or water seal) No No No Yes1 10 Airway/Ventilation/Oxygenation Chest tube thoracostomy monitoring closed (attached to suction) No No No No 11 Airway/Ventilation/Oxygenation Chest tube thoracostomy monitoring open No No No Yes 12 Airway/Ventilation/Oxygenation Chest tube thoracotomy, acute insertion No No No No 13 Airway/Ventilation/Oxygenation Continuous Positive Airway Pressure (CPAP) No Yes1 Yes Yes 14 Airway/Ventilation/Oxygenation BiPAP No No No Yes1 15 Airway/Ventilation/Oxygenation Cricothyrotomy No No No Yes 16 Airway/Ventilation/Oxygenation End tidal CO2 monitoring/capnography No No Yes Yes 17 Airway/Ventilation/Oxygenation EOA/EGTA No No No No 18 Airway/Ventilation/Oxygenation Extubation—removal of ETT No No No Yes 19 Airway/Ventilation/Oxygenation Removal of Supraglottic Airway No No Yes Yes 20 Airway/Ventilation/Oxygenation Gastric decompression by OG tube insertion No No No Yes 21 Airway/Ventilation/Oxygenation Gastric decompression by NG tube insertion No No No Yes 22 Airway/Ventilation/Oxygenation Gastric decompression by alternative airway No No Yes Yes 23 Airway/Ventilation/Oxygenation Head-tilt chin lift Yes Yes Yes Yes 24 Airway/Ventilation/Oxygenation Inspiratory Impedance Threshold Device (ITD) No No Yes1 Yes 25 Airway/Ventilation/Oxygenation Endotracheal Intubation by direct laryngoscopy (including video intubation devices), nasotracheal, digital and transillumination/lighted stylet techniques No No No Yes 26 Airway/Ventilation/Oxygenation Endotracheal Intubations—paralytic assisted, rapid sequence induction (RSI) No No No No 27 Airway/Ventilation/Oxygenation Ventilation—maintenance of previous initiated neuro blocker No No No No 28 Airway/Ventilation/Oxygenation Endotracheal Intubation retrograde No No No No 29 Airway/Ventilation/Oxygenation Mouth to mouth Yes Yes Yes Yes 30 Airway/Ventilation/Oxygenation Mouth to nose Yes Yes Yes Yes 31 Airway/Ventilation/Oxygenation Mouth to stoma Yes Yes Yes Yes 32 Airway/Ventilation/Oxygenation Mouth to barrier Yes Yes Yes Yes 33 Airway/Ventilation/Oxygenation Obstruction—direct laryngoscopy (remove with forceps) No No No Yes 34 Airway/Ventilation/Oxygenation Obstruction-manual (abdominal thrusts, finger sweep, chest thrusts) upper airway Yes Yes Yes Yes 35 Airway/Ventilation/Oxygenation Oxygen therapy—blow by Yes Yes Yes Yes 36 Airway/Ventilation/Oxygenation Oxygen therapy—humidifiers No Yes Yes Yes 37 Airway/Ventilation/Oxygenation Oxygen therapy—nasal cannulas Yes Yes Yes Yes 38 Airway/Ventilation/Oxygenation Oxygen therapy—nonrebreather Yes Yes Yes Yes 39 Airway/Ventilation/Oxygenation Oxygen therapy—partial rebreather No Yes Yes Yes 40 Airway/Ventilation/Oxygenation Oxygen therapy—regulators Yes Yes Yes Yes 41 Airway/Ventilation/Oxygenation Oxygen therapy—simple face mask No Yes Yes Yes 42 Airway/Ventilation/Oxygenation Oxygen therapy—Venturi mask No Yes Yes Yes 43 Airway/Ventilation/Oxygenation Peak expiratory flow assessment No No Yes Yes 44 Airway/Ventilation/Oxygenation Suctioning—meconium aspiration No No No Yes 45 Airway/Ventilation/Oxygenation Suctioning—stoma/tracheostomy Yes Yes Yes Yes 46 Airway/Ventilation/Oxygenation Suctioning—tracheobronchial by advanced airway No Yes2 Yes Yes 47 Airway/Ventilation/Oxygenation Suctioning—upper airway (nasal) Yes Yes Yes Yes 48 Airway/Ventilation/Oxygenation Suctioning—upper airway (oral) Yes Yes Yes Yes 49 Airway/Ventilation/Oxygenation Transtracheal jet ventilation No No No Yes 50 Airway/Ventilation/Oxygenation Single mode, volume controlled auto vent without blender No No Yes1 Yes1 51 Airway/Ventilation/Oxygenation Ventilator, transport single of multimodal with/without blender. Volume control mode only, on patients >1 year of age with no anticipated need to actively titrate ventilator settings during transport. No No No Yes 52 Airway/Ventilation/Oxygenation Ventilators, that are portable, 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. No No No No 53 Cardiovascular/Circulation Blood pressure—auscultation Yes Yes Yes Yes 54 Cardiovascular/Circulation Blood pressure—electronic noninvasive Yes Yes Yes Yes 55 Cardiovascular/Circulation Blood pressure—palpation Yes Yes Yes Yes 56 Cardiovascular/Circulation Electrocardiogram (ECG) monitoring applying leads single lead No Yes2 Yes2 Yes 57 Cardiovascular/Circulation Electrocardiogram (ECG) monitoring obtain and transmit 12 lead ECG No Yes1 Yes Yes 58 Cardiovascular/Circulation Cardiac monitoring—single lead (interpret) No No No Yes 59 Cardiovascular/Circulation Manual chest compressions—adult, child, infant Yes Yes Yes Yes 60 Cardiovascular/Circulation Precordial thump