Chapter 4765-16 EMT-Intermediates

4765-16-01 Advanced emergency medical technician curriculum prior to September 1, 2012.

(A) Prior to September 1, 2012, an EMS training program for a certificate to practice as an advanced emergency medical technician or an advanced emergency medical technician refresher program shall be conducted in accordance with the curriculum as set forth in this rule or in rule 4765-16-06 of the Administrative Code. An EMS training program for a certificate to practice as an advanced emergency medical technician or an advanced emergency medical technician refresher program starting on or after September 1, 2012, shall be conducted in accordance with rule 4765-16-06 of the Administrative Code.

(B) An EMS training program for a certificate to practice as an advanced emergency medical technician shall be conducted in accordance with division (D) of section 4765.16 of the Revised Code and this rule. Such program shall be for one hundred thirty hours according to the "Ohio EMT-Intermediate Curriculum and Transition Course" (March, 2002) objectives approved by the board, which can be found at http://www.ems.ohio.gov /ems_education.stm, in each of the following subject areas:

(1) A preparatory portion that provides, as a minimum, an understanding of:

(a) The roles and responsibilities of the advanced emergency medical technician within the EMS system;

(b) The role of medical direction;

(c) Medical and legal issues;

(d) Basic anatomy and physiology;

(e) Basic principles of pharmacology to include the following medications:

(i) Oxygen;

(ii) Nitroglycerin;

(iii) Dextrose fifty per cent in water;

(iv) Aspirin;

(v) Epinephrine;

(vi) Diphenhydramine;

(vii) Diazepam;

(viii) Lorazepam;

(ix) Bronchodilators;

(x) Naloxone;

(xi) Glucagon;

(xii) Nitrous oxide;

(xiii) Nalbuphine;

(xiv) Morphine sulfate;

(xv) Ketorolac, meperidine, or other analgesics for pain relief;

(xvi) Any additional drug approved by the board.

(f) Procedures for accessing the venous circulation by intravenous and intraosseous needle placement;

(g) Procedures for administering medications;

(h) Procedures for obtaining blood samples;

(2) An airway portion that includes procedures for airway management and ventilation;

(3) A portion that includes procedures for patient assessment, including but not limited to the following:

(a) History taking and physical examinations;

(b) Process for clinical decision making;

(c) The format for dissemination of patient information in oral form;

(d) Procedures for documenting patient assessment, care, and transport;

(4) A trauma portion that includes an understanding of mechanisms of injury, the trauma patient, and the trauma system, including but not limited to the following:

(a) Hemorrhage and shock;

(b) Burn injuries;

(c) Head, spinal, and thoracic trauma;

(d) Extremity trauma;

(e) Trauma in pediatric and geriatric patients.

(5) A medical portion that includes procedures for assessing and managing the following medical emergencies:

(a) Respiratory;

(b) Cardiovascular;

(c) Diabetic;

(d) Allergic reactions;

(e) Toxicological and overdose;

(f) Neurological;

(g) Non-traumatic abdominal;

(h) Environmental;

(i) Behavioral;

(j) Gynecological.

(6) A portion covering special considerations, including but not limited to assessment and management of the following:

(a) Obstetrical emergencies;

(b) Neonatal resuscitations;

(c) Pediatric patients;

(d) Geriatric patients.

(C) During the EMS training program, students must demonstrate competencies by successfully performing the following skills on patients unless otherwise noted:

(1) A minimum of five intravenous access;

(2) A minimum of three intubations, which may be completed on a mannequin;

(3) A minimum of one subcutaneous injection;

(4) A minimum of three intramuscular injections;

(5) A minimum of twenty patient assessments, including medical and trauma assessments, to be performed on all age groups;

(6) A minimum of two intravenous medication administrations;

(7) A minimum of two intraosseous infusions, which maybe completed on a mannequin;

(8) A minimum of one manual defibrillation, which may be completed on a simulated patient;

(9) A minimum of five bronchodilator administrations.

(D) An accredited institution offering an EMS training program, as outlined in paragraphs (B) and (C) of this rule, shall provide for regular evaluations of student performance and achievement throughout the course of the program and shall include a comprehensive written exam at the end of the program, prior to issuance of a certificate of completion.

