Scope of Practice for Each State - Discussion

Any one have information on the scope of practice in Indiana?
 
The PDF for Paramedics in California has some incorrect information that hasn't been corrected, at least as far as Sacramento County goes... Midazolam is authorized and carried. ASA is also authorized and carried. They also now carry the Combitube and the King Tube (Supraglottic Airway)... neither are on the list. The meds were on that list before 2000 and they authorized the Combitube around 2002. The King Tube was authorized this year. Sacramento County also now authorizes Intra Nasal admin of meds. Sacramento County also authorizes O2 powered ATV's, and has for quite some time. I would hope that eventually, they'll allow vents that can use more modes than what amounts to A/C.
 
Akulahawk said:
Sacramento County also authorizes O2 powered ATV's, and has for quite some time. I would hope that eventually, they'll allow vents that can use more modes than what amounts to A/C.
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The ATV is essentially for ventilating the barely living dead. Before a Paramedic in CA can advance to a more sophisticated ventilator, they must first expand their medication protocols (and education) to where they can manage a ventilator patient. I can not imagine transporting an ICU ventilator patient and not have the ability to make them comfortable. That would be doing more harm than good.

They also now carry the Combitube and the King Tube (Supraglottic Airway)... neither are on the list. The meds were on that list before 2000 and they authorized the Combitube around 2002. The King Tube was authorized this year.
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I have noticed some EMS agencies in CA (and FL) are using supraglottic devices more than ETI.
 
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VentMedic said:
The ATV is essentially for ventilating the barely living dead. Before a Paramedic in CA can advance to a more sophisticated ventilator, they must first expand their medication protocols (and education) to where they can manage a ventilator patient. I can not imagine transporting an ICU ventilator patient and not have the ability to make them comfortable. That would be doing more harm than good.

I have noticed some EMS agencies in CA (and FL) are using supraglottic devices more than ETI.
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I couldn't agree more, actually. Of course, once you start expanding a Paramedic's educational & skill level, you start encroaching on the "turf" of other providers... like RN's, PA's, and RRT's. ;)

[sarcasm]Heaven forbid that a Paramedic be capable of managing ICU patients during transports between facilities without requiring an RN to ride along... but that means so much more education... We just can't have Paramedics getting Degrees...:rolleyes:

[/sarcasm]

Can you tell that you just led right into a pet peeve of mine? Paramedics can do more, but they also need the education to do it... as well as the formal recognition of the training/education they've already received.

On a side note: the supraglottic devices that we're authorized for up here won't allow for you to intubate through it. Once it's placed, if you want to/need to intubate the patient, you have to pull the supraglottic device.
 
Akulahawk said:
I couldn't agree more, actually. Of course, once you start expanding a Paramedic's educational & skill level, you start encroaching on the "turf" of other providers... like RN's, PA's, and RRT's. ;)

[sarcasm]Heaven forbid that a Paramedic be capable of managing ICU patients during transports between facilities without requiring an RN to ride along... but that means so much more education... We just can't have Paramedics getting Degrees...:rolleyes:

[/sarcasm]
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Again, what's with using others as an excuse for not being able to do something? Paramedics in other states have had advanced scopes of practice for many years...like 40. They also transport ICU patients. I was transporting IABP patients as a Paramedic 25 years ago in Florida. California has just developed its only little frozen in time state that hasn't allowed for advancement. Perhaps EMS in CA should look at improving the prehospital emergency side of things before trying to move on to critical care.

RNs, PAs and RRTs do not stop YOU from getting a degree as a Paramedic. Degrees for the Paramedic are offered at most community colleges in CA. But, one has to be motivated to provide the best possible care for their patients and not just do the minimum. If you want a nursing example, RNs are only required to have a 2 year degree but many choose to do a 4 year degree. The same for RRTs. PAs could probably do a shorter route but most get their Masters degree.

Do YOU not see a patient care issue with just giving a Paramedic a sophisticated ventilator without the ability to titrate or even use most of the meds required to keep a patient comfortable? I thought you had agreed about the meds.

On a side note: the supraglottic devices that we're authorized for up here won't allow for you to intubate through it. Once it's placed, if you want to/need to intubate the patient, you have to pull the supraglottic device.
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Not many standard EMS agencies are going to buy LMAs that facilitate intubation.
 
