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EMS Scope of Practice

National EMS Scope of Practice Model 2019 (NASEMSO) — the minimum authorized skills for each certification level

NASEMSO 2019 · DOT HS 813 151 · August 2021

EMR

31 authorized skills

First responder — basic life support

EMT

62 authorized skills

Primary EMS provider — basic + selected advanced

AEMT

78 authorized skills

Advanced — focused IV and medication skills

Paramedic

106 authorized skills

Full advanced life support

Airway/Ventilation/Oxygenation

32 skills
SkillEMREMTAEMTParamedic
Airway – nasal
Airway – oral
Airway – supraglottic
Airway obstruction – dislodgement by direct laryngoscopy
Airway obstruction – manual dislodgement techniques
Bag-valve-mask (BVM)
Chest decompression – needle
Chest tube – monitoring and management
Chest tube placement – assist only
CPAP
Cricothyrotomy
End tidal CO2 monitoring and interpretation of waveform capnography
Endotracheal intubation
Gastric decompression – NG Tube
Gastric decompression – OG Tube
Head tilt – chin lift
Jaw-thrust
Mouth-to-barrier
Mouth-to-mask
Mouth-to-mouth
Mouth-to-nose
Mouth-to-stoma
Oxygen therapy – High flow nasal cannula
Oxygen therapy – Humidifiers
Oxygen therapy – Nasal cannula
Oxygen therapy – Non-rebreather mask
Oxygen therapy – Partial rebreather mask
Oxygen therapy – Simple face mask
Oxygen therapy – Venturi mask
Pulse oximetry
Suctioning – Tracheobronchial of an intubated patient
Suctioning – Upper airway

Cardiovascular/Circulation

13 skills
SkillEMREMTAEMTParamedic
Cardiac monitoring – 12-lead ECG acquisition and transmission
Cardiac monitoring – 12-lead ECG interpretive
Cardiopulmonary resuscitation (CPR)
Cardioversion – electrical
Defibrillation – automated/semi-automated
Defibrillation – manual
Hemorrhage control – direct pressure
Hemorrhage control – tourniquet
Hemorrhage control – wound packing
Mechanical CPR device
Telemetric monitoring devices and transmission of clinical data including video data
Transcutaneous pacing
Transvenous cardiac pacing – monitoring and maintenance

Splinting/Spinal Motion Restriction/Patient Restraint

9 skills
SkillEMREMTAEMTParamedic
Cervical collar
Emergency moves for endangered patients
Extremity splinting
Extremity stabilization – manual
Long spine board
Manual cervical stabilization
Mechanical patient restraint
Seated spinal motion restriction (KED, etc.)
Splint – traction

Medication Administration Routes

17 skills
SkillEMREMTAEMTParamedic
Medication administration – Aerosolized/nebulized
Medication administration – Endotracheal tube
Medication administration – Inhaled
Medication administration – Intradermal
Medication administration – Intramuscular
Medication administration – Intramuscular auto-injector
Medication administration – Intranasal
Medication administration – Intranasal unit-dosed premeasured
Medication administration – Intraosseous peds or adult
Medication administration – Intravenous
Medication administration – Mucosal/sublingual
Medication administration – Nasogastric
Medication administration – Oral
Medication administration – Rectal
Medication administration – Subcutaneous
Medication administration – Topical
Medication administration – Transdermal

Medical Director Approved Medications

18 skills
SkillEMREMTAEMTParamedic
Auto-injector antidotes for chemical/hazardous material exposures
Epinephrine auto-injector for anaphylaxis (agency supplied)
Immunizations
Immunizations during a public health emergency
Inhaled – monitor patient administered (nitrous oxide)
Inhaled beta agonist/bronchodilator and anticholinergic for dyspnea and wheezing
Intranasal opioid antagonist for suspected opioid overdose
Intravenous medications
Maintain infusion of blood or blood products
Opioid antagonist auto-injector for suspected opioid overdose
Oral aspirin for chest pain of suspected ischemic origin
Oral glucose for suspected hypoglycemia
Oral over-the-counter analgesics for pain or fever
OTC medications oral and topical
Parenteral analgesia for pain
Sublingual nitroglycerin for chest pain – patient's own prescription only
Sublingual nitroglycerin for chest pain of suspected ischemic origin
Thrombolytics

IV Initiation/Maintenance Fluids

7 skills
SkillEMREMTAEMTParamedic
Access indwelling catheters and implanted central IV ports
Central line – monitoring
Intraosseous – initiation peds or adult
Intravenous – maintenance of medicated IV fluids
Intravenous – maintenance of non-medicated IV fluids
Intravenous access
Intravenous initiation – peripheral

Miscellaneous

11 skills
SkillEMREMTAEMTParamedic
Assisted complicated delivery (childbirth)
Assisted delivery (childbirth)
Blood chemistry analysis
Blood glucose monitoring
Blood pressure – automated
Blood pressure – manual
Eye irrigation
Eye irrigation – hands free irrigation using sterile eye irrigation device
Patient transport
Specimen collection via nasal swab
Venous blood sampling

Note: This represents the NATIONAL FLOOR. Individual states may authorize additional skills beyond this model. State-specific deviations will be added in a future update.