(E) An "Ohio EMT-Intermediate Refresher Curriculum" (March, 2004) , which can be found at http://www.ems.ohio.gov /ems_education.stm, shall consist of forty hours according to objectives approved by the board for the number of hours listed in each of the following subject areas:

(1) Eight hours on pediatric issues;

(2) Eight hours on trauma issues, two of which must pertain to triage and transportation protocols as approved by the board;

(3) Nine hours on medical emergencies;

(4) Four hours on geriatric issues;

(5) Five hours on cardiology;

(6) Two hours on airway and ventilation;

(7) Two hours on EMS operations;

(8) Two hours on obstetrics and gynecology.

(F) An accredited or approved institution offering a refresher program, as outlined in paragraph (E) of this rule, shall provide for regular evaluations of student performance and achievement through written and practical testing, prior to issuance of a certificate of completion.

Effective: 10/18/2013
R.C. 119.032 review dates: 07/15/2013 and 03/12/2018
Promulgated Under: 119.03
Statutory Authority: 4765.11
Rule Amplifies: 4765.16
Prior Effective Dates: 01/01/96, 01/25/99, 03/23/03, 02/06/12

4765-16-02 Transitional EMT-intermediate update course.

(A) An EMT-intermediate who is not certified as having completed training in emergency pharmacology as outlined in paragraph (A) of rule 4765-16-01 of the Administrative Code must complete the 2002 transitional EMT-intermediate update curriculum, as outlined in this rule, prior to July 1, 2005, in order to renew a certificate to practice after that date.

(B) A 2002 transitional EMT-intermediate update course shall only be provided by an EMT-intermediate or EMT-paramedic accredited training program and shall be for forty hours according to the "Ohio EMT-Intermediate Curriculum and Transition Course" (March, 2002) objectives approved by the board, which can be found at http://www.ems.ohio.gov /ems_education.stm, in all of the following subject areas:

(1) A portion that covers an understanding of the basic principles of pharmacology to include the following medications:

(a) Oxygen;

(b) Nitroglycerin;

(c) Dextrose fifty per-cent in water;

(d) Aspirin;

(e) Epinephrine;

(f) Diphenhydramine;

(g) Diazepam;

(h) Lorazepam;

(i) Naloxone;

(j) Bronchodilators;

(k) Glucagon;

(l) Nitrous oxide;

(m) Nalbuphine;

(n) Morphine sulfate;

(o) Ketorolac, meperidine, or other analgesics for pain relief;

(p) Any additional drug approved by the board.

(2) A portion that covers the procedures for accessing venous circulation and administration of medications;

(3) A portion that covers the procedures for establishing and maintaining a patient airway, and oxygenation and ventilation of the patient;

(4) A portion that covers the procedures for assessment and management of the trauma patient with a thoracoabdominal injury.

(C) Completion of the "Ohio EMT-Intermediate Curriculum and Transition Course" (March, 2002), which can be found at http://www.ems.ohio.gov /ems_education.stm, will count as forty hours of continuing education toward the required sixty hours of continuing education for an EMT-intermediate.

(D) An EMT-paramedic who has dropped back to the level of an EMT-intermediate within three years prior to the effective date of this rule is not required to complete the transitional EMT-intermediate update course outlined in this rule.

Effective: 10/18/2013
R.C. 119.032 review dates: 07/15/2013 and 03/12/2018
Promulgated Under: 119.03
Statutory Authority: 4765.11
Rule Amplifies: 4765.16
Prior Effective Dates: 01/01/96, 10/11/96 (Emer), 5/19/97, 7/31/97, 2/22/99, 1/13/02, 03/23/03

4765-16-03 Advanced emergency medical technician continuing education.

(A) Except as otherwise provided in section 4765.31 of the Revised Code and this chapter, when applying for renewal of a certificate to practice, a person certified as an advanced emergency medical technician shall comply with one of the four following continuing education requirements by the expiration date of the current certificate:

(1) Completion of at least sixty hours of continuing education, including all of the following:

(a) Eight hours on pediatric issues;

(b) Four hours on geriatric issues;

(c) Eight hours on trauma issues, to include education on the trauma triage determination pursuant to rule 4765-14-02 of the Administrative Code.

(2) Completion of both of the following:

(a) An advanced emergency medical technician refresher training program, as outlined in rule 4765-16-01 of the Administrative Code or in paragraph (E) of rule 4765-16-06 of the Administrative Code, as evidenced by a certificate of completion in accordance with section 4765.24 of the Revised Code, which will satisfy forty hours of the required sixty hours of continuing education;

(b) Completion of the remaining twenty hours of continuing education.

