(c) A paramedic student or a licensed
paramedic, as part of an organized EMS system, while caring for patients in a
hospital as part of his/her training or continuing education (CE) under the
direct supervision of a physician, registered nurse, or physician assistant, or
while at the scene of a medical emergency or during transport, or during
interfacility transfer, or while working in a small and rural hospital pursuant
to Section 1797.195 of the Health and Safety Code, may perform the following
procedures or administer the following medications when such are approved by
the medical director of the LEMSA and are included in the written policies and
procedures of the LEMSA.
(1) Basic Scope of
Practice:
(A) Utilize electrocardiographic
devices and monitor electrocardiograms, including 12-lead electrocardiograms
(ECG).
(B) Perform defibrillation,
synchronized cardioversion, and external cardiac pacing.
(C) Visualize the airway by use of the
laryngoscope and remove foreign body(ies) with Magill forceps.
(D) Perform pulmonary ventilation by use of
lower airway multi-lumen adjuncts, the esophageal airway, perilaryngeal
airways, stomal intubation, and adult oral endotracheal intubation.
(E) Utilize mechanical ventilation devices
for continuous positive airway pressure (CPAP)/bi-level positive airway
pressure (BPAP) and positive end expiratory pressure (PEEP) in the
spontaneously breathing patient.
(F) Institute intravenous (IV) catheters,
saline locks, needles, or other cannulae (IV lines), in peripheral veins and
monitor and administer medications through pre-existing vascular
access.
(G) Institute intraosseous
(IO) needles or catheters.
(H)
Administer IV or IO glucose solutions or isotonic balanced salt solutions,
including Ringer's lactate solution.
(I) Obtain venous blood samples.
(J) Use laboratory devices, including point
of care testing, for pre-hospital screening use to measure lab values
including, but not limited to: glucose, capnometry, capnography, and carbon
monoxide when appropriate authorization is obtained from State and Federal
agencies, including from the Centers for Medicare and Medicaid Services
pursuant to the Clinical Laboratory Improvement Amendments (CLIA).
(K) Utilize Valsalva maneuver.
(L) Perform percutaneous needle
cricothyroidotomy.
(M) Perform
needle thoracostomy.
(N) Perform
nasogastric and orogastric tube insertion and suction.
(O) Monitor thoracostomy tubes.
(P) Monitor and adjust IV solutions
containing potassium, equal to or less than 40 mEq/L.
(Q) Administer approved medications by the
following routes: IV, IO, intramuscular, subcutaneous, inhalation,
transcutaneous, rectal, sublingual, endotracheal, intranasal, oral or
topical.
(R) Administer, using
prepackaged products when available, the following medications:
1. 10%, 25% and 50% dextrose;
2. activated charcoal;
3. adenosine;
4. aerosolized or nebulized beta-2 specific
bronchodilators;
5.
amiodarone;
6. aspirin;
7. atropine sulfate;
8. pralidoxime chloride;
9. calcium chloride;
10. diazepam;
11. diphenhydramine hydrochloride;
12. dopamine hydrochloride;
13. epinephrine;
14. fentanyl;
15. glucagon;
16. ipratropium bromide;
17. lorazepam;
18. midazolam;
19. lidocaine hydrochloride;
20. magnesium sulfate;
21. morphine sulfate;
22. naloxone hydrochloride;
23. nitroglycerine preparations, except IV,
unless permitted under (c)(2)(A) of this section;
24. ondansetron;
25. sodium bicarbonate;
26. tranexamic acid;
27. ketamine;
28. ketorolac;
29. acetaminophen IV.
(S) In addition to the approved paramedic
scope of practice, the CCP or FP may perform the following procedures and
administer medications, as part of the basic scope of practice for
interfacility transports, when approved by the LEMSA medical director.
1. set up and maintain thoracic drainage
systems;
2. set up and maintain
mechanical ventilators;
3. set up
and maintain IV fluid delivery pumps and devices;
4. blood and blood products;
5. glycoprotein IIB/IIIA
inhibitors;
6. heparin
IV;
7. nitroglycerin IV;
8. norepinephrine;
9. thrombolytic agents;
10. maintain total parenteral
nutrition;
(2) Local Optional Scope of Practice:
(A) Perform or monitor other procedure(s) or
administer any other medication(s) determined to be appropriate for paramedic
use by the medical director of the LEMSA, that have been approved by the
Director of the Authority. Paramedics shall demonstrate competency in
performing these procedures and administering these medications through
training and successful testing.
(B) The medical director of the LEMSA shall
submit a written request, Form #EMSA-0391, revised 01/17, incorporated herein
by reference, to the Director of the Authority for approval of any procedures
or medications proposed for use in accordance with Section 1797.172(b) of the
Health and Safety Code prior to implementation.
(C) The Authority shall, within fourteen (14)
days of receiving Form #EMSA-0391, revised 01/17, notify the medical director
of the LEMSA that the form has been received and shall specify what
information, if any, is missing.
(D) The Director of the Authority, in
consultation with the Emergency Medical Services Medical Directors Association
of California's (EMDAC) Scope of Practice Committee, shall approve or
disapprove the request for additional procedures and/or administration of
medications and notify the LEMSA medical director of the decision within ninety
(90) days of receipt of the completed request. An approved status shall be in
effect for a period of three (3) years. An approved status may be renewed for
another three (3) year period, upon the authority's receipt of a written
request that includes, but is not limited to, the following information: the
utilization of the procedure(s) or medication(s), beneficial effects, adverse
reactions or complications, statistical evaluation, and general
conclusion.
(E) The Director of the
Authority, in consultation with the EMDAC Scope of Practice Committee, may
suspend or revoke approval of any previously approved additional procedure(s)
or medication(s) for cause.
