Chapter 4765-16 EMT-Intermediates

(A) Effective September 1, 2003, a training program for EMT-intermediate certification shall be 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 objectives approved by the board in all of the following subject areas:

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

(a) The roles and responsibilities of the EMT-intermediate 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 percent 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.

(B) During the course, 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.

(C) Training programs offering a course, as outlined in paragraphs (A) and (B) 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.

(D) An EMT-intermediate refresher training program 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.

(E) Training programs offering a course, as outlined in paragraph (D) 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.

Replaces: Former 4765-6-04

R.C. 119.032 review dates: 03/13/2008 and 03/12/2013

Promulgated Under: 119.03

Statutory Authority: RC 4765.11

Rule Amplifies: RC 4765.16

Prior Effective Dates: 1/1/96; 1/25/99; 3/23/03

(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 objectives approved by the board 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 2002 transitional EMT-intermediate update course 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.

Replaces: Part of 4765-8-04

R.C. 119.032 review dates: 03/13/2008 and 03/12/2013

Promulgated Under: 119.03

Statutory Authority: RC 4765.11

Rule Amplifies: RC 4765.16

Prior Effective Dates: 1/1/96; 10/11/96 (Emer); 5/19/97; 7/31/97; 2/22/99; 1/13/02; 3/23/03

(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 EMT-intermediate shall document compliance with one of the four following continuing education requirements:

(1) Completion of a total of not fewer than sixty hours of continuing education, including all of the following:

(a) Eight hours on pediatric issues;

(b) Four hours on geriatric issues;

(c) Beginning with the applicant’s first full certification cycle following the effective date of this rule, eight hours on trauma issues, two of which must pertain to triage and transportation protocols approved by the board.

(2) Completion of an EMT-intermediate refresher course, as outlined in paragraph (D) of rule 4765-16-01 of the Administrative Code, which will satisfy forty hours of the required sixty hours of continuing education.

(3) Current registration with the national registry of emergency medical technicians at the EMT-intermediate or equivalent level, and completion of two hours of continuing education on trauma triage and transportation protocols approved by the board.

(4) A passing score within three attempts on an examination approved by the board, pursuant to section 4765.10 of the Revised Code, to demonstrate competence to have a certificate to practice as an EMT-intermediate renewed without completing an EMS continuing education program. This examination may only be taken during the last six months of an EMT-intermediate’s current certification period.

Replaces: Former 4765-8-07

R.C. 119.032 review dates: 03/13/2008 and 03/12/2013

Promulgated Under: 119.03

Statutory Authority: RC 4765.11

Rule Amplifies: RC 4765.16, 4765.24

Prior Effective Dates: 1/1/96; 2/22/99; 3/23/03

(A) In addition to the skills listed in rule 4765-15-04 of the Administrative Code, and in accordance with section 4765.38 of the Revised Code, an EMT-intermediate 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 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 administration of epinephrine;

(5) Administration of intravenous lifeline and fluid;

(6) Intraosseous infusion;

(7) Saline lock initiation;

(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 EMT-intermediate 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 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 fifty percent in water;

(c) Diphenhydramine;

(d) Benzodiazepines;

(e) Bronchodilators;

(f) Naloxone;

(g) Glucagon;

(h) Nitrous oxide;

(i) Nalbuphine;

(j) Morphine sulfate;

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

(l) Any additional drug approved by the board.

(2) Administration of nebulized medications;

(3) Administration of intranasal medications;

(4) Orotracheal intubation of the apneic patient;

(5) Dual lumen airway of the apneic patient;

(6) Supraglottic airway of the apneic patient;

(7) Needle decompression of the chest.

(8) Replacement of a tracheostomy tube through a stoma;

(9) Set up and application of a 12-lead electrocardiogram, in accordance with written protocols, in either of the following instances:

(a) When the EMT-intermediate is assisting an EMT-paramedic; or

(b) For the purpose of electronic transmission by the EMT-intermediate, provided the following conditions are met:

(i) The EMT-intermediate does not interpret the electrocardiogram;

(ii) The EMT-intermediate minimizes any delay of patient transport to obtain a 12-lead electrocardiogram;

(iii) The EMT-intermediate utilizes the 12-lead electrocardiogram in conjunction with destination protocols approved by the local medical director.

(10) 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 EMT-intermediates 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.

(D) An EMT-intermediate shall not perform emergency medical services within this rule unless the EMT-intermediate 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 EMT-intermediate scope of practice, were not included in the training specified in this paragraph, the EMT-intermediate must have received training regarding such services approved by the local medical director before performing those services.

Effective: 05/29/2008

R.C. 119.032 review dates: 03/23/2008

Promulgated Under: 119.03

Statutory Authority: 4765.11

Rule Amplifies: 4765.38

Prior Effective Dates: 3/23/03

(A) An EMT-intermediate must meet the requirements as outlined in rule 4765-15-02 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.

Replaces: Part of former 4765-6-06, Part of former 4765-8-04

R.C. 119.032 review dates: 03/13/2008 and 03/12/2013

Promulgated Under: 119.03

Statutory Authority: RC 4765.11

Rule Amplifies: RC 4765.16, 4765.30

Prior Effective Dates: 1/1/96, 10/11/96 (Emer); 5/19/97; 7/31/97; 2/22/99; 1/13/02; 2/1/96; 2/22/99; 10/7/03 (Emer); 1/6/04