Scope of Practice

Definition of Scope of Practice:

 “Scope of practice” is a legal description of the distinction between licensed health care personnel and the lay public and among different licensed health care professionals. In general, scopes of practice focus on activities that are regulated by the EMS System medical governance. This includes technical skills that, if done improperly, represent a significant hazard to the patient and therefore must be regulated for public protection.

Scope of practice establishes which activities and procedures that would represent illegal activity if performed without a license and restricts the use of professional titles to persons that are authorized by his system. In addition to drawing the boundaries between the professionals and the layperson, scope of practice also defines the boundaries among professionals, creating either exclusive or overlapping domains of practice.

Emergency Medical Technicians (EMT):

Provides out of hospital emergency medical care and transportation for critical and emergent patients who access the emergency medical services (EMS) system. EMTs have the basic knowledge and skills necessary to stabilize and safely transport patients ranging from non-emergency and routine medical transports to life threatening emergencies. Emergency Medical Technicians function as part of a comprehensive EMS response system, under medical oversight. Emergency Medical Technicians perform interventions with the basic equipment typically found on an ambulance. Emergency Medical Technicians are a critical link between the scene of an emergency and the health care system.

EMT Scope of Practice Matrix
A Airway Management EMT
1 Open and maintain the airway P
2 Oropharyngeal airway adjunct P
3 Nasopharyngeal airway adjunct P
4 Obstructed airway management  P
5 Oral suctioning  P
6   Endotracheal Tube  
a.Trachial tube suctioning 

P

b.Trachial tube replacement   
7 Pulse oximeter equipment application/ P
8 Oxygen Administration  
a. Nasal cannula  P
b. Non-rebreather mask  P
c. Mouth-to-barrier devises  P
9 Ventilation Management  
a. Bag valve mask  P
10 Orotracheal Intubation   
a. Apneic patients   
b. Pulseless and apneic patients   
11 Cricothyrotomy, needle   
12 Dual Lumen Airway   
a. Apneic patients   
b. Pulseless and apneic patients   
13 Supraglottic Airways   
a. Apneic patients  P
b. Pulseless and apneic patients  P
14 Ventilator management - 16 y/o or older  P
15 End Tidal CO2 Monitoring & Detection  P
B Cardiac Management EMT
1 Automated External Defibrillator(AED)  P
2 Cardiac monitor strip interpretation   
3 Manual defibrillation   
4 Cardiopulmonary Resuscitation (CPR)  P
5 Transcutaneous Cardiac pacing   
6 Aspirin administration  P
7 Cardiac medication administration    
  1. Pt assisted
 P
  1. No Pt assist
  
8 Cardioversion   
9 12-lead ECG performance & interpretation   
10 12-lead ECG set up and application for electronic transmission* P
11 Chest compression assist devices  P
Patient Assisted Definition:
  1. May assist with patient's prescription upon patient request and with written protocol.
    2. – OR –
  2. May assist from EMS provided medications with verbal medical direction.
C Medical Management  EMT
1 Glucose monitoring system use P
2 Peripheral IV blood specimens   
3 Oral glucose administration  P
4 Auto-injector Epinephrine (Pt. Assisted)  P
5 Epinephrine administration (Subcutaneous)   
6 Nitroglycerine administration (Pt. Assisted)  P
7 Nitroglycerine administration (Non pt. Assist)   
8 Metered dose inhaler (Pt. Assisted)  P
9 Nebulized medications   
10 Glucagon   
11 Naloxone P
D ALS Care Assistance  EMT
1 Set up of IV administration kit & monitor patient with isotonic I.V Fluids flowing P
2 In the event of a declared mass casualty incident (MCI) as defined in the local MCI plan, the EMT-Basic may monitor patients who have isotonic intravenous fluids flowing  P
3 Cardiac monitor *  P
4 12 lead EKG application **  P
E Trauma Management  EMT
1 Long spine board  P
2 Short spine board  P
3 Splinting devices  P
4 Traction splint  P
5 Cervical Immobilization Device (CID)  P
6 Helmet removal  P
7 Rapid extrication procedures  P
8 Needle decompression of the chest 
9 Soft tissue management  P
10 Management of suspected fractures   
11 Tourniquet Application P
F Preparatory / Basic Performances  EMT
1 Body Substance Isolation precaution/administration  P
2 Taking and recording of vital signs  P
3 Patient Care Report (PCR) documentation  P
4 Emergency childbirth management  P
5 Trauma triage determination in MCI P
G Other  EMT
1 Medication administration (Protocol approved)  P
2 IV lifeline and fluid administration (does not include blood or blood products)  ASSIST ONLY
3 Intra osseous infusion   

