View source for Scope of Practice

== Section 1 - ADMINISTRATIVE POLICIES ==
===1.20 SCOPE OF PRACTICE===

{| class="wikitable"
|-
!  !! Preparation Routine Management Skills !! EMT  !! Paramedic
|-
| 1 || Body Substance Isolation Precautions/Application ||  X ||  X
|-
| 2 ||  Initial/Primary and Secondary Assessments ||  X ||  X
|-
| 3 ||  Obtaining and Recording of Vital Signs  || X ||  X
|-
| 4 ||  Patient Care Report (PCR) Documentation ||  X ||  X
|-
| 5 ||  Obtaining and Documenting Informed Refusals ||  X ||  X
|-
| 6 ||  Initiation of CPR/Determination of Death ||  X ||  X
|-
| 7 ||  Initiation of Trauma Triage Evaluation ||  X ||  X
|-
| 8 ||  IV lifeline and Fluid Administration ||  ||  X
|-
| 9  || Intranasal Mucosal Atomization Device (MAD) Administration ||  ||  X
|-
| 10 ||  Intraosseous Infusion and Medication Administration  ||  || X
|-
| 11 ||  Intramuscular Medication Administration ||  ||  X
|-
| 12 ||  Subcutaneous Medication Administration ||  ||  X
|-
| 13 ||  Saline Lock Initiation ||  X ||  X
|-
| 14 ||  Discontinuing/Removing an Intravenous Line ||  X ||  X
|-
| 15 ||  Reconstitution of Medications for Administration ||  ||  X
|-
| 16 ||  IV Infusion Pump Initiation/Management  ||  ||  X
|-
| 17 ||  Monitor Medicated IV Drips  ||  ||  X
|-
| 18 ||  Buretrol Application and Management  ||  ||  X
|-
| 19  || Blood Alcohol Draw (for LEA) on Scene  ||  ||  X
|-
| 20 ||  Peripheral Venipuncture, Vacutainer Blood Sample Draw ||  X ||  X
|}


{| class="wikitable"
|-
! !! Airway Management Skills !! EMT !! Paramedic
|-
| 1 ||  Open and Maintain the Airway  ||  X ||  X
|-
| 1a ||  Head Tilt-Chin Lift  ||  X ||  X
|-
| 1b ||  Jaw Thrust  ||  X ||  X
|-
| 2  || Obstructed Airway Management  ||  X ||  X
|-
| 3 ||  Oropharyngeal Airway Adjunct Placement and Management  ||  X ||  X
|-
| 4 ||  Nasopharyngeal Airway Adjunct Placement and Management  ||  X ||  X
|-
| 5 ||  Oral Suctioning  ||  X ||  X
|-
| 6 ||  Endotracheal Suctioning  ||  ||  X
|-
| 6a ||  Tracheostomy Tube Suctioning  ||  ||  X
|-
| 6b ||  Tracheostomy Tube Replacement  ||  ||  X
|-
| 7  || Pulse Oximetry Equipment Application/Reading  ||  X ||  X
|-
| 8  || Oxygen Administration  ||  X ||  X
|-
| 8a ||  Nasal Cannula  ||  X ||  X
|-
| 8b ||  Simple Face Mask  ||  X ||  X
|-
| 8c ||  Non-Rebreather Mask  ||  X ||  X
|-
| 9 ||  Mouth-to-Barrier Devices  ||  X ||  X
|-
| 10 ||  Bag Valve Mask Device Application and Management  ||  X ||  X
|-
| 11 ||  Ventilation Management  ||  X ||  X
|-
| 12 ||  Ventilation with a Flow-Restricted O2 Powered Device (Auto-  ||  ||  X
|-
| 13 ||  Orotracheal Intubation  ||  ||  X
|-
| 14 ||  Nasotracheal Intubation  ||  ||  X
|-
| 15 ||  Cricothyrotomy (Needle or Surgical)  ||  ||  X
|-
| 16  || Supraglottic Airway (King LTS-D Tube)  ||  ||  X
|-
| 17  || Ventilator Management - 16 y/o or older  ||  ||  X
|-
| 18 ||  CPAP Administration and Management ||  ||  X
|-
| 19 ||  End Tidal CO2 Monitoring & Detection  ||  X ||  X
|-
| 20  || Dynamic Carbon Monoxide Level Monitoring and Management  ||  ||  X
|-
| 21 ||  Nasogastric (NG) Tube Placement  ||  ||  XX
|}


