§ 1003.24. EMT-paramedic.

 (a)  Roles and responsibilities.

   (1)  An EMT-paramedic who has been granted medical command authorization under §  1003.28 (relating to medical command authorization), or an individual who is a student in an approved EMT-paramedic training program under the supervision of an approved preceptor, may provide in a prehospital, interhospital or in an emergency care setting in a facility, or during the transfer of convalescent or other nonemergency cases, BLS services which may be performed by an EMT as set forth in §  1003.23(a) and (e) (relating to EMT), as well as the ALS services in subsection (d) to prevent loss of life or aggravation of physiological or psychological illness or injury. This section does not prohibit an EMT-paramedic from providing EMS as a good Samaritan.

   (2)  An EMT-paramedic who does not have or chooses not to maintain medical command authorization under §  1003.28 may apply to the Department for certification as an EMT. The rules applicable to certification of an EMT-paramedic as an EMT are in §  1003.23(b)(2). An EMT-paramedic without medical command authorization who is certified as an EMT may provide only the BLS services within an EMT’s scope of practice as set forth in §  1003.23(a) and (e) until the EMT-paramedic has regained medical command authorization in accordance with §  1003.28. Following loss of medical command authorization, an EMT-paramedic may function as an EMT for the ALS ambulance service under which the EMT-paramedic has lost medical command authorization, for 30 days without securing EMT certification, if approval to do so is granted by the ALS service medical director for that ALS ambulance service.

 (b)  Certification.

   (1)  The Department will certify as an EMT-paramedic an individual who meets the following qualifications:

     (i)   Completes an application on a form prescribed by the Department.

     (ii)   Possesses current certification as an EMT.

     (iii)   Is 18 years of age or older.

     (iv)   Has successfully completed a training course for EMT-paramedics approved by the Department.

     (v)   Has successfully completed a practical examination of EMT-paramedic skills.

     (vi)   Has successfully completed a written examination for EMT-paramedics administered by the Department.

   (2)  An individual certified as an EMT-paramedic is permanently certified as an EMT-paramedic, subject to disciplinary action under section 11(j.1) of the act (35 P. S. §  6931(j.1)) and §  1003.27 (relating to disciplinary and corrective action).

   (3)  An EMT-paramedic shall register biennially with the Department on forms supplied by the Department prior to the biennial anniversary date of the EMT-paramedic’s certification and shall supply information requested by the Department on the registration form.

 (c)  Certification by endorsement.

   (1)  For an individual who is 18 years of age or older and who is currently certified in another state as an EMT-paramedic, the Department will endorse the following qualifications as equivalent to those in subsection (b).

     (i)   Certification as an EMT-paramedic in the other state instead of current certification as an EMT in this Commonwealth.

     (ii)   Successful completion of EMT-paramedic training curriculum that meets or exceeds the standards of the training course prescribed by the Department under subsection (b)(1)(iv).

     (iii)   Successful completion of a written examination for EMT-paramedic certification which is determined by the Department to meet or exceed the standards of the written examination prescribed by the Department under subsection (b)(1)(vi).

     (iv)   Successful completion of a practical skills examination for EMT-paramedic certification which is determined by the Department to meet or exceed the standards of the practical skills examination prescribed by the Department under subsection (b)(1)(v).

   (2)  An individual whose EMT-paramedic certification in another state is expired at the time of application may seek to have the satisfaction of paragraph (1)(ii) endorsed as equivalent to the satisfaction of subsection (b)(1)(iv), but will not be considered by the Department for endorsement of qualifications under paragraph (1)(i), (iii) or (iv), and shall successfully complete the EMT-paramedic practical skills and written examinations prescribed by the Department after making application for certification through examination.

 (d)  Scope of practice. An EMT-paramedic’s scope of practice includes the BLS services which may be performed by an EMT in §  1003.23(a) and (e) and the ALS services set forth in this subsection. An EMT-paramedic, with medical command authorization, following the order of a medical command physician, or use of Department approved transfer and medical treatment protocols as authorized by the ALS service medical director, may:

   (1)  Perform pulmonary ventilation by the use of oral, nasal, endotracheal or tracheostomy intubation.

   (2)  Insert, in peripheral veins, intravenous catheters, needles or other cannulae-IV lines.

   (3)  Obtain venous blood samples for analysis, but only for diagnostic and treatment purposes.

   (4)  Prepare and administer approved medication and solutions by intravenous, intramuscular, subcutaneous, intraosseous, oral, sublingual, topical, inhalation, rectal or endotracheal routes.

   (5)  Perform defibrillation and synchronized cardioversion.

   (6)  Perform gastric suction by nasogastric or orogastric intubation.

   (7)  Insert nasogastric or orogastric tubes.

   (8)  Visualize the airway by use of the laryngoscope and remove foreign bodies with forceps.

   (9)  Apply electrodes and monitor cardiac electrical activity including electrocardiograms.

   (10)  Perform Valsalva maneuvers.

   (11)  Use mechanical cardiopulmonary resuscitation devices.

   (12)  Assess and manage patients in accordance with the EMT-paramedic training curriculum approved by the Department.

   (13)  Perform thoracic decompression.

   (14)  Perform cricothyrotomy and pulmonary ventilation.

   (15)  Perform central venous and intraosseous cannulation.

   (16)  Perform external transcutaneous pacing.

   (17)  Perform urinary catheterization.

   (18)  Access central venous lines and subcutaneous indwelling catheters.

   (19)  Perform other ALS skills taught in a training course for EMT-paramedics approved by the Department, if the EMT-paramedic has received training to perform those services and is able to document having received the training, in one of the following:

     (i)   A training course for EMT-paramedics approved by the Department.

     (ii)   A course which is determined by the Department to meet or exceed the standards of a training course for EMT-paramedics preapproved by the Department.

     (iii)   A course for which the EMT-paramedic may receive continuing education credit towards qualifying for medical command authorization.

 (e)  Publication of approved skills.

   (1)  The Department will publish in the Pennsylvania Bulletin, at least annually, a list of the skills taught in the EMT-paramedic training course most recently approved by the Department.

   (2)  If the approved course is not offered by the Department, the Department may exclude, from the published list, skills taught which the Department determines are not appropriate skills to be performed by an EMT-paramedic. An EMT-paramedic may not perform a skill taught in a course under subsection (d)(19)(ii) or (iii) if the Department does not include the skill in the list it publishes under paragraph (1).

   The provisions of this §  1003.24 amended September 1, 1995, effective September 2, 1995, 25 Pa.B. 3685; amended October 13, 2000, effective October 14, 2000, 30 Pa.B. 5363. Immediately preceding text appears at serial pages (256622) to (256624).

   This section cited in 28 Pa. Code §  1003.23 (relating to EMT); 28 Pa. Code §  1003.25b (relating to prehospital registered nurse); and 28 Pa. Code §  1003.29 (relating to continuing education requirements).