Rule Caption: Changes to EMT-P scope of practice: Central IV access, medications and blood products, ECG monitoring.
Adm. Order No.: OMB 5-2011
Filed with Sec. of State: 4-8-2011
Certified to be Effective: 4-8-11
Notice Publication Date: 2-1-2009
Rules Amended: 847-035-0030
Subject: The proposed rule change allows EMT-Ps to access indwelling catheters and implanted central IV ports for fluid and medical administration; adds language that EMT-Ps may administer any medication or blood product after adequate and appropriate instruction, including risks, benefits and use of the medication; and allows EMT-Ps to initiate and interpret ECG monitoring.
(1) The Oregon Medical Board has established a scope of practice for emergency and nonemergency care for First Responders and EMTs. First Responders and EMTs may provide emergency and nonemergency care in the course of providing prehospital care as an incident of the operation of ambulance and as incidents of other public or private safety duties, but is not limited to “emergency care” as defined in OAR 847-035-0001(5).
(2) The scope of practice for First Responders and EMTs is not intended as statewide standing orders or protocols. The scope of practice is the maximum functions which may be assigned to a First Responder or EMT by a Board-approved supervising physician.
(3) Supervising physicians may not assign functions exceeding the scope of practice; however, they may limit the functions within the scope at their discretion.
(4) Standing orders for an individual EMT may be requested by the Board or Section and shall be furnished upon request.
(5) No EMT may function without assigned standing orders issued by Board-approved supervising physician.
(6) An Oregon-certified First Responder or EMT, acting through standing orders, shall respect the patient’s wishes including life-sustaining treatments. Physician supervised First Responders and EMTs shall request and honor life-sustaining treatment orders executed by a physician, nurse practitioner or physician assistant if available. A patient with life-sustaining treatment orders always requires respect, comfort and hygienic care.
(7) A First Responder may perform the following procedures without having signed standing orders from a supervising physician:
(a) Conduct primary and secondary patient examinations;
(b) Take and record vital signs;
(c) Utilize noninvasive diagnostic devices in accordance with manufacturer’s recommendation;
(d) Open and maintain an airway by positioning the patient’s head;
(e) Provide external cardiopulmonary resuscitation and obstructed airway care for infants, children, and adults;
(f) Provide care for soft tissue injuries;
(g) Provide care for suspected fractures;
(h) Assist with prehospital childbirth; and
(i) Complete a clear and accurate prehospital emergency care report form on all patient contacts and provide a copy of that report to the senior EMT with the transporting ambulance.
(8) A First Responder may perform the following additional procedures only when the First Responder is part of an agency which has a Board-approved supervising physician who has issued written standing orders to that First Responder authorizing the following:
(a) Administration of medical oxygen;
(b) Maintain an open airway through the use of:
(A) A nasopharyngeal airway device;
(B) A noncuffed oropharyngeal airway device;
(C) A Pharyngeal suctioning device.
(c) Operate a bag mask ventilation device with reservoir;
(d) Provision of care for suspected medical emergencies, including administering liquid oral glucose for hypoglycemia; and
(e) Administer epinephrine by automatic injection device for anaphylaxis;
(f) Perform cardiac defibrillation with an automatic or semi-automatic defibrillator, only when the First Responder:
(A) Has successfully completed a Section- approved course of instruction in the use of the automatic or semi-automatic defibrillator; and
(B) Complies with the periodic requalification requirements for automatic or semi-automatic defibrillator as established by the Section.
(9) An Oregon-certified EMT-Basic may perform the following procedures:
(a) Perform all procedures that an Oregon-certified First Responder can perform;
(b) Ventilate with a non-invasive positive pressure delivery device;
(c) Insert a cuffed pharyngeal airway device in the practice of airway maintenance. A cuffed pharyngeal airway device is:
(A) A single lumen airway device designed for blind insertion into the esophagus providing airway protection where the cuffed tube prevents gastric contents from entering the pharyngeal space; or
(B) A multi-lumen airway device designed to function either as the single lumen device when placed in the esophagus, or by insertion into the trachea where the distal cuff creates an endotracheal seal around the ventilatory tube preventing aspiration of gastric contents.
(d) Perform tracheobronchial tube suctioning on the endotracheal intubated patient;
(e) Provide external cardiopulmonary resuscitation and obstructed airway care for infants, children, and adults;
(f) Provide care for suspected shock, including the use of the pneumatic anti-shock garment;
(g) Provide care for suspected medical emergencies, including:
(A) Obtaining a capillary blood specimen for blood glucose monitoring;
(B) Administer epinephrine by subcutaneous injection or automatic injection device for anaphylaxis;
(C) Administer activated charcoal for poisonings; and
(D) Administer aspirin for suspected myocardial infarction.
