2014 Changes to the PA EMS Scope of Practice

The new Scope of Practice for Emergency Medical Service Providers was posted today and is scheduled for release this coming Saturday, November 29th. For reference, the soon-to-be old Prehospital Practitioner Scope of Practice is available here.

The most noticeable update is the much-anticipated inclusion of the Advanced EMT (AEMT) skills. As usual, one step forward comes with one step back: the EMR (formerly, First Responder) skill set was scaled back a bit. The EMT has gained some new abilities, and both EMTs and Paramedics have lost a couple of skills. The following is a quick breakdown to save you the time of comparing the documents.

I’ve also uploaded a comparison chart. Major additions/deletions are highlighted in blue. Lines that are blacked out indicate that nobody is allowed to perform that particular skill.

Items in italics indicate that skills may be performed only in the presence and under direct supervision of a Paramedic or higher.

Items in bold indicate that additional training and authorization by the service’s medical director is required. The service must also comply with DOH requirements for performing a skill.

Emergency Medical Responder (EMR)

According to the document, EMRs can no longer:

  • Use a BVM with an inline nebulizer
  • Use EtCO2
  • Use Pulse oximetry
  • Use CO-oximetry
  • Operate a transport ventilator
  • Apply ECG electrodes
  • Apply cervical collars

Despite being too stupid (in the state’s eyes) to apply a cervical collar or use a pulse oximeter, EMR’s are now allowed to administer naloxone via an auto-injector or the intranasal route.

Emergency Medical Technician (EMT)

EMT’s have gained the following skills:

  • Perform tracheobronchial suctioning via an advanced airway (that’s already been placed)
  • Administer oxygen via a Venturi mask
  • Use a mechanical CPR device
  • Automatic transport ventilators no longer require additional training (footnote removed).

EMTs are no longer allowed to perform EtCO2 monitoring.

Advanced Emergency Medical Technician (AEMT)

Since all of the AEMT skills are new, here’s a quick rundown of what the AEMT can and can’t do. This isn’t an exhaustive list, but rather a quick dispelling of the rumors and hearsay that have been running around. Consider checking out the AEMT Information page as well.

Allowed:

  • Most medication routes, as discussed in class.
  • IV:
    • Start a saline lock (no fluid)
    • Administer a fluid bolus (crystalloid solutions, as published by DOH)
  • Application of electrodes, including transmission of 12-lead ECGs
  • Irrigation with a corneal contact device (Morgan lens)
  • Blood glucose assessment
  • Intraosseous insertion in the physical presence and under direct supervision of Paramedic+.
  • Peak expiratory flow assessment

Not allowed:

  • Chest decompression
  • Medication administration via IV/IO, ET, or NG
  • Interpretation of ECGs
    • Any manual electrical or pharmacological intervention that is based on interpreting ECGs (AED is OK)
  • Accessing central lines, or external jugular (EJ) cannulation
  • Monitoring an IV infusion with added medication, even with an IV pump

Paramedic

  • Footnote for “additional training required” was removed for ITD
  • BiPAP is no longer allowed
  • Blended/multi-mode ventilators are no longer allowed
  • Urinary catheterization is no longer allowed

In addition to the above highlights, some wording has changed and various lines have been removed, added and/or otherwise reorganized (please review the original document). Fortunately, all of us are allowed to perform “Patient management per Statewide EMS Protocols and Department approved protocols” (isn’t that the point of them?); however, they no longer spell out that we’re allowed to use PPE, do tripsheets, use the radio, or talk to the hospital staff, and there’s no mention of whether or not we’re allowed to perform clean technique. (According to the previous scope, only Paramedics were allowed to wash their hands, use clean gloves and make an effort to prevent direct contamination of equipment and supplies.)

Things nobody likes doing anyway.

 

Again, please read the original document. There’s a chance I’ve missed something. If you do notice any inaccuracies, let me know.

2014 Changes to the PA EMS Scope of Practice

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