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VentMedic said:
Again, what's with using others as an excuse for not being able to do something? Paramedics in other states have had advanced scopes of practice for many years...like 40. They also transport ICU patients. I was transporting IABP patients as a Paramedic 25 years ago in Florida. California has just developed its only little frozen in time state that hasn't allowed for advancement. Perhaps EMS in CA should look at improving the prehospital emergency side of things before trying to move on to critical care.

RNs, PAs and RRTs do not stop YOU from getting a degree as a Paramedic. Degrees for the Paramedic are offered at most community colleges in CA. But, one has to be motivated to provide the best possible care for their patients and not just do the minimum. If you want a nursing example, RNs are only required to have a 2 year degree but many choose to do a 4 year degree. The same for RRTs. PAs could probably do a shorter route but most get their Masters degree.

Do YOU not see a patient care issue with just giving a Paramedic a sophisticated ventilator without the ability to titrate or even use most of the meds required to keep a patient comfortable? I thought you had agreed about the meds.



Not many standard EMS agencies are going to buy LMAs that facilitate intubation.
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Hard to "get" the sarcasm, especially in the written medium. California does have a restrictive scope of practice compared to most of the rest of the country. If you understood how EMS developed in this state, then perhaps you would understand why Paramedics don't have the expanded scope of practice that is enjoyed in other states. Paramedics weren't licensed here until the mid-90's and each local EMS agency still accredits Paramedics for practice in "their" system.

The State to the North (Oregon) has a much wider scope than here... they've streamlined their EMT-P levels greatly. At one time, they had 6 different levels of Paramedic. Now they've got only ONE that I can find. However, they require a degree and LOTS of education. I am in total agreement with that. Looking at their educational requirements, I met all of their educational requirements either through my Bachelor's Program (non-EMS) or via separate EMT-P education/training.

I believe that a well educated Paramedic should be able to handle most, if not all, the stuff that CCT-RN's do. I believe that a Paramedic should be able to handle a sophisticated Vent and use the appropriate meds to keep patients comfortable and appropriately ventilated. Simply turning a Paramedic loose on a ventilated patient without appropriate training and clinical experience, would be a negligent act, IMHO. Same with any other procedure or medication that could be administered in the field OR during interfacility transports.

I am not providing an excuse for ME to go do something. I *want* to be able to provide FAR better care than I'm restricted to... and I'm going to be stuck here in this state for a while. That has nothing to do with why California Paramedics are restricted in what they can do.

As far as agencies & companies purchasing intubating LMA's, I agree... they're going to generally be too expensive for widespread use.
 
Akulahawk said:
The State to the North (Oregon) has a much wider scope than here... they've streamlined their EMT-P levels greatly. At one time, they had 6 different levels of Paramedic. Now they've got only ONE that I can find. However, they require a degree and LOTS of education. I am in total agreement with that. Looking at their educational requirements, I met all of their educational requirements either through my Bachelor's Program (non-EMS) or via separate EMT-P education/training.
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Actually, Oregon at one point had 4 levels of EMT (technically it may have been 5 since I think there was some type of First Responder level) that was changed to 3 when things were restructured.
EMT 1: current EMT-Basic minus asa, subq/IM epi, and assisted ntg/albuterol.
EMT 2: 1+IV's.
EMT 3: Damn near a paramedic minus some of the school, a few meds and certain procedures (pericardialcentesis, intracardiac epi, femoral lines and a couple other things that I can't remember now) It's unfortunately what the "new and improved" EMT-Intermediate level has now become...biggest load of bull:censored::censored::censored::censored: I've seen in a long time.
EMT 4: Today's paramedic minus the degree and with a couple procedures we generally don't do (pericardialcentesis, intracardiac epi).

Never had 6 levels, and definitely not at the paramedic level.

Cheers.

Edit: and there are now disposable intubating LMA's out. While they still probably aren't as cheap as an ET tube, they are definetly not as exspensive as the reuseable type.

Double edit: If you meet the requirements for the degree, ever consider moving? Even if you are short a couple of classes it is possible to get a provisional cert while you finish up, though there's several hoops to jump through.
 