(h) Perform cardiac defibrillation with an automatic or semi-automatic defibrillator;
(i) Transport stable patients with saline locks, heparin locks, foley catheters, or in-dwelling vascular devices;
(j) Perform other emergency tasks as requested if under the direct visual supervision of a physician and then only under the order of that physician;
(k) Complete a clear and accurate prehospital emergency care report form on all patient contacts;
(l) Assist a patient with administration of sublingual nitroglycerine tablets or spray and with metered dose inhalers that have been previously prescribed by that patient’s personal physician and that are in the possession of the patient at the time the EMT-Basic is summoned to assist that patient;
(m) In the event of a release of military chemical warfare agents from the Umatilla Army Depot, the EMT-Basic who is a member or employee of an EMS agency serving the DOD-designated Immediate Response Zone who has completed a Section-approved training program may administer atropine sulfate and pralidoxime chloride from a Section-approved pre-loaded auto-injector device, and perform endotracheal intubation, using protocols promulgated by the Section and adopted by the supervising physician. 100% of EMT-Basic actions taken pursuant to this section shall be reported to the Section via a copy of the prehospital emergency care report and shall be reviewed for appropriateness by Section staff and the Subcommittee on EMT Certification, Education and Discipline;
(n) In the event of a release of organophosphate agents the EMT-Basic, who has completed Section-approved training, may administer atropine sulfate and pralidoxime chloride by autoinjector, using protocols approved by the Section and adopted by the supervising physician; and
(o) In the event of a declared Mass Casualty Incident (MCI) as defined in the local Mass Casualty Incident plan, the EMT-Basic may monitor patients who have isotonic intravenous fluids flowing.
(10) An Oregon certified Advanced Emergency Medical Technician (AEMT) may perform the following procedures:
(a) Perform all procedures that an Oregon-certified EMT-Basic can perform;
(b) Initiate and maintain peripheral intravenous (I.V.) lines;
(c) Initiate saline or similar locks;
(d) Draw peripheral blood specimens;
(e) Initiate and maintain an intraosseous in the pediatric patient;
(f) Tracheobronchial suctioning of an already intubated patient;
(g) Adminster the following medications under specific written protocols authorized by the supervising physician or direct orders from a licensed physician:
(A) Physiologic isotonic crystalloid solution.
(B) Anaphylaxis; epinephrine
(C) Antidotes: Naloxene hydrochloride;
(i) Hypertonic glucose,
(E) Vasodilators: Nitroglycerine;
(F) Nebulized bronchodilators:
(ii) Ipratropium bromide;
(G) Analgesics for acute pain: nitrous oxide.
(11) An Oregon certified EMT-Intermediate may perform the following procedures:
(a) Perform all procedures that an Oregon-certified Advanced EMTcan perform;
(b) Initiate and maintain an intraosseous infusion;
(c) Administer the following medications under specific written protocols authorized by the supervising physician, or direct orders from a licensed physician:
(i) Atropine sulfate;
(C) Analgesics for acute pain:
(ii) Nalbuphine Hydrochloride;
(iii) Ketorolac tromethamine;
(D) Antihistamine: Diphenhydramine;
(E) Diuretic: Furosemide;
(F) Intraosseous infusion anesthetic; Lidocaine;
(G) Anti-Emetic: Ondansetron;
(d) Administer immunizations in the event of an outbreak or epidemic as declared by the Governor of the state of Oregon, the State Public Health Officer or a county health officer, as part of an emergency immunization program, under the agency’s supervising physician’s standing order;
(e) Administer immunizations for seasonal and pandemic influenza vaccinations according to the CDC Advisory Committee on Immunization Practices (ACIP), and/or the Oregon State Public Health Officer’s recommended immunization guidelines as directed by the agency’s supervising physician’s standing order.
(f) Distribute medications at the direction of the Oregon State Public Health Officer as a component of a mass distribution effort.
(g) Administer routine or emergency immunizations, as part of an EMS Agency’s occupational health program, to the EMT’s EMS agency personnel, under the supervising physician’s standing order.
(h) Insert an orogastric tube;
(i) Maintain during transport any intravenous medication infusions or other procedures which were initiated in a medical facility, and if clear and understandable written and verbal instructions for such maintenance have been provided by the physician, nurse practitioner or physician assistant at the sending medical facility;
(j) Electrocardiographic rhythm interpretation;
(k) Perform cardiac defibrillation with a manual defibrillator.
(l) Access indwelling catheters and implanted central IV ports for fluid and medication administration.
(12) An Oregon-certified EMT-Paramedic may perform the following procedures:
(a) Perform all procedures that an Oregon-certified EMT-Intermediate can perform;
(b) Initiate the following airway management techniques:
(A) Endotracheal intubation;
(B) Cricothyrotomy; and
(C) Transtracheal jet insufflation which may be used when no other mechanism is available for establishing an airway.
(c) Initiate a nasogastric tube;
(d) Provide advanced life support in the resuscitation of patients in cardiac arrest;
(e) Perform emergency cardioversion in the compromised patient;
(f) Attempt external transcutaneous pacing of bradycardia that is causing hemodynamic compromise;
(g) Electrocardiographic interpretation.
