1. 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 )

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
170 hours
S-SV EMS Agency MICN Training (Updated )

3. EMS Personnel Minimum Training Requirements
Advanced EMT (AEMT)
EMT + additional 160 hours
Paramedic
EMT + additional 1090 hours
S-SV EMS Agency MICN Training (Updated )

4. S-SV EMS Agency MICN Training (Updated 12-2018)
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 )

5. S-SV EMS Agency MICN Training (Updated 12-2018)
PSFA Scope of Practice
Basic scope of practice
BLS assessment
CPR and AED
BLS procedures (spinal motion restriction, 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 )

6. S-SV EMS Agency MICN Training (Updated 12-2018)
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 )

7. S-SV EMS Agency MICN Training (Updated 12-2018)
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 )

8. S-SV EMS Agency MICN Training (Updated 12-2018)
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 )

9. S-SV EMS Agency MICN Training (Updated 12-2018)
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 )

10. S-SV EMS Agency MICN Training (Updated 12-2018)
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 (Adult pts only)
i-gel LMA (Adult pts only) when working for ALS provider
S-SV EMS Agency MICN Training (Updated )

11. S-SV EMS Agency MICN Training (Updated 12-2018)
AEMT Scope of Practice
Basic scope of practice
All items in PSFA, EMR and EMT basic scope
King airway device, i-gel LMA (adult & pedi pts)
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 )

12. S-SV EMS Agency MICN Training (Updated 12-2018)
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 )

13. S-SV EMS Agency MICN Training (Updated 12-2018)
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 )

14. S-SV EMS Agency MICN Training (Updated 12-2018)
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 )

15. 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 )

16. 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 )

17. 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 )

18. 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 (optional by provider)
i-gel LMA (adult & pedi pts)
IV acetaminophen
Ketamine (pain management)
Ketorolac
TXA
S-SV EMS Agency MICN Training (Updated )

19. 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 )

20. Air Ambulance Personnel
Air ambulance flight nurses follow the scope of practice allowed by their RN licensure and any optional items allowed by their medical director
Flight nurses follow the policies/protocols established by their provider medical director
Flight paramedics must follow S-SV EMS policies/protocols
Flight paramedics are also allowed to intubate pediatric patients
S-SV EMS Agency MICN Training (Updated )