 
4 Saline lock initiation   

 
H Additional services
In the event of an emergency declared by public health that affects the public's health, ,EMT may perform immunizations and administer drugs or dangerous drugs, in relation to the emergency, provided the EMT is under physician medical direction and has received appropriate training regarding the administration of such immunizations and/or drugs.
Advanced Emergency Medical Technician (AEMT):

The primary focus of this profession is to provide basic and limited advanced emergency medical care and transportation for critical and emergent patients who access the emergency medical system. This individual possesses the basic knowledge and skills necessary to provide patient care and transportation. Advanced Emergency Medical Technicians function as part of a comprehensive EMS response, under medical oversight. Advanced Emergency Medical Technicians perform interventions with the basic and advanced equipment typically found on an ambulance. The Advanced Emergency Medical Technician is a link from the scene to the emergency health care system.

AEMT Scope of Practice Matrix 
A Airway Management  AEMT
1 Open and maintain the airway  P
2 Oropharyngeal airway adjunct  P
3 Nasopharyngeal airway adjunct  P
4 Obstructed airway management  P
5 Oral suctioning  P
6 Endotracheal Tube  P
a.Trachial tube suctioning  P
b.Trachial tube replacement  P
7 Pulse oximeter equipment application/ P
8 Oxygen Administration  
a. Nasal cannula  P
b. Non-rebreather mask  P
c. Mouth-to-barrier devises  P
9 Ventilation Management  
a. Bag valve mask  P
10 Orotracheal Intubation   
a. Apneic patients  P
b. Pulseless and apneic patients  P
11 Cricothyrotomy, needle  P
12 Dual Lumen Airway   
a. Apneic patients  P
b. Pulseless and apneic patients  P
13 Supraglottic Airways   
a. Apneic patients  P
b. Pulseless and apneic patients  P
14 Ventilator management - 16 y/o or older  P
15 End Tidal CO2 Monitoring & Detection  P
B Cardiac Management  AEMT
1 Automated External Defibrillator(AED)  P
2 Cardiac monitor strip interpretation  P
3 Manual defibrillation  P
4 Cardiopulmonary Resuscitation (CPR)  P
5 Transcutaneous Cardiac pacing  P
6 Aspirin administration  P
7 Cardiac medication administration    
  1. Pt assisted 
 P
  1. No Pt assist 
 P
8 Cardioversion  P
9 12-lead EKG performance & interpretation  P
10 12-lead EKG set up and application for electronic transmission*  P
11 Chest compression assist devices  P
Patient Assisted Definition:
  1. May assist with patient's prescription upon patient request and with written protocol.
    2. – OR –
  2. May assist from EMS provided medications with verbal medical direction.
C Medical Management  AEMT
1 Glucose monitoring system use P
2 Peripheral IV blood specimens   
3 Oral glucose administration  P
4 Auto-injector Epinephrine (Pt. Assisted)  P
5 Epinephrine administration (Subcutaneous)  P
6 Nitroglycerine administration (Pt. Assisted)  P
7 Nitroglycerine administration (Non pt. Assist)  P
8 Metered dose inhaler (Pt. Assisted)  P
9 Nebulized medications  P
10 Glucagon  P
11 Naloxone P
D Pre-hospital ALS Assistance  AEMT
1 Set up of IV administration kit & monitor patient with isotonic I.V Fluids flowing P
2 In the event of a declared mass casualty incident (MCI) as defined in the local MCI plan, the EMT-Basic may monitor patients who have isotonic intravenous fluids flowing  P
3 Cardiac monitor *  P
4 12 lead EKG application **  P
E Trauma Management  AEMT
1 Long spine board  P
2 Short spine board  P
3 Splinting devices  P
4 Traction splint  P
5 Cervical Immobilization Device (CID)  P
6 Helmet removal  P
7 Rapid extrication procedures  P
8 Needle decompression of the chest 
9 Soft tissue management  P
10  Management of suspected fractures  P
11 Tourniquet Application P
F Preparatory / Basic Performances  AEMT
1 Body Substance Isolation precaution/administration  P
2 Taking and recording of vital signs  P
3 Patient Care Report (PCR) documentation  P
4 Emergency childbirth management  P
5 Trauma triage determination in MCI P
G Other  AEMT
1 Medication administration (Protocol approved)  P
2 IV lifeline and fluid administration (does not include blood or blood products)  P
3 Intra osseous infusion  P
4 Saline lock initiation  P
H Additional services
In the event of an emergency declared by public's health, AEMT may perform immunizations and administer drugs or dangerous drugs, in relation to the emergency, provided the AEMT is under physician medical direction and has received appropriate training regarding the administration of such immunizations and/or drugs.
I Nerve Agent or Organophosphate Release
An AEMT may administer drugs or dangerous drugs contained within a nerve agent antidote auto-injector kit, including a MARK I kit, in response to suspected or known exposure to a nerve or organophosphate agent provided that this action is done under physician medical direction and has received appropriate training regarding the administration of such drugs within the nerve agent antidote auto-injector kit.
Paramedic (P):