No No No Yes 61 Cardiovascular/Circulation Cardioversion—synchronized No No No Yes 62 Cardiovascular/Circulation Defibrillation—counter shock manual No No No Yes 63 Cardiovascular/Circulation Transcutaneous cardiac pacing No No No Yes 64 Cardiovascular/Circulation Transvenous or Epicardial pacing, Management of No No No No 65 Cardiovascular/Circulation Defibrillation—automated external defibrillator (AED) Yes Yes Yes Yes 66 Cardiovascular/Circulation Hemodynamic monitoring/assist (Swan Ganz, central venous pressure) No No No No 67 Cardiovascular/Circulation Intra-aortic balloon pump or invasive cardiac assist device monitoring/assist No No No No 68 Cardiovascular/Circulation Mechanical chest compression device application and use Yes1 Yes1 Yes1 Yes1 69 Cardiovascular/Circulation Thrombolytic therapy—initiation No No No No 70 Cardiovascular/Circulation Thrombolytic therapy—monitoring No No No No 71 IV Initiation/Maintenance/Fluid Central venous cannulation/insertion No No No No 72 IV Initiation/Maintenance/Fluid Central venous line-access of existing catheters with external ports No No No Yes 73 IV Initiation/Maintenance/Fluid External jugular vein cannulation No No No Yes 74 IV Initiation/Maintenance/Fluid Saline lock insertions as no-flow IV No No Yes Yes 75 IV Initiation/Maintenance/Fluid Intraosseous-needle placement and infusion-tibia, femur and humerus No No Yes Yes 76 IV Initiation/Maintenance/Fluid IV insertion, peripheral venous initiation (cannulation) No No Yes Yes 77 IV Initiation/Maintenance/Fluid Sub-cutaneous indwelling catheters—access of existing catheters No No No No 78 IV Initiation/Maintenance/Fluid Venous blood sampling, peripheral—for clinical diagnostic purposes only No No Yes Yes 79 IV Initiation/Maintenance/Fluid Venous blood sampling, peripheral—for legal purposes only (Applies to Paramedics only, as defined and permitted by Act 142 of 2016) No No No Yes 80 IV Initiation/Maintenance/Fluid Venous central line (blood sampling) obtaining No No No No 81 IV Initiation/Maintenance/Fluid Arterial line—capped—transport No Yes Yes Yes 82 IV Initiation/Maintenance/Fluid Arterial line—monitoring/assist No No No No 83 IV Initiation/Maintenance/Fluid Blood/Blood-by-products administration (initiation) No No No Yes1 84 IV Initiation/Maintenance/Fluid Blood/Blood-by-products administration (monitoring) No No No Yes1 85 Lifting and moving Patient lifting, moving and transfers Yes Yes Yes Yes 86 Lifting and moving Patient restraints on transport devices Yes Yes Yes Yes 87 Medication administration routes Endotracheal (ET) No No No Yes 88 Medication administration routes Inhalation (aerosolized/nebulized) No Yes Yes Yes 89 Medication administration routes Intramuscular (IM) No No Yes Yes 90 Medication administration routes Intranasal (IN) No No Yes Yes 91 Medication administration routes Intraosseous (IO)—tibia, humerus or femur No No Yes Yes 92 Medication administration routes Intravenous (IV)—fluid bolus No No Yes Yes 93 Medication administration routes Intravenous (IV)—monitoring or maintaining existing IV infusions, (crystalloid fluid as published in the EMS medication list in the Pennsylvania Bulletin), during interfacility transport No No Yes Yes 94 Medication administration routes Intravenous (IV) infusion with added medication, including by intravenous pump No No No Yes 95 Medication administration routes Nasogastric No No No Yes 96 Medication administration routes Enteral feeding devices, Management of No No No No 97 Medication administration routes Oral—over-the-counter medications for pain, fever and hypoglycemia (as listed in the approved medication list) No Yes Yes Yes 98 Medication administration routes Inhalation over-the-counter medication inhalation of alcohol prep pad Yes Yes Yes Yes 99 Medication administration routes Rectal No No No Yes 100 Medication administration routes Subcutaneous No No Yes Yes 101 Medication administration routes Sublingual (Note: EMT may only assist patient with his/her prescribed Nitroglycerin (NTG)) No Yes Yes Yes 102 Medication administration routes Topical No No No Yes 103 Medications Auto-injector benzodiazepine for seizure No No No Yes 104 Medications Auto-injector epinephrine (assist patient with his/her prescribed medication) No Yes Yes Yes 105 Medications Auto-injected epinephrine-primary use—not patients own prescription No Yes1 Yes Yes 106 Medications IM injection of Epinephrine as approved by PA EMS protocol No Yes1 Yes Yes 107 Medications Medications as published in the Pennsylvania Bulletin by the Department Yes Yes Yes Yes 108 Medications Immunizations as published in the Pennsylvania Bulletin by the Department No No No Yes 109 Medications Over the counter (OTC) medications (except as listed elsewhere for pain, fever, hypoglycemia) No No No No 110 Medications Oxygen Yes1 Yes Yes Yes 111 Medications Auto-injector nerve agent antidote—
