EMS Prehospital Personnel Training and Scope of Practice S-SV EMS MICN Course Module 2 EMS Prehospital Personnel Training and Scope of Practice S-SV EMS Agency MICN Training (Updated 07-2017)

EMS Personnel Minimum Training Requirements Public Safety First Aid (PSFA) – Minimum requirement for lifeguards, firefighters and law enforcement personnel in California 24 hours – including CPR and AED Emergency Medical Responder (EMR) 48 – 60 hours Emergency Medical Technician (EMT) – Minimum requirement for ambulance personnel 170 hours S-SV EMS Agency MICN Training (Updated 07-2017)

EMS Personnel Minimum Training Requirements Advanced EMT (AEMT) EMT + additional 160 hours Paramedic EMT + additional 1090 hours Critical Care Paramedic (CCP) - Utilized for interfacility transport (IFT) only Paramedic + additional 202 hours S-SV EMS Agency MICN Training (Updated 07-2017)

S-SV EMS Agency MICN Training (Updated 07-2017) EMS Personnel PSFA, EMR, EMT, and AEMT personnel are certified by the local EMS Agency (LEMSA) Follow LEMSA policies/protocols for patient care Paramedic personnel are licensed, but do not function independently Offline medical control – LEMSA policies/protocols Online medical control (base hospital order) – Outside LEMSA policies/protocols but still within scope of practice (under base hospital physician providing orders) S-SV EMS Agency MICN Training (Updated 07-2017)

S-SV EMS Agency MICN Training (Updated 07-2017) PSFA Scope of Practice Basic scope of practice BLS assessment CPR and AED BLS procedures (spinal immobilization, splinting, etc.) Assist with administration of oral glucose or patient’s prescribed medications Utilize commercial tourniquets and hemostatic dressings S-SV EMS Agency MICN Training (Updated 07-2017)

S-SV EMS Agency MICN Training (Updated 07-2017) PSFA Scope of Practice Optional scope of practice (requires S-SV EMS approval and additional training) Supplemental oxygen (NC, NRM, BVM) NPAs and OPAs Mark 1/DuoDote auto injectors Epinephrine auto-injectors IN naloxone S-SV EMS Agency MICN Training (Updated 07-2017)

S-SV EMS Agency MICN Training (Updated 07-2017) EMR Scope of Practice Basic scope of practice All items in PSFA basic scope Supplemental oxygen NPA, OPA, BVM Optional scope of practice (requires S-SV EMS approval and additional training) Mark 1/DuoDote auto-injectors Epinephrine auto-injectors IN naloxone S-SV EMS Agency MICN Training (Updated 07-2017)

S-SV EMS Agency MICN Training (Updated 07-2017) EMT Scope of Practice Basic scope of practice All items in PSFA & EMR basic scope SpO2 monitoring CPAP Administer oral glucose Traction splint Set up for ALS procedures S-SV EMS Agency MICN Training (Updated 07-2017)

S-SV EMS Agency MICN Training (Updated 07-2017) EMT Scope of Practice Expanded scope of practice (based on provider/ community needs - requires additional training) Administer aspirin Perform finger stick blood glucose testing utilizing a glucometer Monitor IVs (D5W/NS/LR) in the prehospital setting or during IFTs Monitor NG tubes, Foley, and/or tracheostomy tubes during IFTs S-SV EMS Agency MICN Training (Updated 07-2017)

S-SV EMS Agency MICN Training (Updated 07-2017) EMT Scope of Practice Optional scope of practice (requires S-SV EMS approval and additional training) Mark 1/DuoDote auto-injectors Epinephrine auto-injectors IN naloxone King airway device S-SV EMS Agency MICN Training (Updated 07-2017)

S-SV EMS Agency MICN Training (Updated 07-2017) AEMT Scope of Practice Basic scope of practice All items in PSFA, EMR and EMT basic scope King airway device Tracheal-bronchial suctioning of an intubated patient Obtain venous/capillary blood samples Use a blood glucose measuring device Establish peripheral IVs and saline locks Establish IOs (pediatric patients only) S-SV EMS Agency MICN Training (Updated 07-2017)

