EMS Scope of Practice

Category Skill EMR EMT AEMT P*
1 Airway/Ventilation/Oxygenation Airway—Nonsurgical Alternative/Rescue Airway—CombiTubeTM, iGel® Supraglottic, King LT-D AirwayTM or King LTS-D AirwayTM No No Yes Yes
2 Airway/Ventilation/Oxygenation Airway—Oropharyngeal (OPA) & Nasopharyngeal (NPA) Yes Yes Yes Yes
3 Airway/Ventilation/Oxygenation Airway—Pharyngeal tracheal lumen (PTL) No No No No
4 Airway/Ventilation/Oxygenation Bag-valve-ETT/Nonsurgical alternative airway ventilation Yes2 Yes2 Yes Yes
5 Airway/Ventilation/Oxygenation Bag-valve-ventilation—with in-line small-volume nebulizer No Yes2 Yes Yes
6 Airway/Ventilation/Oxygenation Bag-valve-mask (BVM) ventilation Yes Yes Yes Yes
7 Airway/Ventilation/Oxygenation Chest decompression—needle No No No Yes
8 Airway/Ventilation/Oxygenation Chest tube thoracostomy, monitoring of existing tube in a closed system (for example water seal or suction) No No No No
9 Airway/Ventilation/Oxygenation Chest tube thoracostomy, monitoring of existing tube in a open system (for example vented, Heimlich valve) No No No Yes
10 Airway/Ventilation/Oxygenation Chest tube thoracostomy, acute insertion No No No No
11 Airway/Ventilation/Oxygenation Continuous positive airway pressure (CPAP) No Yes1 Yes Yes
12 Airway/Ventilation/Oxygenation Biphasic positive airway pressure (BiPAP) for patients chronically on BiPAP for >48 hours No No No Yes
13 Airway/Ventilation/Oxygenation Biphasic positive airway pressure (BiPAP) for patients on BiPAP for <48 hours No No No No
14 Airway/Ventilation/Oxygenation Cricothyrotomy—needle No No No Yes
15 Airway/Ventilation/Oxygenation Cricothyrotomy—open/surgical No No No Yes
16 Airway/Ventilation/Oxygenation Cricothyrotomy—overwire (Seldinger) technique No No No Yes
17 Airway/Ventilation/Oxygenation End tidal CO2 monitoring/capnography No No Yes Yes
18 Airway/Ventilation/Oxygenation Esophageal obturator airway (EOA)/esophageal gastric tube airway (EGTA) No No No No
19 Airway/Ventilation/Oxygenation Extubation—removal of ETT No No No Yes
20 Airway/Ventilation/Oxygenation Gastric decompressions—Orogastric or nasogastric tube insertion No No No Yes
21 Airway/Ventilation/Oxygenation Gastric decompression by alternative/rescue airway (CombiTubeTM or King LTS-DTM) No No Yes Yes
22 Airway/Ventilation/Oxygenation Head-tilt/chin lift Yes Yes Yes Yes
23 Airway/Ventilation/Oxygenation Inspiratory Impedance Threshold Device (ITD) No No Yes1 Yes
24 Airway/Ventilation/Oxygenation Endotracheal Intubation—by direct laryngoscopy (including video intubation devices), nasotracheal, digital and transillumination/lighted stylet techniques No No No Yes
25 Airway/Ventilation/Oxygenation Endotracheal Intubation—paralytic assisted, rapid sequence induction (RSI) No No No No
26 Airway/Ventilation/Oxygenation Ventilation—maintenance of previously initiated neuromuscular blockade No No No No
27 Airway/Ventilation/Oxygenation Endotracheal Intubation—retrograde technique No No No No
28 Airway/Ventilation/Oxygenation Laryngeal mask airway (LMA) No No No No
29 Airway/Ventilation/Oxygenation Mouth-to-mouth, nose, stoma, barrier and pocket mask Yes Yes Yes Yes
30 Airway/Ventilation/Oxygenation Obstruction—direct laryngoscopy (remove with forceps) No No No Yes
31 Airway/Ventilation/Oxygenation Obstruction—manual (abdominal thrusts, finger sweep, chest thrusts) upper airway Yes Yes Yes Yes
32 Airway/Ventilation/Oxygenation Oxygen therapy—blow-by delivery Yes Yes Yes Yes
33 Airway/Ventilation/Oxygenation Oxygen therapy—humidifiers No Yes Yes Yes
34 Airway/Ventilation/Oxygenation Oxygen therapy—nasal cannula Yes Yes Yes Yes
35 Airway/Ventilation/Oxygenation Oxygen therapy—nonrebreather Yes Yes Yes Yes
36 Airway/Ventilation/Oxygenation Oxygen therapy—partial rebreather No Yes Yes Yes