{| class="wikitable"
|-
! !! Cardiac Management Skills !! EMT !! Paramedic
|-
| 1 || Automated External Defibrillator (AED)  ||  X ||  X
|-
| 2 ||  Cardiac Monitor Setup  ||  X ||  X
|-
| 3 ||  Cardiac Monitor Rhythm Interpretation X
|-
| 4 ||  Cardiopulmonary Resuscitation (CPR)  ||  X ||  X
|-
| 5 ||  Impedance Threshold Device ResQ-Pod Initiation/Management  ||  X ||  X
|-
| 6 ||  Transcutaneous Cardiac pacing  ||  ||  X
|-
| 7 ||  Aspirin Administration  ||  X ||  X
|-
| 8 ||  Cardiac Medication Administration X
|-
| 9 ||  Cardioversion  ||  ||  X
|-
| 10 ||  12-lead EKG Setup  ||  X ||  X
|-
| 11 ||  12-Lead Interpretation  ||  ||  X
|-
| 12 ||  Chest compression Assist Devices (Auto-Pulse)  ||  X ||  X
|-
| 13 ||  Dynamic Capnography Monitoring  ||  ||  X
|}


{| class="wikitable"
|-
! !! Medical Management Skills !! EMT !! Paramedic
|-
| 1  || Glucose Monitoring System Use  ||  X ||  X
|-
| 2  || Peripheral IV Blood Specimens  ||  ||  X
|-
| 3  || Oral Glucose Administration  ||  X ||  X
|-
| 4 ||  Auto-Injector Epinephrine (Pt. Assisted)  ||  X ||  X
|-
| 5 ||  Epinephrine Administration (Subcutaneous)  ||  ||  X
|-
| 6 ||  Nitroglycerine Administration (Pt. Assisted)  ||  X ||  X
|-
| 7  || Nitroglycerine Administration (Non pt. Assist)  ||  ||  X
|-
| 8 ||  Metered dose Inhaler (Pt. Assisted)  ||  X ||  X
|-
| 9 ||  Nebulized Medications  ||  ||  X
|-
| 10 ||  Set up of IV Administration Kit  ||  X ||  X
|-
| 11 ||  Automated Non-invasive Blood Pressure Monitoring  ||  X ||  X
|}


====Patient Assisted Definition:====
*May assist with patient's prescription upon patient request and with written protocol.
*May assist from EMS provided medications with verbal medical direction
 

{| class="wikitable"
|-
! !! Trauma Management Skills !! EMT !!Paramedic
|-
| 1 ||  Selective Spinal Immobilization  ||  X ||  X
|-
| 2 ||  Spinal Cervical Immobilization  ||  X ||  X
|-
| 3 ||  Application of Cervical Collar  ||  X ||  X
|-
| 4 ||  Cervical Immobilization Device (CID) Application  ||  X ||  X
|-
| 5 ||  Long Spine Board  ||  X ||  X
|-
| 6  || Short Device Board (KED)  ||  X ||  X
|-
| 7 ||  Splinting Devices  ||  X ||  X
|-
| 8 ||  Traction Splint  ||  X ||  X
|-
| 9 ||  Reeves Stretcher  ||  X ||  X
|-
| 10  || Pediatric Immobilizer  ||  X ||  X
|-
| 11  || Helmet Removal  ||  X ||  X
|-
| 12 ||  Rapid Extrication Procedures  ||  X ||  X
|-
| 13 ||  Needle Decompression of the Chest (Pleural Decompression)  ||  ||  X
|-
| 14 ||  Burn Wounds Management  ||  X ||  X
|-
| 15 ||  Soft Tissue Injury Management  ||  X ||  X
|-
| 16 ||  Bleeding Control Including Tourniquets  ||  X ||  X
|-
| 17 ||  Management of Suspected Fractures  ||  X ||  X
|-
| 18 ||  Emergency Childbirth Management  ||  X ||  X
|-
| 19 ||  Removal of TASER Probes  ||  X ||  X
|-
| 20 ||  Emergency C-Section  ||  ||  X
|}


