1. S-SV EMS MICN Course Module 2 EMS Prehospital Personnel Training and Scope of Practice S-SV EMS Agency MICN Training (Updated 05-2016) 1

2. 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  160 hours S-SV EMS Agency MICN Training (Updated 05-2016) 2

3. 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 05-2016) 3

4. 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 05-2016) 4

5. 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 05-2016) 5

6. PSFA Scope of Practice Optional scope of practice (requires S-SV EMS approval and additional training)  Supplemental oxygen  NPA, OPA, BVM  Mark 1/DuoDote auto injectors  Epinephrine auto-injectors  IN naloxone S-SV EMS Agency MICN Training (Updated 05-2016) 6

7. 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 05-2016) 7

8. EMT Scope of Practice Basic scope of practice  All items in PSFA & EMR basic scope  SpO2 monitoring  CPAP  Administer aspirin and oral glucose  Traction splint  Set up for ALS procedures  Monitor IVs (D5W/NS/LR), NG tubes, Foley, and/or tracheostomy tubes during IFT S-SV EMS Agency MICN Training (Updated 05-2016) 8

9. 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 05-2016) 9

10. 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 05-2016) 10

11. AEMT Scope of Practice Basic scope of practice (continued)  Medications in a route other than IV/IO o Activated charcoal (PO) o Albuterol (nebulizer) o Aspirin (PO) o Epinephrine 1:1,000 (IM) o Glucagon (IM/IN) o Naloxone (IM/IN) o Nitroglycerin (SL) S-SV EMS Agency MICN Training (Updated 05-2016) 11

12. AEMT Scope of Practice Basic scope of practice (continued)  IV/IO medications o Dextrose, Normal Saline and Lactated Ringers IV solutions o Dextrose (D10 and D50) o Naloxone S-SV EMS Agency MICN Training (Updated 05-2016) 12

13. 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 05-2016) 13

14. 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 05-2016) 14

15. 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 o IV, IO, IM, SQ, inhalation, transcutaneous, rectal, SL, ET, IN, oral, or topical S-SV EMS Agency MICN Training (Updated 05-2016) 15

16. Paramedic Scope of Practice Basic scope of practice – approved medications S-SV EMS Agency MICN Training (Updated 05-2016) 16  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

17. Paramedic Scope of Practice Basic scope of practice – approved medications S-SV EMS Agency MICN Training (Updated 05-2016) 17  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  Pediatric oral intubation

18. 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 05-2016) 18

19. 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 05-2016) 19

20. 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 05-2016) 20

21. 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 05-2016) 21