37 Airway/Ventilation/Oxygenation Oxygen therapy—regulators Yes Yes Yes Yes
38 Airway/Ventilation/Oxygenation Oxygen therapy—simple face mask No Yes Yes Yes
39 Airway/Ventilation/Oxygenation Oxygen therapy—Venturi mask No Yes Yes Yes
40 Airway/Ventilation/Oxygenation Peak expiratory flow assessment No No Yes Yes
41 Airway/Ventilation/Oxygenation Suctioning—meconium aspiration No No No Yes
42 Airway/Ventilation/Oxygenation Suctioning—stoma/tracheostomy Yes Yes Yes Yes
43 Airway/Ventilation/Oxygenation Suctioning—tracheobronchial by advanced airway No Yes2 Yes Yes
44 Airway/Ventilation/Oxygenation Suctioning—upper airway (nasal) Yes Yes Yes Yes
45 Airway/Ventilation/Oxygenation Suctioning—upper airway (oral) Yes Yes Yes Yes
46 Airway/Ventilation/Oxygenation Transtracheal jet ventilation No No No Yes
47 Airway/Ventilation/Oxygenation Single mode, volume controlled automated ventilator (without blender) No No Yes1 Yes1
48 Airway/Ventilation/Oxygenation Ventilators, transport—single or multi-modal, with or without blender, using volume control mode only, on patients >1 year of age with no anticipated need to actively titrate ventilator settings during transport. No No No Yes
49 Airway/Ventilation/Oxygenation Ventilators, that are portable and capable of being transported with a patient and are multi-modal, with a blender, that are used on patients requiring pressure control, pressure support or other advanced setting, or when there is an anticipated need by a healthcare provider involved with the care of the patient to actively titrate ventilator settings during transport, regardless of ventilation mode No No No No
50 Cardiovascular/Circulation Blood pressure—auscultation Yes Yes Yes Yes
51 Cardiovascular/Circulation Blood pressure—electronic non-invasive Yes Yes Yes Yes
52 Cardiovascular/Circulation Blood pressure—palpation Yes Yes Yes Yes
53 Cardiovascular/Circulation Electrocardiogram (ECG) monitoring—apply electrodes for single leads No Yes2 Yes2 Yes
54 Cardiovascular/Circulation Electrocardiogram (ECG) monitoring—obtain and transmit 12-lead ECG No Yes Yes Yes
55 Cardiovascular/Circulation Electrocardiogram (ECG) monitoring—12-lead (interpret) No No No Yes
56 Cardiovascular/Circulation Cardiac monitoring—single lead (interpret) No No No Yes
57 Cardiovascular/Circulation Manual chest compressions—adult, child, infant Yes Yes Yes Yes
58 Cardiovascular/Circulation Cardioversion—synchronized No No No Yes
59 Cardiovascular/Circulation Defibrillation—counter shock—manual No No No Yes
60 Cardiovascular/Circulation Transcutaneous cardiac pacing No No No Yes
61 Cardiovascular/Circulation Transvenous or Epicardial pacing, Management of No No No No
62 Cardiovascular/Circulation Defibrillation—automated external defibrillator (AED) Yes Yes Yes Yes
63 Cardiovascular/Circulation Hemodynamic monitoring/assist (Swan Ganz, central venous pressure) No No No No
64 Cardiovascular/Circulation Intra-aortic balloon pump or invasive cardiac assist device monitoring/assist No No No No
65 Cardiovascular/Circulation Mechanical chest compression device use No Yes1 Yes1 Yes1
66 Cardiovascular/Circulation Thrombolytic therapy—initiation No No No No
67 Cardiovascular/Circulation Thrombolytic therapy—monitoring No No No No
68 IV Initiation/Maintenance/Fluids Central venous cannulation/insertion No No No No
69 IV Initiation/Maintenance/Fluids Central venous line—access of existing catheters with external ports No No No Yes
70 IV Initiation/Maintenance/Fluids External jugular vein cannulation No No No Yes
71 IV Initiation/Maintenance/Fluids Saline lock insertions as no-flow IV No No Yes Yes
72 IV Initiation/Maintenance/Fluids Intraosseous—needle placement and infusion—tibia, femur and humerus No No Yes Yes