(3) Current registration with the national registry of emergency medical technicians at the advanced emergency medical technician or equivalent level, and completion of the education on the trauma triage determination pursuant to rule 4765-14-02 of the Administrative Code.

(4) A passing score within three attempts on an examination approved by the board, pursuant to rule 4765-8-05 of the Administrative Code, to demonstrate competence to have a certificate to practice as an advanced emergency medical technician renewed without completing an EMS continuing education program. This examination may only be taken during the last six months of an advanced emergency medical technician's current certification period or during a board approved extension granted pursuant to rule 4765-19-03 of the Administrative Code.

(B) An individual that receives a board approved extension of time to complete continuing education requirements listed in paragraph (A) of this rule, must complete the requirements and submit an "EMS Application-Renewal" or form "EMS 0043" (June, 2008), which can be found at http://ems.ohio.gov/ems_forms.stm, to the division, no later than the expiration date of the granted extension.

Effective: 10/18/2013
R.C. 119.032 review dates: 07/15/2013 and 03/12/2018
Promulgated Under: 119.03
Statutory Authority: 4765.11
Rule Amplifies: 4765.16 , 4765.24 , 4765.31
Prior Effective Dates: 01/01/96, 02/22/99, 3/23/03, 07/02/09, 02/06/12

4765-16-04 Advanced emergency medical technician scope of practice.

(A) In addition to the emergency medical services listed in rules 4765-12-04 and 4765-15-04 of the Administrative Code, and in accordance with section 4765.38 of the Revised Code, an advanced emergency medical technician may perform the following emergency medical services only pursuant to the written or verbal authorization of a physician or of the cooperating physician advisory board, or authorization transmitted through a direct communication device by a physician, physician assistant designated by physician, or registered nurse designated by a physician, or in accordance with written protocols as specified in division (C) of section 4765.38 of the Revised Code:

(1) Cardiac monitor strip interpretation;

(2) Manual defibrillation;

(3) Obtaining blood specimens;

(4) Subcutaneous or intramuscular administration of epinephrine;

(5) Intravenous access and peripheral initiation;

(6) Intravenous maintenance and fluid administration;

(7) Intraosseous insertion;

(8) Saline lock;.

(B) In addition to the emergency medical services described in paragraph (A) of this rule, and in accordance with section 4765.38 of the Revised Code, an advanced emergency medical technician who has completed a training program pursuant to this chapter of the Administrative Code may perform the following emergency medical services only pursuant to the written or verbal authorization of a physician or of the cooperating physician advisory board, or authorization transmitted through a direct communication device by a physician, physician assistant designated by physician, or registered nurse designated by a physician, or in accordance with written protocols as specified in division (C) of section 4765.38 of the Revised Code:

(1) Administration of the following medications:

(a) Sublingual nitroglycerin;

(b) Dextrose in water;

(c) Epinephrine at the concentration of one to one thousand;

(d) Diphenhydramine;

(e) Benzodiazepines;

(f) Bronchodilators;

(g) Naloxone;

(h) Glucagon;

(i) Nitrous oxide;

(j) Nalbuphine;

(k) Narcotics or other analgesics for pain relief;

(l) Lidocaine, for pain relief after intraosseous insertions;

(m) Any additional drug approved by the board.

(2) Administration of aerosolized or nebulized medications;

(3) Administration of intranasal medications;

(4) Orotracheal intubation of the apneic patient;

(5) Dual lumen airway of the apneic patient;

(6) Extraglottic airway of the apneic patient;

(7) Needle decompression of the chest;

(8) Tracheostomy tube replacement;

(9) Laryngoscopy for removal of airway obstruction;

(10) Set up and application of a twelve-lead electrocardiogram, in accordance with written protocols, in either of the following instances:

(a) When the advanced emergency medical technician is assisting a paramedic; or

(b) For the purpose of electronic transmission by the advanced emergency medical technician, provided the following conditions are met:

(i) The advanced emergency medical technician does not interpret the electrocardiogram;

(ii) The advanced emergency medical technician minimizes any delay of patient transport while obtaining a twelve-lead electrocardiogram;

(iii) The advanced emergency medical technician utilizes the twelve-lead electrocardiogram in conjunction with destination protocols approved by the local medical director.