S-SV EMS Agency MICN Training (Updated 07-2017) AEMT Scope of Practice Basic scope of practice (continued) Medications in a route other than IV/IO Activated charcoal (PO) Albuterol (nebulizer) Aspirin (PO) Epinephrine 1:1,000 (IM) Glucagon (IM/IN) Naloxone (IM/IN) Nitroglycerin (SL) S-SV EMS Agency MICN Training (Updated 07-2017)

S-SV EMS Agency MICN Training (Updated 07-2017) AEMT Scope of Practice Basic scope of practice (continued) IV/IO medications Dextrose, Normal Saline and Lactated Ringers IV solutions Dextrose (D10 and D50) Naloxone S-SV EMS Agency MICN Training (Updated 07-2017)

S-SV EMS Agency MICN Training (Updated 07-2017) AEMT Scope of Practice Additional scope of practice (only for AEMTs certified as an EMT II prior to 7/1/2010 – very limited number of personnel in S-SV EMS region) Administer atropine, epinephrine 1:10,000, lidocaine, morphine, midazolam and sodium bicarbonate Perform synchronized cardioversion and defibrillation Utilize a cardiac monitor (including 12 Lead EKGs) S-SV EMS Agency MICN Training (Updated 07-2017)

Paramedic Scope of Practice Basic scope of practice All items in PSFA, EMR, EMT and AEMT basic scope Cardiac monitors (including 12 Lead EKGs) Perform synchronized cardioversion, defibrillation and external cardiac pacing Utilize a laryngoscope and Magill forceps King airway device, stomal intubation and adult oral intubation Peripheral IVs, saline locks and IOs on adult and pedi. pts S-SV EMS Agency MICN Training (Updated 07-2017)

Paramedic Scope of Practice Basic scope of practice (continued) Point of care testing (FSBG, capnography, CO oximetry) Valsalva maneuver Needle cricothyrotomy and thoracostomy Monitor thoracostomy tubes and/or ≤ 40 mEQ/L potassium IV solutions during IFTs Administer approved medications via multiple routes IV, IO, IM, SQ, inhalation, transcutaneous, rectal, SL, ET, IN, oral, or topical S-SV EMS Agency MICN Training (Updated 07-2017)

Paramedic Scope of Practice Basic scope of practice – approved medications Activated charcoal Adenosine Albuterol Amiodarone Aspirin Atropine sulfate Calcium chloride Dextrose (D10 and D50) Diphenhydramine Dopamine Epinephrine (1:1 and 1:10) Fentanyl Glucagon Ipratropium bromide Lidocaine Midazolam S-SV EMS Agency MICN Training (Updated 07-2017)

Paramedic Scope of Practice Basic scope of practice – approved medications Morphine sulfate Naloxone Nitroglycerin (except IV) Ondansetron Pralidoxime chloride Sodium bicarbonate Optional Scope of practice (approved for all S-SV EMS accredited paramedics) Nasotracheal intubation S-SV EMS Agency MICN Training (Updated 07-2017)

Paramedic Scope of Practice Optional scope of practice – IFTs only (requires S-SV EMS approval and additional training) Monitor IV infusions of magnesium sulfate, nitroglycerin, heparin, and/or amiodarone Monitor pre-existing blood transfusions Utilize automatic transport ventilators S-SV EMS Agency MICN Training (Updated 07-2017)

Critical Care Paramedic (CCP) Additional scope of practice for CCP licensed personnel during IFTs only (currently no S-SV EMS providers operating at this level) Set up and maintain thoracic drainage systems Set up and maintain mechanical ventilators Set up and maintain IV fluid delivery pumps/devices Blood and blood products Glycoprotein IIB/IIIA inhibitors S-SV EMS Agency MICN Training (Updated 07-2017)

Critical Care Paramedic (CCP) CCP scope of practice (continued) Heparin IV Nitroglycerin IV Norepinephrine Thrombolytic agents Maintain total parenteral nutrition S-SV EMS Agency MICN Training (Updated 07-2017)

Air Ambulance Personnel Air ambulance flight nurses follow their basic scope of practice allowed by their licensure and any optional scope of practice allowed by their provider medical director Flight nurses follow the policies/protocols established by their provider medical director (cannot conflict with S-SV EMS policies/protocols) Flight paramedics must follow S-SV EMS policies/protocols S-SV EMS Agency MICN Training (Updated 07-2017)