Pennsylvania Adopts Critical Care Transport Scope

Today, Pennsylvania announced the scope of practice and medication list for Critical Care Emergency Medical Service Providers. Unfortunately, all of the skills and medications listed apply to interfacility transports and/or must be performed in the physical presence of a PHRN/PHPE/PHP.

Critical Care Scope of Practice

Category Skill Critical Care Transport Provider (Paramedic, PHRN, PHPE or PHP)
8 Airway/ventilation/oxygenation Chest tube thoracostomy, monitoring of existing tube in a closed system (for example water seal or suction) Yes1
9 Airway/ventilation/oxygenation Chest tube thoracostomy, acute insertion Yes2
12 Airway/ventilation/oxygenation Biphasic positive airway pressure (BiPAP) for patients acutely on BiPAP for <48 hours Yes1
24 Airway/ventilation/oxygenation Endotracheal Intubation—paralytic assisted, rapid sequence induction (RSI) Yes2
25 Airway/ventilation/oxygenation Ventilation—Maintenance of previously initiated neuromuscular blockade Yes1
28 Airway/ventilation/oxygenation Laryngeal mask airway (LMA) Yes1
49 Airway/ventilation/oxygenation Ventilators, transport—single or multi-modal, with or without blender, using volume control mode only, on patients >1 year of age with no anticipated need to actively titrate ventilator settings during transport. Yes1
64 Cardiovascular/circulation Transvenous or Epicardial pacing, Management of Yes2
66 Cardiovascular/circulation Hemodynamic monitoring/assist (pulmonary artery catheter, central venous pressure) Yes2
67 Cardiovascular/circulation Intra-aortic balloon pump or invasive cardiac assist device or extracorporeal membrane oxygenation—monitoring/assist Yes2
69 Cardiovascular/circulation Thrombolytic therapy—initiation Yes2
70 Cardiovascular/circulation Thrombolytic therapy—monitoring Yes2
77 IV Initiation/maintenance/fluids Sub-cutaneous indwelling catheters—access of existing catheters Yes1
79 IV Initiation/maintenance/fluids Venous central line (blood sampling)—obtaining Yes1
81 IV Initiation/maintenance/fluids Arterial line—monitoring Yes1
82 IV Initiation/maintenance/fluids Blood products—initiation and continued administration Yes2
94 Medication administration routes Enteral Feeding Devices, Management of Yes1
103 Medications Medications for Critical Care Transport Providers as published in Pennsylvania Bulletin by the Department Yes1
105 Medications Over-the-counter (OTC) medications (Note: aspirin and glucose covered elsewhere) Yes1
112 Patient Assessment/management Portable blood analysis devices, use of (glucometer covered elsewhere) Yes1
121 Patient Assessment/management Intracranial pressure monitoring/assist Yes2
126 Patient Assessment/management Urinary catheterization Yes1

Yes—The skill is in the scope of practice for paramedics, PHRNs, PHPEs and PHPs who are authorized to function for an EMS agency that has been licensed as a CCT ambulance service. (Emphasis added)

1. Paramedics, PHRNs, PHPEs and PHPs who are authorized to function for an EMS agency that has been licensed as a CCT ambulance service may only perform or assist with these skills during interfacility transport with a CCT ambulance. (Emphasis added)

2. Paramedics who are authorized to function for an EMS agency that has been licensed as a CCT ambulance service may assist a PHRN, PHPE or PHP with this skill only during interfacility transport with a CCT ambulance and when in the direct physical presence of, and supervised by, the higher level provider. (Emphasis added)

 

Critical Care Medication List

  1. Abciximab2
  2. Albumin1,2
  3. Anti-Coagulants/Anti-Platelets: All Types (Not otherwise specified)1,2
  4. Anti-Emetics: All Types (Not otherwise specified)1.2
  5. Anti-Hypertensives: All Types (Not otherwise specified)2
  6. Antivenom1,2
  7. Atenolol1,2
  8. Barbiturates2
  9. Bivalirudin2
  10. Blood Products2
  11. Clopidogrel2
  12. Dextran1,2
  13. Digoxin2
  14. Dilaudid2
  15. Eptifibatide2
  16. Esmolol2
  17. Fibrinolytics/Thrombolytics: All Types2
  18. Glucocorticoids/Mineralcorticoids1,2
  19. Heparin2
  20. Hespan1,2
  21. Hydralazine1,2
  22. Hydroxocobalamin1,2
  23. Insulin2
  24. Ketamine1,2
  25. Ketorolac1,2
  26. Labetolol1,2
  27. Mannitol2
  28. Metaproterenol1,2
  29. Metoprolol1,2
  30. Milrinone1,2
  31. Non-Depolarizing Agents1,2
  32. Norepinephrine2
  33. Other Non-Benzodiazepine Anti-Convulsants2
  34. Phenylephrine2
  35. Phenytoin/Phosphenytoin1,2
  36. Plasmanate1,2
  37. Potassium Chloride2
  38. Propofol1,2
  39. Propranolol1,2
  40. Prostaglandins: All Types2
  41. Quinidine Sulfate/Gluconate2
  42. Romazicon2
  43. Succinylcholine2
  44. Theophylline1,2
  45. Tirofiban2
  46. Tocolytics: All Types (Not otherwise specified)2
  47. Total Parenteral Nutrition2

Footnotes:
1. Paramedics who are authorized to function for an EMS agency that has been licensed as a CCT ambulance service are restricted to the maintenance and monitoring of medication administration that is initiated at the sending medical facility. (Emphasis added)

2. Paramedics who are authorized to function for an EMS agency that has been licensed as a CCT ambulance service may only administer the medication in the direct physical presence of, and supervised by, a PHRN, PHPE or PHP. (Emphasis added)

 

Pennsylvania Adopts Critical Care Transport Scope

Leave a Reply