Expanded Scope of Practice
Adding Additional Medications or Procedures for EMTs
Statutes and regulations permit a Physician Medical Director for an EMS organization to add to the scope of practice for an EMT-I, EMT-II, and/or EMT-III. This page has been designed to assist the physician in following these procedures.
The Section continues to receive applications for approval of additional medications and procedures. Many of these requests for approval are incomplete and must be returned to the physician medical director for additional information. The most common deficiencies are:
- inadequate behavioral objectives (typically quality and quantity), and
- lack of detailed training plan that includes an overview of the training schedule and number of hours for the modules within the training program.
Downloads to assist the Physician Medical Director in developing requests for Additional Medications or Procedures are included below. NOTE: Presence on this list is NOT an endorsement of adding a procedure to a specific EMS level.
Application form:
Sample Learning Objectives:
- test blood glucose with glucometer [ CLIA Application for certification ]
- transcutaneous pacing
- synchronized cardioversion
- pelvic fracture stabilization
- insert a gastric tube in a pediatric patient
- additional medications
Sample Training Schedule:
There are several non-invasive procedures that have become the "standard of care." These do NOT require the completion of the procedures required in 7 AAC 26.670. These are:
Procedure/Medication |
EMS
Level |
Pulse Oximetry Aspirin |
EMT-I |
End-tidal CO2 detectors
Glucometry |
EMT-II |
Obtaining
12-lead EKGs |
EMT-III |
Applicable Regulations and Statues:
- 7 AAC 26.040: Scope of Certified Activities
- 7 AAC 26.670: Approval of Additional Medications and Procedures
- 7 AAC 26.999: Definitions (ALS/BLS)
- AS 18.080.200. Definitions (ALS)
7 AAC 26.040. SCOPE OF CERTIFIED ACTIVITIES. (a) A state-certified EMT-I may perform basic life support as defined in 7 AAC 26.999, may use an automated external defibrillator if properly trained as defined in AS 09.65.090 (f), and, under the direct or indirect supervision of a physician, may
(1) practice approved airway management techniques;
(2) repealed 8/16/2002 ; and
(3) use a manual defibrillator if certified as a manual defibrillator technician under 7 AAC 26.510 - 7 AAC 26.590.
(b) A state-certified EMT-II may perform the skills of an EMT-I and, under the direct or indirect supervision of a physician, may
(1) practice approved airway management techniques;
(2) start peripheral intravenous (I.V.) treatment;
(3) obtain blood for laboratory analysis;
(4) administer five-percent dextrose in water, crystalloid volume-replacement solutions, 50 percent dextrose in water, and naloxone hydrochloride (Narcan);
(5) repealed 8/16/2002 ; and
(6) use a manual defibrillator if certified as a manual defibrillator technician under 7 AAC 26.510 - 7 AAC 26.590.
(c) A state-certified EMT-III may, under the direct or indirect supervision of a physician, perform the skills of an EMT-II and may apply electrodes and monitor cardiac activity, countershock ventricular fibrillation and pulseless ventricular tachycardia, administer lidocaine, administer atropine, administer morphine, and administer epinephrine 1:1,000 and 1:10,000.
(d) An EMT-I, EMT-II, or EMT-III may use those additional medications or procedures that have been approved by the department and are on file with the department under 7 AAC 26.670.
(e) An EMT-II or EMT-III who is not under the supervision of a medical director may only perform those procedures defined as basic life support in 7 AAC 26.999.
(f) Repealed 8/16/2002 . (History: Eff. 12/31/81 , Register 80; am 10/14/84 , Register 92; am 10/23/92 , Register 124; am 5/22/96 , Register 138; am 7/4/99 , Register 151; am 8/16/2002 , Register 163)
Authority: AS 09.65.090 AS 18.08.080 AS 18.08.082 AS 18.08.084
Editor's note: Copies of the curricula related to the use of the automated external defibrillator used by the American Heart Association or American Red Cross may be obtained, for a fee, from those organizations.
7 AAC 26.670. APPROVAL OF ADDITIONAL MEDICATIONS AND PROCEDURES. (a) In order for a medical director to authorize a state-certified EMT-I, EMT-II, or EMT-III to use additional medications or procedures not covered under 7 AAC 26.040(a) , (b), or (c), the medical director shall
(1) submit to the department a request for approval; the request must include a plan for training and evaluation covering the additional skills; and
(2) if the request is approved, following the training and evaluation, send the department a list of individuals who are authorized to use the additional medications or procedures.
(b) The department will maintain a list of the approved additional medications or procedures for an authorized EMT-I, EMT-II, or EMT-III. (History: Eff. 10/23/92 , Register 124; am 5/22/96 , Register 138)
Authority: AS 18.08.080 AS 18.08.082 AS 18.08.084
7 AAC 26.999. DEFINITIONS. In this chapter,
(3) "advanced life support" has the meaning given in AS 18.08.090 (renumbered as AS 18.08.200);
(9) "basic life support" means those emergency care skills outlined in the goals and objectives of the department's Emergency Medical Technician-I Course Objectives, adopted by reference in 7 AAC 26.050(b) (2), including administration of oxygen, of the patient's prescribed nitroglycerin, bronchodilator inhaler, or epinephrine autoinjector, and of over-the-counter medicines, such as activated charcoal, that are necessary to carry out the objectives outlined in the course; "basic life support" does not include manual defibrillation;
Authority: AS 18.08.010 AS 18.08.080 AS 18.08.082 AS 18.08.084
AS 18.080.200. DEFINITIONS. In this chapter
(1)
"advanced life support" means emergency care techniques provided under
the written or oral orders of a physician that include manual electric
cardiac defibrillation, administration of antiarrhythmic agents, intravenous
therapy, intramuscular therapy, or use of endotracheal intubation devices;