73 IV Initiation/Maintenance/Fluids IV insertion, peripheral venous—initiation (cannulation) No No Yes Yes
74 IV Initiation/Maintenance/Fluids Sub-cutaneous indwelling catheters—access of existing catheters No No No No
75 IV Initiation/Maintenance/Fluids Venous blood sampling, peripheral—for clinical diagnostic purposes only No No Yes Yes
76 IV Initiation/Maintenance/Fluids Venous blood sampling, peripheral—for legal purposes only (Applies to Paramedics only, as defined and permitted by Act 142 or 2016) No No No Yes
77 IV Initiation/Maintenance/Fluids Venous central line (blood sampling) obtaining No No No No
78 IV Initiation/Maintenance/Fluids Arterial line—capped—transport No Yes Yes Yes
79 IV Initiation/Maintenance/Fluids Arterial line—monitoring/assist No No No No
80 IV Initiation/Maintenance/Fluids Blood/Blood-by-products administration (initiation and continuation) No No No No
81 Lifting and Moving Patient lifting, moving and transfers Yes Yes Yes Yes
82 Lifting and Moving Patient restraints on transport devices Yes Yes Yes Yes
83 Medication administration routes Endotracheal (ET) No No No Yes
84 Medication administration routes Inhalation (aerosolized/nebulized) No Yes Yes Yes
85 Medication administration routes Intramuscular (IM) No No Yes Yes
86 Medication administration routes Intranasal (IN) No No Yes Yes
87 Medication administration routes Intraosseous (IO)—tibia, humerus or femur No No Yes Yes
88 Medication administration routes Intravenous (IV)—fluid bolus No No Yes Yes
89 Medication administration routes Intravenous (IV)—monitoring or maintaining existing intravenous infusion (crystalloid fluid as published in the EMS medication list in the Pennsylvania Bulletin) during interfacility transport No No Yes Yes
90 Medication administration routes Intravenous (IV) infusion, with added medication, including by intravenous pump No No No Yes
91 Medication administration routes Nasogastric No No No Yes
92 Medication administration routes Enteral feeding devices, Management of No No No No
93 Medication administration routes Oral—over-the-counter medications for pain, fever and hypoglycemia (as listed in the approved medication list) No Yes Yes Yes
94 Medication administration routes Rectal No No No Yes
95 Medication administration routes Subcutaneous No No Yes Yes
96 Medication administration routes Sublingual (Note: EMT may only assist patient with his/her prescribed Nitroglycerin (NTG)) No Yes Yes Yes
97 Medication administration routes Topical No No No Yes
98 Medications Auto-injector benzodiazepine for seizure No No No Yes
99 Medications Auto-injector epinephrine (assist patient with his/her prescribed medication) No Yes Yes Yes
100 Medications Auto-injected epinephrine-primary use—not patient's own prescription No Yes1 Yes Yes
101 Medications Medications as published in Pennsylvania Bulletin by the Department Yes Yes Yes Yes
102 Medications Immunizations as published in the Pennsylvania Bulletin by the Department No No No Yes
103 Medications Over-the-counter (OTC) medications (except as listed elsewhere for pain, fever, and hypoglycemia) No No No No
104 Medications Oxygen Yes1 Yes Yes Yes
105 Medications Auto-injector nerve agent antidote—self or peer rescue Yes Yes Yes Yes
106 Medications Auto-injector nerve agent antidote—patient treatment No Yes3 Yes3 Yes
107 Medications Metered-dose inhaler (MDI) bronchodilator (Note: EMT may only assist patient with his/her own prescribed medication) No Yes Yes Yes
108 Medications Naloxone—Intranasal or intramuscular auto-injector Yes1,6 Yes1,6 Yes Yes
109 Medications Glucagon—Intranasal (powder spray) or intramuscular auto-injector No Yes1 Yes Yes
110 Patient assessment/management Behavioral—Restrain violent patient Yes1 Yes Yes Yes
111 Patient assessment/management Blood glucose assessment No Yes1 Yes Yes
