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National EMS Scope of Practice

Background
Overview of the EMS Profession.
The Practice Model provides a resource for defining the practice of EMS personnel. EMS clinicians are atypical health care professionals in that they provide medical care in many environments, locations, and situations. Much of this care occurs in out-of-hospital settings with little onsite supervision. Physician medical directors provide medical oversight to ensure and maintain safe EMS practices.

This is occasionally performed in-person by medical directors in the field or through electronic communications, but more commonly is accomplished through protocol development and quality improvement based on evidence-based treatment standards and resources such as this Practice Model. EMS personnel are not independent clinicians, but are expected to execute many treatment modalities based on their assessments and protocols in challenging situations. They must be able to exercise considerable judgment, problem-solving, and decision-making skills.

EMS is a local function and organized several ways. These include agencies that are volunteer, career, or a combination; agencies that are operated by government, health care system, or private entities; and agencies that are stand-alone fire-based or law enforcement-based EMS. Common models are municipal government (fire-based or third-service) or a contracted service with a private (profit or nonprofit) entity. Levels of licensure exist for EMS personnel, each offering different scopes of practice. EMS personnel provide medical care to those with emergent, urgent, and in some cases chronic medical needs. EMS is a component of the overall health care system, and delivers care as part of a system intended to reduce the morbidity and mortality associated with illness and injury. EMS care is enhanced through the linking with other community health resources and integration within the health care system.


In the vast majority of communities, residents call for EMS by dialing 9-1-1 when they need emergency medical care, and the appropriate resources are dispatched. EMS personnel respond and provide care to the patient in the setting in which the patient became ill or injured, including the home, field, recreational, work, and industrial settings. Many of these are in high-risk situations such as on highways and freeways, in violent scenarios, and other unusual or atypical settings.


Many EMS personnel provide medical transportation services for patients requiring medical care while enroute to or between medical facilities, in both ground and air ambulance entities. These transport situations may originate from emergency scenes, or may be scheduled transports moving patients from one licensed facility to another.

The complexity of care delivered by EMS personnel can range from very basic skills to exceptionally complex monitoring and interventions for very high-acuity patients. Medical care at mass gatherings such as concerts or sporting events and high-risk activities like fireground1 operations or law enforcement tactical operations are a growing expectation of EMS personnel. EMS personnel sometimes serve in emergency response or primary care roles combined with occupational settings in remote areas (off-shore oil rigs and wildland fires, etc.).

EMS personnel also work in more traditional health care settings in hospitals, urgent care centers,doctor’s offices, and long-term care facilities. Finally, EMS personnel are involved in numerous community and public health initiatives, such as working with health care systems to provide non-emergent care and follow-up to certain patient populations as well as providing immunizations, illness and injury prevention programs, and other health initiatives.

BACKGROUND: At the request of the National Highway Traffic Safety Administration’s (NHTSA’s)
Office of Emergency Medical Services (OEMS) a subject matter expert panel (the panel) considered the
following questions to facilitate urgent changes to the 2019 National EMS Scope of Practice Model
(Model) to add specimen collection via nasal swabbing to the Emergency Medical Responder (EMR),
Emergency Medical Technician (EMT), Advanced Emergency Medical Technician (AEMT), and
Paramedic level scopes of practice:

  1. Is there evidence that the procedure or skill is beneficial to public health?
  2. What is the clinical evidence that the new skill or medication as used by EMS practitioners will promote access to quality healthcare or improve patient outcomes?
  3. Should the new skill or administration be specific to a public health emergency versus common daily practice?


METHODS: NHTSA convened the panel over the course of three meetings to review and discuss the
available evidence.
DISCUSSION: The panel considered the ability of EMRs, EMTs, AEMTs, and Paramedics to perform
the psychomotor skill of specimen collection via nasal swab and recommended that specimen collection
via nasal swab be added only to the EMT, AEMT, and Paramedic scopes of practice as part of their
common daily practice.


EMTs shall only undertake the practice if they possess the necessary educational preparation, experience
and knowledge to properly conduct specimen collection via nasal swab.

National EMS Scope of Practice Model 2019: Including Change Notices 1.0 and 2.0

The National EMS Scope of Practice Model (model) was first published in February 2007 by the National Highway Traffic Safety Administration’s (NHTSA’s) Office of Emergency Medical Services (EMS). The most recent version of the model was published by NHTSA in February 2019.

Special photo credited: Nurudin, RN, EMT - EMS Instructor

The model was developed by the National Association of State EMS Officials (NASEMSO) with funding provided by NHTSA and the Health Resources and Services Administration (HRSA). Over the past 14 years, the model has provided guidance for States in developing their EMS Scope of Practice legislation, rules, and regulation. While the model provides national guidance, each State maintains the authority to regulate EMS within its border, and determine the scope of practice of State-licensed EMS clinicians.

Recognizing that the model may impact States’ ability to urgently update their Scope of Practice rules, in 2016 the National EMS Advisory Council (NEMSAC) recommended that NHTSA develop a standardized urgent update process for the model. The Rapid Process for Emergent Changes to the National EMS Scope of Practice Model (rapid process) was developed by NASEMSO and published by NHTSA in September 2018.

Using the rapid process, in March 2021 NHTSA convened a subject matter expert panel (panel) to respond to the following questions:

1) Should immunizations via the intramuscular (IM) route be added to the emergency medical responder (EMR) and emergency medical technician (EMT) scope of practice levels?;

2) Should monoclonal antibody (MCA) infusion be added to the advanced EMT (AEMT) and paramedic scope of practice levels?; and

3) Should specimen collection via nasal swabbing be added to the EMR, EMT, AEMT, and paramedic scope of practice levels?

The panel considered the ability of EMRs and EMTs to perform the psychomotor skill of medication administration via the IM route and recommended that IM medication administration be added only to the EMT scope of practice as part of their common daily practice.

The panel considered the ability of EMRs and EMTs to administer medical director approved immunizations and recommended that immunizations during a public health emergency be added
only to the EMT scope of practice.

The panel considered the ability of EMRs, EMTs, AEMTs, and Paramedics to perform the psychomotor skill of specimen collection via nasal swab and recommended that specimen collection via nasal swab be added only to the EMT, AEMT, and Paramedic scopes of practice as part of their common daily practice.

The panel did not issue a recommendation on MCA infusion. Based on the panel’s recommendations NHTSA used the rapid process to develop the two attached change notices on IM medication administration, vaccinations during a public health emergency, and specimen collection via nasal swab.
It should be noted that, although the recommendations address the psychomotor skills associated
with these specific activities, the assumption of the panel in making the recommendations was
that all associated educational activities, knowledge of indications and potential contraindications, other potential skills (e.g.: drawing the appropriate dose of medication up from an ampule or vial [single or multi-dose], supervised assessment of skill competency, and quality improvement activities) would be components of the entire program.

Source: EMS Gov National EMS Scope of Practice Model 2019: Including Change Notices 1.0 and 2.0

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