(h) Initiate needle thoracentesis for tension pneumothorax in a prehospital setting;
(i) Initiate placement of a femoral intravenous line when a peripheral line cannot be placed;
(j) Initiate placement of a urinary catheter for trauma patients in a prehospital setting who have received diuretics and where the transport time is greater than thirty minutes; and
(k) Initiate or administer any medications or blood products under specific written protocols authorized by the supervising physician, or direct orders from a licensed physician.
(13) The Board has delegated to the Section the following responsibilities for ensuring that these rules are adhered to:
(a) Designing the supervising physician and agent application;
(b) Approving a supervising physician or agent; and
(c) Investigating and disciplining any EMT or First Responder who violates their scope of practice.
(d) The Section shall provide copies of any supervising physician or agent applications and any EMT or First Responder disciplinary action reports to the Board upon their request.
(14) The Section shall immediately notify the Board when questions arise regarding the qualifications or responsibilities of the supervising physician or agent of the supervising physician.
Stat. Auth.: ORS 682.245
Stats. Implemented: ORS 682.245
Hist.: ME 2-1983, f. & ef. 7-21-83; ME 3-1984, f. & ef. 1-20-84; ME 12-1984, f. & ef. 8-2-84; ME 7-1985, f. & ef. 8-5-85; ME 12-1987, f. & ef. 4-28-87; ME 27-1987(Temp), f. & ef. 11-5-87; ME 5-1988, f. & cert. ef. 1-29-88; ME 12-1988, f. & cert. ef. 8-5-88; ME 15-1988, f. & cert. ef. 10-20-88; ME 2-1989, f. & cert. ef. 1-25-89; ME 15-1989, f. & cert. ef. 9-5-89, & corrected 9-22-89; ME 6-1991, f. & cert. ef. 7-24-91; ME 10-1993, f. & cert. ef. 7-27-93; ME 3-1995, f. & cert. ef. 2-1-95; ME 1-1996, f. & cert. ef. 2-15-96; ME 3-1996, f. & cert. ef. 7-25-96; BME 6-1998, f. & cert. ef. 4-27-98; BME 13-1998(Temp), f. & cert. ef. 8-6-98 thru 2-2-99; BME 14-1998, f. & cert. ef. 10-26-98; BME 16-1998, f. & cert. ef. 11-24-98; BME 13-1999, f. & cert. ef. 7-23-99; BME 14-2000, f. & cert. ef. 10-30-00; BME 11-2001, f. & cert. ef. 10-30-01; BME 9-2002, f. & cert. ef. 7-17-02; BME 10-2002, f. & cert. ef. 7-22-02; BME 1-2003, f. & cert. ef. 1-27-03; BME 12-2003, f. & cert. ef. 7-15-03; BME 4-2004, f. & cert. ef. 1-27-04; BME 11-2004(Temp), f. & cert. ef. 4-22-04 thru 10-15-04; BME 12-2004(Temp), f. & cert. ef. 6-11-04 thru 12-8-04; BME 21-2004(Temp), f. & cert. ef. 11-15-04 thru 4-15-05; BME 2-2005, f. & cert. ef. 1-27-05; BME 5-2005, f. & cert. ef. 4-21-05; BME 9-2005, f. & cert. ef. 7-20-05; BME 18-2006, f. & cert. ef. 7-25-06; BME 22-2006, f. & cert. ef. 10-23-06; BME 7-2007, f. & cert. ef. 1-24-07; BME 11-2007, f. & cert. ef. 4-26-07; BME 24-2007, f. & cert. ef. 10-24-07; BME 11-2008, f. & cert. ef. 4-24-08; BME 19-2008, f. & cert. ef. 7-21-08; BME 10-2009, f. & cert. ef. 5-1-09; BME 13-2009, f. & cert. ef. 7-20-09; BME 18-2009, f. & cert. ef. 10-23-09; BME 22-2009(Temp), f. & cert. ef. 10-23-09 thru 4-15-10; BME 5-2010, f. & cert. ef. 1-26-10; BME 8-2010(Temp), f. & cert. ef. 4-26-10 thru 10-15-10; BME 12-2010, f. & cert. ef. 7-26-10; BME 18-2010, f. & cert. ef. 10-25-10; OMB 1-2011, f. & cert. ef. 2-11-11; OMB 5-2011, f. & cert. ef. 4-8-11
Notes 1.) This online version of the OREGON BULLETIN is provided for convenience of reference and enhanced access. The official, record copy of this publication is contained in the original Administrative Orders and Rulemaking Notices filed with the Secretary of State, Archives Division. Discrepancies, if any, are satisfied in favor of the original versions. Use the OAR Revision Cumulative Index found in the Oregon Bulletin to access a numerical list of rulemaking actions after November 15, 2010.