California EMSA online newsletter: New Paramedic category, bigger scopes of practice

[mycrofft]

http://www.emsa.ca.gov/newsletter/2013/06-June/June-13.asp#EMTandParamedicRegulationChanges
AND I QUOTE


"The EMT regulations involved amendments to the basic scope of practice and training standards. Additions to the basic scope of practice include:

Pulse oximetry;
Humidifiers;
Partial non-rebreathers & venturi masks;
Continuous positive airway pressure;
Tourniquets and hemostatic dressings;
OTC Medications with LEMSA approval;
Aspirin"

Paramedics, something for you also:

"The Paramedic regulations underwent significant revisions to the basic and local optional scope of practice, and created a new level of EMS provider: the Critical Care Paramedic.

Additions to the basic scope of practice include:

Utilization and monitoring of electrocardiographic devices;
External cardiac pacing;
Use of perilaryngeal airways;
CPAP (Continuous positive airway pressure)/BPAP (Bi-level positive airway pressure)/PEEP (Positive end-expiratory pressure);
Use of intraosseous (IO) needles and catheters;
Use of laboratory devices, including prehospital point of care testing, including glucose, capnometry, capnography, and carbon monoxide when appropriate authorization is obtained from State and Federal agencies;
Performance of nasogastric and orogastric tube insertion and suction;
Additional medications: amiodarone, fentanyl, ipratropium bromide, lorazepam, magnesium sulfate, ondansetron
The following two items were removed from the basic scope and placed into the local optional scope:

Pediatric intubation;
Furosemide."

etcetera, etcetera, etcetera..​

 

[Aprz]

I find pulse oximetry, CPAP, OTC medications, and ASA interesting for EMTs. Doesn't seem like much has changed for paramedics although BiPAP looks interesting, but sounds like it's exclusive to critical care paramedics (CCP).

The big question is are the countys' medical directors gonna include some of these things?

 

[DesertMedic66]

I find pulse oximetry, CPAP, OTC medications, and ASA interesting for EMTs. Doesn't seem like much has changed for paramedics although BiPAP looks interesting, but sounds like it's exclusive to critical care paramedics (CCP).

The big question is are the countys' medical directors gonna include some of these things?

For my county probably not.

 

[CodeBru1984]

I find pulse oximetry, CPAP, OTC medications, and ASA interesting for EMTs. Doesn't seem like much has changed for paramedics although BiPAP looks interesting, but sounds like it's exclusive to critical care paramedics (CCP).

The big question is are the countys' medical directors gonna include some of these things?

I suppose I'll find out in July when San Diego County adopts their new protocols.

 

[Masenko]

Are these not usually included in the emt scope? In my EMT class the last couple of chapters we just covered included material on pulse oximetry, CPAP, BPAP, and Capnometry among other things on that list. Are these additions just subjects all EMS providers must know, but don't particularly get to practice regularly?

 

[Akulahawk]

Those are things that California EMT Basics didn't have in their scope of practice. "BPAP" is not for EMT use. All those changes could potentially be useless because local EMSA's can still pick and choose what basic scope stuff they'll approve for their system. I'd be OK with each system being able to pick and choose from the "local optional scope" list, but they shouldn't be able to pick and choose from the state basic scope.

 

[JPINFV]

The big question is are the countys' medical directors gonna include some of these things?

Up until today I'd say that I would say that it was a sure bet that Orange County wouldn't allow any of it, but considering that I came across their proposal to start licensing private ambulance companies for 911 paramedic response, I'm not too sure anymore.

 

[Amberlamps916]

Up until today I'd say that I would say that it was a sure bet that Orange County wouldn't allow any of it, but considering that I came across their proposal to start licensing private ambulance companies for 911 paramedic response, I'm not too sure anymore.

I think it would take years to get off the ground in OC.

 

[JPINFV]

I think it would take years to get off the ground in OC.

It's a start, and that'll do.

 

[Rialaigh]

So just to clarify since I have never really looked at California's scope of practice

Currently Paramedics cannot check a BGL ? (it makes it sound like that from "[B"Use of laboratory devices, including prehospital point of care testing, including glucose[/B],")

Also you guys cannot give Zofran?

 

[Wes]

Every time I read about California's scope of practice, I am thankful to live in a delegated practice state (Texas) where there is no scope of practice and our service's medical director makes such decisions.

 

[JPINFV]

So just to clarify since I have never really looked at California's scope of practice

Currently Paramedics cannot check a BGL ? (it makes it sound like that from "[B"Use of laboratory devices, including prehospital point of care testing, including glucose[/B],")

Also you guys cannot give Zofran?

No, they can. However POC testing includes things like iStats.

 

[Flight-LP]

Interesting read!

A step forward for Cali, but still worlds behind other areas of the country. Hopefully the transition will lead to other improvements in the future.

 

[Monkey]

I don't get it... it says these are new for Ca, but in San Diego we've been doing that stuff for years.

We don't have a couple of the drugs listed that are national, but the rest are pretty much standard.

July we have a bunch of changes to BLS and ALS protocols, (hemostatic dressings) but I don't see how that list is "new" other than some of the BLS stuff. What am I missing?

 

[JPINFV]

I don't get it... it says these are new for Ca, but in San Diego we've been doing that stuff for years.

We don't have a couple of the drugs listed that are national, but the rest are pretty much standard.

July we have a bunch of changes to BLS and ALS protocols, (hemostatic dressings) but I don't see how that list is "new" other than some of the BLS stuff. What am I missing?

Based off of what was written here, it looks like some of the things are being moved from optional scope of practice sections to the main scope of practice. Also areas can get things added to the scope of practice to evaluate them.

 

[Amberlamps916]

It's a start, and that'll do.

I'm not knocking it, I'm all for it as well. I'm wondering what the backlash from OCFA is going to be like.

 

[JPINFV]

I'm wondering what the backlash from OCFA is going to be like.

[popcorn.gif]

 

[patzyboi]

Thought pulse oximetry and aspirin were already in the EMT scope of practice.

Not medication in CA though, but in other states.

 

[CodeBru1984]

Thought pulse oximetry and aspirin were already in the EMT scope of practice.

Not medication in CA though, but in other states.

In other states it probably is for basics, but not in all of California.

 

[DesertMedic66]

Thought pulse oximetry and aspirin were already in the EMT scope of practice.

Not medication in CA though, but in other states.

They are listed in the optional skills for CA EMTs. According to the document they will now be removed from the optional section and placed in EMT protocols.