(11) Withdraw blood for the purpose of determining the alcohol, drug, controlled substance, metabolite of a controlled substance, or combination content of the whole blood, blood serum, or blood plasma as provided in division (D) of section 4765.38 of the Revised Code when performed in accordance with the criteria established in rule 4765-6-06 of the Administrative Code and the protocols established by the medical director of the emergency medical service organization with which the advanced emergency medical technician is affiliated.

(12) Any other services approved by the board pursuant to rule 4765-6-01 of the Administrative Code.

(13) Any other services pursuant to a research study approved by the board under rule 4765-6-04 of the Administrative Code and within the parameters established by the board for such study.

(C) A physician or cooperating physician advisory board that serves as the medical director for any EMS organization may limit, but not exceed, the scope of practice for those advanced emergency medical technicians who provide emergency medical services under the auspices of the physician's certificate to practice medicine and surgery, or osteopathic medicine and surgery, issued under Chapter 4731. of the Revised Code to include the withdrawing of blood for evidence collection.

(D) An advanced emergency medical technician shall not perform emergency medical services within this rule unless the advanced emergency medical technician has received training as part of an initial certification course or through subsequent training approved by the board. If certain emergency medical services, within the advanced emergency medical technician scope of practice, were not included in the training specified in this paragraph, the advanced emergency medical technician must have received training regarding such services approved by the local medical director before performing those services.

Effective: 10/18/2013
R.C. 119.032 review dates: 07/15/2013 and 03/12/2018
Promulgated Under: 119.03
Statutory Authority: 4765.11 , 4765.38
Rule Amplifies: 1547.11 , 4506.17 , 4511.19 , 4765.38
Prior Effective Dates: 3/23/03, 5/29/08, 12/2/10, 02/06/12

4765-16-05 EMT-intermediate special requirements.

(A) An EMT-intermediate must meet the requirements as outlined in rule 4765-15-01 of the Administrative Code.

(B) In addition to the requirements listed above, an EMT-intermediate shall complete the programs listed in paragraphs (C), (D), and (E) of this rule through an accredited institution in order to renew if the EMT-intermediate has not completed the curriculum outlined in rule 4765-16-01 of the Administrative Code.

(C) An epinephrine training program shall consist of one hour including the following:

(1) Pathophysiology of anaphylactic reaction;

(2) Pharmacology of epinephrine;

(3) Assessment and care of adult and pediatric patients with allergic reactions;

(4) Practical application of subcutaneous injection;

(5) Written and practical testing.

(D) A cardiac monitoring and manual defibrillation training program shall consist of twenty hours allocated as follows:

(1) One hour devoted to assessment and management of the cardiac patient;

(2) Two hours devoted to anatomy, physiology, pathophysiology, and electrophysiology of the heart;

(3) Eight hours devoted to cardiac monitoring and electrocardiogram interpretation;

(4) Six hours devoted to electrical intervention to support or correct the cardiac function;

(5) Three hours of written and practical testing.

(E) An intraosseous infusion training program shall consist of three hours including the following:

(1) Pathophysiology of intraosseous infusion;

(2) Mechanics of intraosseous;

(3) Written and practical testing.

(F) Notwithstanding the provisions of rule 4765-16-04 of the Administrative Code, an EMT-intermediate shall not perform any services in which the EMT-intermediate has not been trained.

Effective: 10/18/2013
R.C. 119.032 review dates: 07/16/2013 and 03/12/2018
Promulgated Under: 119.03
Statutory Authority: 4765.11
Rule Amplifies: 4765.16
Prior Effective Dates: 01/01/96, 10/11/96 (Emer), 5/19/97, 7/31/97, 2/22/99, 1/13/02, 10/7/03 (Emer), 1/6/04

4765-16-06 Advanced emergency medical technician curriculum.

(A) Effective September 1, 2012, an EMS training program for a certificate to practice as an advanced emergency medical technician or an advanced emergency medical technician refresher program started on or after this date, shall be conducted in accordance with this rule. Prior to September 1, 2012, an EMS training program for a certificate to practice as an advanced emergency medical technician or an advanced emergency medical technician refresher program may, but is not required to, teach the curriculum in accordance with this rule.