Is an allied health professional whose primary focus is to provide advanced emergency medical care for critical and emergent patients who access the emergency medical system? This individual possesses the complex knowledge and skills necessary to provide patient care and transportation. Paramedics function as part of a comprehensive EMS response, under medical oversight. Paramedics perform interventions with the basic and advanced equipment typically found on an ambulance. The Paramedic is a link from the scene into the health care system.

Paramedic Scope of Practice Matrix
A Airway Management  P
1 Open and maintain the airway  P
2 Oropharyngeal airway adjunct  P
3 Nasopharyngeal airway adjunct  P
4 Obstructed airway management  P
5 Oral suctioning  P
6   Endotracheal Tube   
a.Trachial tube suctioning  P
b.Trachial tube replacement  P
7 Pulse oximeter equipment application/ P
8 Oxygen Administration  
a. Nasal cannula  P
b. Non-rebreather mask  P
c. Mouth-to-barrier devises  P
9 Ventilation Management  
a. Bag valve mask  P
10 Orotracheal Intubation   
a. Apneic patients  P
b. Pulseless and apneic patients  P
11 Cricothyrotomy, needle  P
12 Dual Lumen Airway   
a. Apneic patients  P
b. Pulseless and apneic patients  P
13 Supraglottic Airways   
a. Apneic patients  P
b. Pulseless and apneic patients  P
14 Ventilator management - 16 y/o or older  P
15 End Tidal CO2 Monitoring & Detection  P
B Cardiac Management P
1 Automated External Defibrillator(AED)  P
2 Cardiac monitor strip interpretation  P
3 Manual defibrillation  P
4 Cardiopulmonary Resuscitation (CPR)  P
5 Transcutaneous Cardiac pacing  P
6 Aspirin administration  P
7 Cardiac medication administration    
  1. Pt assisted 
 P
  1. No Pt assist 
 P
8 Cardioversion  P
9 12-lead EKG performance & interpretation  P
10 12-lead EKG set up and application for electronic transmission*  P
11 Chest compression assist devices  P
Patient Assisted Definition:
  1. May assist with patient's prescription upon patient request and with written protocol.
    2. – OR –
  2. May assist from EMS provided medications with verbal medical direction.
C Medical Management P
1 Glucose monitoring system use P
2 Peripheral IV blood specimens  P
3 Oral glucose administration  P
4 Auto-injector Epinephrine (Pt. Assisted)  P
5 Epinephrine administration (Subcutaneous)  P
6 Nitroglycerine administration (Pt. Assisted)  P
7 Nitroglycerine administration (Non pt. Assist)  P
8 Metered dose inhaler (Pt. Assisted)  P
9 Nebulized medications  P
10 Glucagon  P
11 Naloxone P
D Pre-hospital ALS Assistance P
1 Set up of IV administration kit & monitor patient with isotonic I.V Fluids flowing P
2 In the event of a declared mass casualty incident (MCI) as defined in the local MCI plan, the EMT-Basic may monitor patients who have isotonic intravenous fluids flowing  P
3 Cardiac monitor *  P
4 12 lead EKG application **  P
E Trauma Management P
1 Long spine board  P
2 Short spine board  P
3 Splinting devices  P
4 Traction splint  P