{| class="wikitable"
|-
! !! Approved Medications !! EMT !! Paramedic
|-
| 1 ||  Adenosine (Adenocard)  ||  ||  X
|-
| 2 ||  Albuterol (Proventil)  ||  ||  X
|-
| 3 ||  Aspirin (Chewable)  ||  X ||  X
|-
| 4 ||  Atropine Sulfate  ||  ||  X
|-
| 5 ||  Calcium Chloride  ||  ||  X
|-
| 6 ||  Cimetidine (Tagamet) ||  ||  X
|-
| 7 ||  Dextrose 50%  ||  ||  X
|-
| 8 ||  Diazepam (Valium)  ||  ||  X
|-
| 9  || Diltiazem (Cardizem)  ||  ||  X
|-
| 10 ||  Diphenhydramine (Benadryl)  ||  ||  X
|-
| 11 ||  Dopamine (Intropin)   ||  ||  X
|-
| 12 ||  Epinephrine   ||  ||  X
|-
| 13 ||  Epinephrine (Patient’s own Auto injector)  ||  X ||  X
|-
| 14 ||  Flumazenil (Romazicon)   ||  ||  X
|-
| 15 ||  Furosemide (Lasix)   ||  ||  X
|-
| 16 ||  Glucagon   ||  ||  X
|-
| 17 ||  Glucose (Oral)  ||  X ||  X
|-
| 18  || Ketolorac (Toradol)   ||  ||  X
|-
| 19 ||  Levalbuterol HCL (Xopenex)   ||  ||  X
|-
| 20 ||  Lidocaine HCL   ||  ||  X
|-
| 21  || Magnesium Sulfate   ||  ||  X
|-
| 22  || Methylprednisolone (Solu-medrol)   ||  ||  X
|-
| 23 ||  Midazolam (Versed)   ||  ||  X
|-
| 24 ||  Morphine Sulfate   ||  ||  X
|-
| 25 ||  Naloxone (Narcan)   ||  ||  X
|-
| 26 ||  Nitroglycerin Sublingual  ||  X ||  X
|-
| 27 ||  Nitroglycerine Drip   ||  ||  X
|-
| 28 ||  Nitrous Oxide   ||  ||  X
|-
| 29 ||  Ondansetron Hydrochloride (Zofran)   ||  ||  X
|-
| 30 ||  Oxygen  ||  X ||  X
|-
| 31 ||  Pontocaine Ophthalmic   ||  ||  X
|-
| 32  || Promethazine (Phenergan)   ||  ||  X
|-
| 33  || Sodium Bicarbonate   ||  ||  X
|-
| 34 ||  Vaponefrine (Racemic Epinephrine)   ||  ||  X
|-
| 35 ||  Vasopressin   ||  ||  X
|}


==== Additional Skills/Procedures as Authorized by the Medical Director ====
* The Medical Director reserves the right to authorize personnel to use additional skills and abilities outside of this Scope of Practice for which they have been trained for during special events, local or regional disasters or other situations where it is in the best interest of the welfare of the public and/or the need to mitigate a natural or man-made disaster.
* The Medical Director also authorizes the EMT to administer oral or sublingual medications to patients under the direct supervision of a Seminole County Paramedic.


====Additional services====
* 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 first responder or 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====
* A first responder, EMT-basic, or EMT-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 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.