NORTH COAST EMERGENCY MEDICAL SERVICES                                                      Policy #5402

POLICIES AND PROCEDURES

Subject:            Medical Control

                         Paramedic Scope of Practice

I.          Authority and Reference

            A.        Division 2.5, Health and Safety Code.

            B.         California Code of Regulations, Title 22.

            C.        North Coast Emergency Medical Services Policies and Procedures.

II.         Purpose

            To define the regional paramedic scope of practice.

III.       Procedure

While at the scene of an emergency, and during transport of the sick and injured, or as a part of their training or continuing education, a paramedic or a paramedic student may, in accordance with North Coast EMS policies and procedures and California State law, do the following:

            A.        Perform any skill identified in the EMT-I or EMT-II scope of practice.

            B.         Administer the following medications:

1.         Activated charcoal.

2.         Adenosine (Adenocard).

3.         Albuterol Sulfate (Proventil, Ventolin).

4.         Aspirin

5.         Atropine Sulfate.

6.         Bretylium Tosylate (Bretylol).

7.         Calcium Chloride.

8.         Dextrose 25% and 50%.

9.         Diazepam (Valium).

10.       Diphenhydramine hydrochloride (Benadryl).

11.       Dopamine hydrochloride (Intropin).

12.       Epinephrine.

13.       Furosemide (Lasix).

14.       Glucagon.

15.       KCl < 40 meq/l.

16.       Lidocaine hydrochloride.

17.       Magnesium sulfate.

18.       Metaproterenol sulfate (Alupent).

19.       Morphine sulfate.

20.       Naloxone hydrochloride (Narcan).

21.       Neosynephrine topical application during nasotracheal intubation.

22.       Oral Nitroglycerine preparations.

23.       Oxytocin (Pitocin).

24.       Procainamide.

25.       Sodium Bicarbonate.

26.       Syrup of Ipecac.

C.  Perform the following procedures:

1.         Adult and pediatric endotracheal (ET) intubation and use of Magill forceps.

2.         Adult and pediatric nasotracheal (NT) intubation.

3.   Use of esophageal obturator airway (EOA) or esophageal gastric tube airway (EGTA).

4.         Needle cricothyrotomy.

5.         Defibrillation.

6.         Synchronized cardioversion of conscious or unconscious patients.

7.         Carotid sinus massage/Valsalva maneuver.

8.   Insertion of intravenous (IV) catheters, saline locks, needles, or other cannulae in peripheral veins (including eternal jugular vein).

9.   Monitor and administer medications through pre-existing central or peripheral vascular access device.

10.       Intraosseous infusion (IO).

11. Administration of IV Glucose or isotonic balanced salt solutions.

12.       Obtain venous blood samples for laboratory analysis.

13.       Determination of blood glucose level via glucose test strip.

14. Administration of medications via IV, intramuscular (IM), subcutaneous (SQ), posterior venous plexis (PVP), endotracheal (ET), nasotracheal (NT), and intraosseous (IO) routes.

15.       Aerosol therapy with small volume nebulizer.

16.       Rectal administration of Diazepam.

17.       Monitoring Potassium chloride (KCl).

18. Use of non-invasive diagnostic monitoring devices (e.g., pulse oximetry, end tidal CO₂ detector).

19.       Adult and pediatric nasogastric/orogastric tube insertion and suction.

20. Needle thoracostomy.

21.       Monitoring thoracostomy tubes.

22.       Use of pneumatic antishock trousers (MAST/PASG).

23.       Use of snakebite kit and constricting bands.