5 Cervical Immobilization Device (CID)  P
6 Helmet removal  P
7 Rapid extrication procedures  P
8 Needle decompression of the chest  P
9 Soft tissue management  P
10 Management of suspected fractures  P
11 Tourniquet Application P
F Preparatory / Basic Performances P
1 Body Substance Isolation precaution/administration  P
2 Taking and recording of vital signs  P
3 Patient Care Report (PCR) documentation  P
4 Emergency childbirth management  P
5 Trauma triage determination in MCI  
G Other  P
1 Medication administration (Protocol approved)  P
2 IV lifeline and fluid administration (does not include blood or blood products)  P
3 Intra osseous infusion  P
4 Saline lock initiation  P
H Additional services
In the event of an emergency declared as a public's health the Paramedic may perform immunizations and administer drugs or dangerous drugs, in relation to the emergency, provided this done under physician medical direction and has received appropriate training regarding the administration of such immunizations and/or drugs.
I Nerve Agent or Organophosphate Release
The Paramedic may administer drugs or dangerous drugs contained within a nerve agent antidote auto-injector kit, including a MARK I kit, in response to suspected or known exposure to a nerve or organophosphate agent provided this is administered under physician medical direction and has received appropriate training regarding the administration of such drugs within the nerve agent antidote auto-injector kit.
J Approved Paramedic and Advanced EMT Medications
Emergency Medical Service Health Care Providers General Scope of Practice Matrix

Health care Provider Title:

  • Emergency Medical Technician (EMT).
  • Advance Emergency Medical Technician (AEMT).
  • Paramedic (P).
# Note: Their Scope of Practice is based on their Standing Operative Procedures and Medical Protocol set by the EMS Medical Director (EMS Physician)
Scope of Practice Matrix
  Airway Management  EMT AEMT P
1 Open and maintain the airway  P P P
2 Oropharyngeal airway adjunct 

P

P

P
3 Nasopharyngeal airway adjunct 

P

P

P
4 Obstructed airway management  P P P
5 Oral suctioning 

P

P

P

6   Endotracheal Tube       
a.Trachial tube suctioning 

P

P

P

b.Trachial tube replacement     

P

7 Pulse oximeter equipment application/

P

P

P

8 Oxygen Administration      
a. Nasal cannula 

P

P

P

b. Non-rebreather mask 

P

P

P

c. Mouth-to-barrier devises 

P

P

P
9 Ventilation Management      
a. Bag valve mask 

P

P P
10 Orotracheal Intubation       
a. Apneic patients    P P
b. Pulseless and apneic patients    P P
11 Cricothyrotomy, needle    P P
12 Dual Lumen Airway       
a. Apneic patients     

P

b. Pulseless and apneic patients    P

P

13 Supraglottic Airways       
a. Apneic patients  P P

P

b. Pulseless and apneic patients  P P

P

14 Ventilator management - 16 y/o or older    P

P

15 End Tidal CO2 Monitoring & Detection      P

P

  Cardiac Management  EMT AEMT P
1 Automated External Defibrillator(AED) 

