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National Ems Scope of Practice Model 2019 NATIONAL EMS SCOPE OF PRACTICE MODEL 2019 The National Highway Traffic Safety Administration Education Credentialing Certification Licensure NHTSA III.NA110NAL -•w•• TRAPPIC u,n, ••-•nunoN DISCLAIMER This publication is distributed by the U.S. Department of Transportation, National Highway Traffic Safety Administration, in the interest of information exchange. The opinions, findings, and conclusions expressed in this publication are those of the authors and not necessarily those of the Department of Transportation or the National Highway Traffic Safety Administration. The United States Government assumes no liability for its contents or use thereof. If trade or manufacturers’ names or products are mentioned, it is because they are considered essential to the object of the publications and should not be construed as an endorsement. The United States Government does not endorse products or manufacturers. Suggested APA Format Citation: National Association of State EMS Officials. National EMS Scope of Practice Model 2019 (Report No. DOT HS 812-666). Washington, DC: National Highway Traffic Safety Administration. The National EMS Scope of Practice Model February 2019 Technical Report Documentation Page 1. Report No. 2. Government Accession No. 3. Recipient’s Catalog No. DOT HS 812 666 4. Title and Subtitle 5. Report Date National EMS Scope of Practice Model 2019 February 2019 6. Performing Organization Code 7. Author(s) 8. Performing Organization Report No. National Association of State EMS Officials DOT-VNTSC-NHTSA-812-666 9. Performing Organization Name and Address 10. Work Unit No. (TRAIS) National Association of State EMS Officials 201 Park Washington Court 11. Contract or Grant No. Falls Church, VA 22046-4527 12. Sponsoring Agency Name and Address 13. Type of Report and Period Covered National Highway Traffic Safety Administration Final Report Office of Emergency Medical Services 1200 New Jersey Avenue SE. 14. Sponsoring Agency Code Washington, DC 20590 15. Supplementary Notes 16. Abstract The National EMS Scope of Practice Model (Practice Model) supports a system of Emergency Medical Services personnel licensure—permission granted to an individual by the State to perform certain restricted activities—and is a guide for States in developing their Scope of Practice legislation, rules, and regulation. The Practice Model is a consensus document, guided by data and expert opinion that reflects the skills representing the minimum competencies of the levels of EMS personnel. The Practice Model has been utilized by States as a means to increase uniformity in EMS for over a decade. 17. Key Words 18. Distribution Statement Document is available to the public from the National Technical Information Service, www.ntis.gov 19 Security Classif. (of this report) 20. Security Classif. (of this page) 21 No. of Pages 22. Price Unclassified Unclassified Form DOT F 1700.7 (8-72) Reproduction of completed page autHorized 3 The National EMS Scope of Practice Model February 2019 Table of Contents Table of Contents ........................................................................................................... 4 ! Executive Summary ....................................................................................................... 6 ! I. Background ................................................................................................................. 8 ! Overview of the EMS Profession .............................................................................................................. 8 ! The Evolution of the EMS Agenda for the Future .................................................................................... 9 ! Implementation of the 2007 National EMS Scope of Practice Model .................................................... 10 ! Approach to Revising the National EMS Scope of Practice Model ........................................................ 12 ! The Role of State Government ................................................................................................................ 13 ! II. Understanding Professional Scope of Practice .................................................... 14 ! Overview ................................................................................................................................................. 14 ! The Interdependent Relationship Between Education, Certification, Licensure, and Credentialing ...... 15 ! Scope of Practice versus Standard of Care .............................................................................................. 20 ! A Comprehensive Approach to Safe and Effective Out-of-Hospital Care ............................................. 20 ! III. Special Considerations .......................................................................................... 21 ! Liability in EMS Licensing and Oversight .............................................................................................. 21 ! Scope of Practice for Special Populations ............................................................................................... 21 ! Scope of Practice During Disasters, Public Health Emergencies, and Extraordinary Circumstances .... 22 ! Scope of Practice for EMS Personnel Functioning in Nontraditional Roles .......................................... 22 ! Specialty Care Delivered by Licensed EMS Personnel .......................................................................... 22 ! Military-to-Civilian EMS Transition ....................................................................................................... 23 ! IV. Description of Levels ............................................................................................. 25 ! Emergency Medical Responder ............................................................................................................... 25 ! Emergency Medical Technician .............................................................................................................. 26 ! Advanced Emergency Medical Technician ............................................................................................. 27 ! Paramedic ................................................................................................................................................ 28 ! V. Depth and Breadth of Knowledge .......................................................................... 31 ! VI. Interpretive Guidelines ........................................................................................... 32 ! I. Skill – Airway/Ventilation/Oxygenation ............................................................................................. 32 ! II. Skill – Cardiovascular/Circulation ..................................................................................................... 33 ! III. Skill – Splinting, Spinal Motion Restriction, and Patient Restraint .................................................. 34 ! IV. Skill – Medication Administration – Routes ..................................................................................... 35 ! V. Medical Director Approved Medications ........................................................................................... 36 ! VI. Skill – IV Initiation/Maintenance Fluids ........................................................................................... 37 ! VII. Skill – Miscellaneous ....................................................................................................................... 37 ! VII. Definitions .............................................................................................................. 38 ! Appendix I. History of Occupational Regulation in EMS ......................................... 41 ! Appendix II. Changes and Considerations from the 2007 Practice Model ............. 45 ! Nomenclature .......................................................................................................................................... 45 ! Table of Contents 4 The National EMS Scope of Practice Model February 2019 Academic Degree Requirements for Paramedics .................................................................................... 46 ! Attendant Qualifications for Ambulance Transport ................................................................................ 46 ! Portable Technologies ............................................................................................................................. 47 ! Deletions/Updates ................................................................................................................................... 47 ! Additions to the Interpretive Guidelines ................................................................................................. 48 ! Appendix III. Legal Differences Between Certification and Licensure ................... 50 ! Appendix IV. Acknowledgements .............................................................................. 52 ! Subject Matter Expert Panel .................................................................................................................... 52 ! Contributors ............................................................................................................................................. 54 ! Technical Writers .................................................................................................................................... 54 ! Project Manager .....................................................................................................................................
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