Chapter 4765-16 | EMT-Intermediates

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

• Effective: January 1, 2024
• Promulgated Under: 119.03

[Comment: For dates and availability of material incorporated by reference in this chapter, see rule 4765-1-03 of the Administrative Code.]

(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) One hour on identifying and interacting with individuals with dementia;

(d) Eight hours on trauma issues.

(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 (A) 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.

(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 Renewal Application" no later than the expiration date of the granted extension.

Last updated January 2, 2024 at 9:22 AM

Supplemental Information

Authorized By: 4765.11
Amplifies: 4765.16, 4765.24, 4765.31, 4765.162
Five Year Review Date: 8/1/2028
Prior Effective Dates: 3/23/2003, 10/18/2013, 6/15/2018

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

• Effective: January 1, 2024
• Promulgated Under: 119.03

(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.

Last updated January 2, 2024 at 9:22 AM

Supplemental Information

Authorized By: 4765.11, 4765.38
Amplifies: 1547.11, 4506.17, 4511.19, 4765.38
Five Year Review Date: 8/1/2028
Prior Effective Dates: 2/6/2012, 1/1/2021

Rule 4765-16-05 | EMT-intermediate special requirements.

• Effective: October 18, 2013
• Promulgated Under: 119.03

(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.

Last updated September 12, 2023 at 12:05 PM

Supplemental Information

Authorized By: 4765.11
Amplifies: 4765.16
Five Year Review Date: 8/1/2028
Prior Effective Dates: 1/1/1996, 1/13/2002, 10/7/2003 (Emer.), 1/6/2004

Rule 4765-16-06 | Advanced emergency medical technician curriculum.

• Effective: January 1, 2025
• Promulgated Under: 119.03

[Comment: For dates and availability of material incorporated by reference in this chapter, see rule 4765-1-03 of the Administrative Code.]

(A) 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 competency based and conducted in accordance with the "National EMS Education Standards" approved by NHTSA in programs approved by the board, and consistent with the scope of practice set forth in rule 4765-16-04 of the Administrative Code. The national approved standards referenced in this paragraph are required core competencies for instruction in an EMS training program. Elements of the scope of practice not referenced in the "National EMS Education Standards" are added competencies that may be taught at the discretion of the EMS training program. Such EMS training program shall consist of:

(1) Didactic and laboratory education;

(2) Clinical and field training, to include minimum skill set competencies as outlined in paragraph (C) of this rule.

(B) An EMS training program for advanced emergency medical technician certification shall include all of the following subject areas:

(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 milligram per milliliter;

(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) Oral ondansetron;

(n) 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) A minimum of two hours on identifying and interacting with individuals with dementia;

(15) EMS operations.

(C) In addition to meeting the requirements in paragraphs (A) and (B) of this rule, 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 (A), (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" education standards approved by the board and for the number of hours as follows:

(1) Eight hours on pediatric issues;

(2) Eight hours on trauma issues;

(3) Eight hours on medical emergencies;

(4) Four hours on geriatric issues;

(5) One hour on identifying and interacting with individuals with dementia;

(6) Five hours on cardiac emergencies;

(7) Two hours on airway and ventilation;

(8) Two hours on EMS operations;

(9) 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.

Last updated January 2, 2025 at 8:31 AM

Supplemental Information

Authorized By: 4765.11
Amplifies: 4765.16, 4765.162
Five Year Review Date: 8/1/2028