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triemal04 said:
Actually, Oregon at one point had 4 levels of EMT (technically it may have been 5 since I think there was some type of First Responder level) that was changed to 3 when things were restructured.
EMT 1: current EMT-Basic minus asa, subq/IM epi, and assisted ntg/albuterol.
EMT 2: 1+IV's.
EMT 3: Damn near a paramedic minus some of the school, a few meds and certain procedures (pericardialcentesis, intracardiac epi, femoral lines and a couple other things that I can't remember now) It's unfortunately what the "new and improved" EMT-Intermediate level has now become...biggest load of bull:censored::censored::censored::censored: I've seen in a long time.
EMT 4: Today's paramedic minus the degree and with a couple procedures we generally don't do (pericardialcentesis, intracardiac epi).

Never had 6 levels, and definitely not at the paramedic level.

Cheers.

Edit: and there are now disposable intubating LMA's out. While they still probably aren't as cheap as an ET tube, they are definetly not as exspensive as the reuseable type.

Double edit: If you meet the requirements for the degree, ever consider moving? Even if you are short a couple of classes it is possible to get a provisional cert while you finish up, though there's several hoops to jump through.
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Question for ya? How long ago did they change over to what you're describing (4 level?) because I distinctly recall there being 3 levels of Paramedic - basically what you're describing as the Level 2-4. I also distinctly recall that was the streamlined version from what came before it... which was something like 6 levels of Paramedic... and each one was different. This was from something like about 10-15 years ago, if I recall correctly, perhaps longer.

Oh, and for why I can't move... got too many ties down here right now. I'd probably be much happier in Oregon (for Paramedic Scope, and other reasons...) but suffice to say, I'm stuck here for a few more years, barring something really strange happening.
 
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Akulahawk said:
Question for ya? How long ago did they change over to what you're describing (4 level?) because I distinctly recall there being 3 levels of Paramedic - basically what you're describing as the Level 2-4. I also distinctly recall that was the streamlined version from what came before it... which was something like 6 levels of Paramedic... and each one was different. This was from something like about 10-15 years ago, if I recall correctly, perhaps longer.

Oh, and for why I can't move... got too many ties down here right now. I'd probably be much happier in Oregon (for Paramedic Scope, and other reasons...) but suffice to say, I'm stuck here for a few more years, barring something really strange happening.
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Currently there are 3 levels of EMT; Basic, Intermediate and Paramedic. The 1-4 was what it used to be before. I think (but don't quote me on this one) that it changed to the current system a bit before the degree became mandatory, so say mid 90's. You might be thinking of the old EMT-3 and EMT-4 that I mentioned; there wasn't a lot of difference between the two except that the EMT-4 could also call themselves a paramedic.
 
Quoted from Texas Department of State Health Services website:

Texas does not have a rigid scope of practice for EMS personnel defined in rule or law as some other states do. That’s because Texas Medical Board rules allow physician-medical directors to delegate medical tasks to EMS personnel as long as they’ve trained and/or verified and documented the training, in the context of the Texas Medical Board language of 22 Texas Administrative Code, Section 197.1. Medical personnel with specific training and competencies may be able to perform skills outside the bounds of traditional practice if their medical director evaluates, provides additional training, authorizes them accordingly and develops protocols to match. For the purpose of this explanation, traditional practice may be defined as the knowledge and competencies described in the DOT National Standard Curriculum at each EMS training level.
 
New Mexico

All information on New Mexico scope of practice can be found at www.nmems.org.
 
North Carolina

SOP can be found here:
http://www.ncems.org/pdf/NCCEPStandardsSkillsImplementation2009.pdf

Complete list of protocols can be found here:
http://www.ncems.org/pdf/NCCEPStandardsProcedures2009.pdf


Exact protocols are written by the medical director of each system, and can vary by county, but for the most part they stick to the state guidelines. NC intermediates and paramedics have a slightly expanded scope past NREMT-P I have heard, and basics are not permitted to intubate, although they are taught the procedure in accordance with NREMT standards.
 
Virginia

I didn't see Virginia's posted, so here it is.

www . vdh . virginia . gov/OEMS/Training/Transition . htm

Bear with me, I can't post links yet. Just take out the spaces around the periods.

Click on Scope/Procedures & Scope/Formulary.
 
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