P

P

P

2 Cardiac monitor strip interpretation    P

P

3 Manual defibrillation    P

P

4 Cardiopulmonary Resuscitation (CPR) 

P

P

P

5 Transcutaneous Cardiac pacing    P

P

6 Aspirin administration  P P

P

7 Cardiac medication administration        
  1. Pt assisted 
 assist P

P

  1. No Pt assist 
   P

P

8 Cardioversion    P

P

9 12-lead EKG performance & interpretation    P

P

10 12-lead EKG set up and application for electronic transmission*  P P

P

11 Chest compression assist devices  P P

P

Patient Assisted Definition:
  1. May assist with patient's prescription upon patient request and with written protocol.
    2. – OR –
  2. May assist from EMS provided medications with verbal medical direction.
  Medical Management  EMT AEMT P
1 Glucose monitoring system use P P

P

2 Peripheral IV blood specimens     

P

3 Oral glucose administration 

P

P

P

4 Auto-injector Epinephrine (Pt. Assisted) 

P

P

P

5 Epinephrine administration (Subcutaneous)    P

P

6 Nitroglycerine administration (Pt. Assisted)  P P P
7 Nitroglycerine administration (Non pt. Assist)    P

P

8 Metered dose inhaler (Pt. Assisted)  P P

P

9 Nebulized medications    P

P

10 Glucagon    P

P

11 Naloxone P P

P

  Pre-hospital ALS Assistance  EMT AEMT P
1 Set up of IV administration kit & monitor patient with isotonic I.V Fluids flowing

P

P

P

2 In the event of a declared mass casualty incident (MCI) as defined in the local MCI plan, the EMT-Basic may monitor patients who have isotonic intravenous fluids flowing 

P

P

P

3 Cardiac monitor * 

P

P

P

4 12 lead EKG application ** 

P

P

P

* Set-up of equipment only a Paramedic and AEMT     must be present, or procedure(s) cannot be performed
** Set-up of equipment only. If a Paramedic OR AEMT is not present, procedure(s) shall not be performed except as previously noted in cardiac management section  
  Trauma Management  EMT AEMT P
1 Long spine board 

P

P

P

2 Short spine board 

P

P

P

3 Splinting devices 

P

P

P

4 Traction splint 

P

P

P

5 Cervical Immobilization Device (CID) 

P

P

P

6 Helmet removal 

P

P

P

7 Rapid extrication procedures 

P

P

P

8 Needle decompression of the chest    P P
9 Soft tissue management 

P

P

P

10 Management of suspected fractures 

 

P

P

11 Tourniquet Application

P

P

P

  Preparatory / Basic Performances  EMT AEMT P
1 Body Substance Isolation precaution/administration 

P

P

P

2 Taking and recording of vital signs 

P

P

P

3 Patient Care Report (PCR) documentation 

P

P

P

4 Emergency childbirth management 

P

P

P

5 Trauma triage determination in MCI

P

P

P

  Other  EMT AEMT P
1 Medication administration (Protocol approved)    P P
2 IV lifeline and fluid administration (does not include blood or blood products)    P

P

3 Intra osseous infusion    P

P

4 Saline lock initiation    P

P

   
In the event of an emergency declared by the governor that affects the public's health, EMT-basic or EMT-paramedic may perform immunizations and administer drugs or dangerous drugs, in relation to the emergency, provided the EMT is under physician medical direction and has received appropriate training regarding the administration of such immunizations and/or drugs.  
  Nerve Agent or Organophosphate Release
An Advanced EMT or Paramedic or Paramedic Nursing, may administer drugs or dangerous drugs contained within a nerve agent antidote auto-injector kit, including a MARK I kit, in response to suspected or known exposure to a nerve or organophosphate agent provided the first responder or EMT is under physician medical direction and has received appropriate training regarding the administration of such drugs within the nerve agent antidote auto-injector kit.
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