112 Patient assessment/management Portable blood analysis devices, use of (glucometer covered elsewhere) No No No No
113 Patient assessment/management Childbirth—umbilical cord cutting Yes Yes Yes Yes
114 Patient assessment/management Childbirth (abnormal/complications) No Yes Yes Yes
115 Patient assessment/management Childbirth (normal)—cephalic delivery Yes Yes Yes Yes
116 Patient assessment/management Carbon Monoxide CO-oximetry monitoring No Yes1 Yes1 Yes1
117 Patient assessment/management Carbon Monoxide CO—Exhaled Analysis Device No Yes1 Yes1 Yes1
118 Patient assessment/management Carbon Monoxide monitoring, with environmental surveillance devices Yes Yes Yes Yes
119 Patient assessment/management Hemodynamic monitoring/assist (Swan Ganz, central venous pressure) No No No No
120 Patient assessment/management Dislocation reduction No No No No
121 Patient assessment/management Eye irrigation (Note: irrigation through corneal contact device limited to AEMT and Paramedic) Yes Yes Yes Yes
122 Patient assessment/management Intracranial monitoring/assist No No No No
123 Patient assessment/management Patient management per Statewide EMS Protocols and Department approved protocols Yes Yes Yes Yes
124 Patient assessment/management Pulse oximetry monitoring No Yes Yes Yes
125 Patient assessment/management Splinting, extremity—manual, rigid, soft, vacuum Yes Yes Yes Yes
126 Patient assessment/management Splinting, femur—traction No Yes Yes Yes
127 Patient assessment/management Urinary catheterization No No No No
128 Patient assessment/management Wound care, dressing, bandaging Yes Yes Yes Yes
129 Patient assessment/management Wound care, removal of Taser probe/barb No No No No
130 Patient assessment/management Wound drainage vacuum devices, monitoring No Yes Yes Yes
131 Patient assessment/management Wound care, hemorrhage control—direct pressure, wound packing, tourniquet, bandaging, hemostatic agents Yes Yes Yes Yes
132 Patient assessment/management Wound care, irrigation and skin closure with tape or adhesive glue No No No No
133 Spine Care Restrict spinal motion—Cervical collar application Yes Yes Yes Yes
134 Spine Care Restrict spinal motion—Helmet removal or stabilization No Yes Yes Yes
135 Spine Care Restrict spinal motion—manual cervical spine stabilization Yes Yes Yes Yes
136 Spine Care Restrict spinal motion—rapid extrication with precautions to restrict spinal movement No Yes Yes Yes
137 Spine Care Devices to restrict spinal motion—for example—vacuum mattress, extrication devices, scoop stretcher and spine board) No Yes Yes Yes

EMR—Emergency Medical Responder;
EMT—Emergency Medical Technician;
AEMT—Advanced Emergency Medical Technician;
P*—Paramedic (*includes—PHRN/PHPE/PHP)

No—The skill is not in the scope of practice for the level of certification.
Yes—The skill is in the scope of practice for the level of certification.

  1. Additional training and authorization by EMS agency medical director is required, and this skill may only be used when functioning with a licensed EMS agency that complies with Department requirements for providing this skill.
  2. May assist a P, PHRN, PHPE or PHP with this skill only when in the physical presence of and under the direct supervision of the higher level provider.
  3. May perform this skill only in the physical presence of and under the direct supervision of a P, PHRN, PHPE or PHP.
  4. After July 1, 2015, Statewide ALS Protocol will include any restrictions placed upon the use of this skill.
  5. This skill becomes effective July 1, 2015.
  6. Department-approved Act 139 training required and approval of the EMS medical director, and this skill may only be used when functioning with a licensed EMS agency that complies with Department requirements for providing this skill.