(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 (B) 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 (B) of section 4765.38 of the
Revised Code:
(1) Administration of the
following medications:
(a) Sublingual nitroglycerin (non-patient assisted);
(b) Dextrose in water;
(c) Epinephrine at the concentration of one milligram per
milliliter via subcutaneous or intramuscular routes;
(d) Diphenhydramine;
(e) Benzodiazepines;
(f) Bronchodilators;
(g) Naloxone via endotracheal tube, intramuscular, intravenous,
intraosseous, or subcutaneous;
(h) Glucagon;
(i) Nitrous oxide;
(j) Nalbuphine;
(k) Narcotics or other analgesics for pain relief;
(l) Lidocaine, for pain relief after intraosseous
insertions;
(m) Oral ondansetron for patients twelve years or
older;
(n) Ketamine;
(o) Any additional drug approved by the board.
(2) Administration of
aerosolized or nebulized medications (non-patient assisted);
(3) Administration of
intranasal medications;
(4) Orotracheal intubation of the apneic
patient;
(5) Orotracheal
intubation of the pulseless and apneic patient;
(6) Dual lumen airway of the apneic
patient;
(7) Extraglottic airway of the apneic
patient;
(8) Needle decompression of the
chest;
(9) Tracheostomy tube
replacement;
(10) Laryngoscopy for removal of airway
obstruction;
(11) 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.
(12) 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 (C) 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.
(13) Any other services approved by the
board pursuant to rule 4765-6-01 of the Administrative Code.
(14) 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) The utilization of waveform
capnography is mandatory for all patients requiring invasive airway devices
with the exception of stable patients with no cardiac or pulmonary complaints
or symptoms unless ordered by the transferring physician.
As used in this rule, an invasive airway device
is any airway device inserted or pre-positioned into a patient's airway by
means of the mouth, directly into the trachea, or into the trachea by means of
a tracheostomy tube, cricothyrotomy or nasotracheal intubation. Dual lumen and
extraglottic airways, even though they are blindly inserted into the
hypopharynx or the esophagus, are considered invasive airway devices.
(D) 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.
(E) 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.