self or peer rescueYes Yes Yes Yes 112 Medications Auto-injector nerve agent antidote—
patient treatmentNo Yes3 Yes3 Yes 113 Medications Metered-dose inhaler (MDI) bronchodilator (EMT may only assist patient with their own prescribed inhaler) No Yes Yes Yes 114 Medications Naloxone—Intranasal or intramuscular auto injector Yes1,4 Yes1,4 Yes Yes 115 Medications Glucagon—Intranasal (powder spray) or intramuscular auto-injector No Yes1 Yes Yes 116 Patient assessment/management Behavioral—restrain violent patient Yes1 Yes Yes Yes 117 Patient assessment/management Blood glucose assessment No Yes1 Yes Yes 118 Patient assessment/management Portable blood analysis devices, use of (glucometer covered elsewhere) No No No No 119 Patient assessment/management Childbirth—umbilical cord cutting Yes Yes Yes Yes 120 Patient assessment/management Childbirth—(abnormal/complications) No Yes Yes Yes 121 Patient assessment/management Childbirth (normal)—cephalic Yes Yes Yes Yes 122 Patient assessment/management Carbon Monoxide CO—oximetry monitoring No Yes1 Yes1 Yes1 123 Patient assessment/management Carbon Monoxide CO—exhaled analysis device No Yes1 Yes1 Yes1 124 Patient assessment/management Carbon Monoxide with environmental surveillance devices Yes Yes Yes Yes 125 Patient assessment/management Hemodynamic monitoring/assist (Swan Ganz, central venous pressure) No No No No 126 Patient assessment/management Dislocation reduction No No No No 127 Patient assessment/management Eye irrigation (irrigation through corneal contact device limited to AEMT and P) Yes Yes Yes Yes 128 Patient assessment/management Intracranial monitoring/assist No No No No 129 Patient assessment/management Patient management per Statewide EMS protocols and Department approved protocols Yes Yes Yes Yes 130 Patient assessment/management Pulse oximetry monitoring No Yes Yes Yes 131 Patient assessment/management Splinting, extremity—manual, rigid, soft, vacuum Yes Yes Yes Yes 132 Patient assessment/management Splinting, femur—traction No Yes Yes Yes 133 Patient assessment/management Urinary catheterization No No No No 134 Patient assessment/management Wound care, dressing bandaging Yes Yes Yes Yes 135 Patient assessment/management Wound care, removal of Taser probe/barb No No No No 136 Patient assessment/management Wound drain—vacuum devices, monitoring No Yes Yes Yes 137 Patient assessment/management Wound care, hemorrhage control—
direct pressure, wound packing, tourniquet, bandaging, hemostatic agentsYes Yes Yes Yes 138 Patient assessment/management Wound care, irrigation and skin closure with tape or adhesive glue No No No No 139 Spinal Care Restrict spinal motion—Cervical collar application Yes Yes Yes Yes 140 Spinal Care Restrict spinal motion—Helmet removal or stabilization No Yes Yes Yes 141 Spinal Care Restrict spinal motion—manual cervical spine stabilization Yes Yes Yes Yes 142 Spinal Care Restrict spinal motion—rapid extrication with precautions to restrict spinal movement No Yes Yes Yes 143 Spinal Care Devices to restrict spinal motion, vacuum mattress, extrication device, scoop stretcher and spine board No Yes Yes Yes EMR—Emergency Medical Responder;
EMT—Emergency Medical Technician;
AEMT—Advanced Emergency Medical Technician;
P*—Paramedic (*includes—PHRN/PHPE/PHP)
No—The skill is not in the scope of practice for the level certification.
Yes—The skill is in the scope of practice for the level of certification.
1. Additional training and authorization by EMS agency medical director is required, and this skill may only be used when functioning with a licensed EMS agency that complies with Department requirements for providing this skill.
2. May assist a P, PHRN, PHPE or PHP with this skill only in the physical presence of and under the direct supervision of the higher-level provider.
3. May perform this skill only in the physical presence of and under the direct supervision of a P, PHRN, PHPE or PHP.
4. Department-approved Act 139 training required and approval of the EMS medical director, and this skill may only be used when functioning with a licensed EMS agency that complies with Department requirements for providing this skill.
DR. DEBRA L. BOGEN,
Acting Secretary
[Pa.B. Doc. No. 23-1799. Filed for public inspection December 29, 2023, 9:00 a.m.]
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