(B) An EMS training program for a certificate to practice as an advanced emergency medical technician shall be conducted in accordance with division (D) of section 4765.16 of the Revised Code and this rule. The EMS training program shall be conducted in accordance with the "National EMS Education Standards" (August, 2009) approved by NHTSA, the "Ohio Approved EMS Curriculum Standards" (February, 2012) approved by the board, and the scope of practice set forth in rule 4765-16-04 of the Administrative Code. The "National EMS Education Standards" (August, 2009) approved by NHTSA and the "Ohio Approved EMS Curriculum Standards" (February, 2012) approved by the board can be found at http://ems.ohio.gov/ems_education.stm. Such EMS training program shall consist of a minimum of two hundred hours to include all of the following:

(1) Preparatory;

(2) Anatomy and physiology;

(3) Medical terminology;

(4) Physiology;

(5) Life span development;

(6) Public health;

(7) Pharmacology;

(a) Sublingual nitroglycerin;

(b) Dextrose in water;

(c) Epinephrine at the concentration of one to one thousand;

(d) Diphenhydramine;

(e) Benziodiazepines;

(f) Bronchodilators;

(g) Naloxone;

(h) Glucagon;

(i) Nitrous oxide;

(j) Nalbuphine;

(k) Narcotics or other analgesics for pain relief;

(l) Lidocaine, for pain relief after intraosseous infusion;

(m) Any additional drug approved by the board.

(8) Airway management, respiration, and artificial ventilation, to include:

(a) Orotracheal intubation with apneic patients to include insertion of endotracheal, extraglottic and dual lumen airway devices;

(b) Laryngoscopy for the removal of airway obstruction;

(c) Tracheostomy tube replacement and suctioning;

(d) Continuous positive airway pressure device administration and management;

(e) End tidal carbon dioxide monitoring and detection.

(9) Patient assessment;

(10) Medicine, to include the following:

(a) Manual defibrillation;

(b) Cardiac monitor strip interpretation;

(c) Intraosseous insertion;

(d) Chest compression assist devices.

(11) Shock and resuscitation;

(12) Trauma, to include:

(a) Trauma triage determination pursuant to rule 4765-14-02 of the Administrative Code;

(b) Needle decompression of the chest.

(13) Special patient populations;

(14) EMS operations.

(C) During the training program, students must demonstrate competencies by successfully performing the following skills on patients unless otherwise noted:

(1) A minimum of five intravenous accesses;

(2) A minimum of three intubations, which may be completed on a mannequin;

(3) A minimum of three insertions of extraglottic airway devices, which may be completed on a mannequin;

(4) A minimum of three insertions of dual lumen airway devices, which may be completed on a mannequin;

(5) A minimum of one subcutaneous injection, which may be completed on a mannequin or simulator;

(6) A minimum of three intramuscular injections;

(7) A minimum of twenty patient assessments, including medical and trauma assessments, to be performed on all age groups;

(8) A minimum of two intravenous medication administrations;

(9) A minimum of two intraosseous infusions, which maybe completed on a mannequin;

(10) A minimum of one manual defibrillation, which may be completed on a mannequin or simulator;

(11) A minimum of three bronchodilator administrations.

(D) An accredited institution offering an EMS training program as outlined in paragraphs (B) and (C) of this rule, shall provide for regular written and practical skills evaluations of student performance and achievement throughout the course of the program. Evaluations shall include a comprehensive written examination and an examination of practical skills, prior to issuance of a certificate of completion.

(E) An advanced emergency medical technician refresher training program shall consist of forty hours according to the "Advanced Emergency Medical Technician Refresher Training Program" (May, 2012) education standards approved by the board, all of which can be found at http://ems.ohio.gov/ems_education.stm, and for the number of hours as follows:

(1) Eight hours on pediatric issues;

(2) Eight hours on trauma issues, to include education on the trauma triage determination pursuant to rule 4765-14-02 of the Administrative Code;

(3) Nine hours on medical emergencies;

(4) Four hours on geriatric issues;

(5) Five hours on cardiac emergencies;

(6) Two hours on airway and ventilation;

(7) Two hours on EMS operations;

(8) Two hours on obstetrics and gynecology.

(F) An accredited or approved institution offering a refresher program, as outlined in paragraph (E) of this rule, shall provide for regular evaluation of student performance and achievement through written and practical examinations, prior to issuance of a certificate of completion.

Effective: 10/18/2013
R.C. 119.032 review dates: 07/15/2013 and 03/12/2018
Promulgated Under: 119.03
Statutory Authority: 4765.11
Rule Amplifies: 4765.16
Prior Effective Dates: 02/06/12