Chapter 4765-17 | EMT-Paramedics

Rule 4765-17-02 | Paramedic 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 who is certified as a paramedic shall comply with one of the four following education requirements by the expiration date of the current certificate:

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

(a) Twelve hours on pediatric issues;

(b) Four hours on geriatric issues;

(c) A minimum of one hour on identifying and interacting with individuals with dementia;

(d) Eight hours on trauma issues;

(e) Six hours on emergency cardiac care continuing education, which may be satisfied upon successful completion of one of the following:

(i) An advanced cardiac life support course of the American heart association, which will satisfy this requirement;

(ii) An advanced cardiac life support course of the American safety and health institute, which will satisfy this requirement;

(iii) An equivalent program approved or designated by the board which can be found at http://www.ems.ohio.gov/links/ems_CErequirementsEMS.pdf;

(iv) Six hours of continuing education in emergency cardiac care.

(2) Completion of both of the following:

(a) A paramedic refresher course, as outlined in rule 4765-17-01 of the Administrative Code or paragraph (F) of rule 4765-17-04 of the Administrative Code as evidenced by a certificate of completion issued in accordance with section 4765.24 of the Revised Code, which will satisfy forty-eight hours of the required seventy-five hours of continuing education;

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

(3) Current registration with the national registry of emergency medical technicians at the paramedic 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 a paramedic renewed without completing an EMS continuing education program. This examination may only be taken during the last six months of a paramedic'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 to complete continuing education requirements listed in paragraph (A) of this rule, must complete the requirements and submit an "EMS Renewal Application" to the division, no later than the expiration date of the granted extension.

Last updated January 2, 2024 at 9:23 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: 10/18/2013

Rule 4765-17-03 | Paramedic scope of practice.

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

(A) In addition to the skills listed in rules 4765-12-04, 4765-15-04 and 4765-16-04 of the Administrative Code, and in accordance with section 4765.39 of the Revised Code, a paramedic 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 a physician, or registered nurse designated by a physician, or in accordance with written protocols as specified in division (B) of section 4765.39 of the Revised Code:

(1) Orotracheal intubation;

(2) Nasotracheal intubation;

(3) Cricothyrotomy (surgical);

(4) Cricothyrotomy (needle);

(5) Dual lumen airways;

(6) Extraglottic airways;

(7) Positive end-expiratory pressure;

(8) Bilevel positive air pressure;

(9) Ventilator management of patients sixteen years of age or older;

(10) Chest tube monitoring and management;

(11) Central line monitoring;

(12) Transcutaneous cardiac pacing;

(13) Administration of cardiac medication;

(14) Cardioversion;

(15) Twelve-lead electrocardiogram performance and interpretation;

(16) Administration of nitroglycerin;

(17) Administration of aerosolized or nebulized medication;

(18) Epinephrine administration via intravenous or intraosseous route;

(19) Placement of nasogastric or orogastric tubes;

(20) Administration of other medications pursuant to written protocols;

(21) Intravenous infusion pump;

(22) Blood chemistry analysis;

(23) Thrombolytic therapy initiation and monitoring;

(24) Immunizations for influenza to firefighters, EMTs, AEMTs, or paramedics in accordance with section 4765.391 of the Revised Code;

(25) Maintenance of medicated intravenous fluids;

(26) Maintenance of blood administration;

(27) Eye irrigation morgan lens;

(28) 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 4765.39 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 paramedic is affiliated;

(29) 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;

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

(B) A paramedic may perform non-emergent ambulance transport of a stable patient less than sixteen years of age who has a chronic condition requiring a tracheostomy tube and a ventilator provided the patient's caregiver accompanies the patient during transport and the patient's caregiver has received appropriate training in use of the patient's ventilator.

A caregiver is not required to accompany the patient if the patient is accompanied by an Ohio licensed registered nurse or respiratory therapist, or other appropriately trained and licensed Ohio healthcare provider.

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

Last updated January 2, 2024 at 9:23 AM

Supplemental Information

Authorized By: 4765.11, 4765.39
Amplifies: 1547.11, 4506.17, 4511.19, 4765.39, 4765.391
Five Year Review Date: 8/1/2028
Prior Effective Dates: 5/29/2008, 2/6/2012, 6/15/2018

Rule 4765-17-04 | Paramedic 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 a paramedic shall be in accordance with division (E) of section 4765.16 of the Revised Code and this rule and shall require all students complete an anatomy and physiology course as a prerequisite for admission into the EMS training program for a certificate to practice as a paramedic. 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 4765-17-03 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 paramedic 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;

(8) Airway management, respiration, and artificial ventilation;

(9) Patient assessment;

(10) Medicine, to include chest compression assist devices;

(11) Shock and resuscitation;

(12) Trauma, to include trauma triage determination pursuant to rule 4765-14-02 of the Administrative Code;

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

(1) A minimum of ninety patient assessments, to include:

(a) A minimum of fifty adult assessments;

(b) A minimum of thirty geriatric assessments;

(c) A minimum of ten pediatric assessments;

(d) Within the ninety patient assessments, the following must be included:

(i) Fifteen chest complaints;

(ii) Fifteen shortness of breath complaints;

(iii) Fifteen abdominal pain complaints;

(iv) Fifteen altered mental status complaints.

(2) A minimum of fifteen medication administrations, to include:

(a) A minimum of two intravenous medication administrations;

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

(c) A minimum of three intramuscular injections;

(d) A minimum of five bronchodilator administrations.

(3) A minimum of thirty intravenous accesses and maintenance;

(4) Programs are expected to provide live intubation experience when possible. At a minimum, students shall be successful in any combination of live patients, high-definition fidelity simulations, low fidelity simulations or cadaver labs in all age brackets. Each student shall perform:

(a) A minimum of ten direct adult orotracheal intubations and ten direct pediatric orotracheal intubations as an individual student competency evaluation in the laboratory;

(b) A minimum of two direct adult orotracheal intubations and two direct pediatric orotracheal intubations as an individual student competency evaluation in a laboratory scenario;

(5) A minimum of thirty electrocardiogram interpretations;

(6) A minimum of fifty advanced life support ambulance runs;

(7) A minimum of two intraosseous initiations, which may be completed on a mannequin or simulator;

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

(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 EMS training program. Evaluations shall include a comprehensive written examination and an examination of practical skills, prior to the issuance of a certificate of completion.

(E) A paramedic refresher program shall consist of at least forty-eight hours according to the "Paramedic Refresher Training Program" education standards approved by the board for the number of hours listed in each of the following subject areas:

(1) Twelve hours on pediatric issues;

(2) Eight hours on trauma issues, to include education on each of the following:

(a) Chest tube monitoring;

(b) Maintenance of blood products.

(3) Nine hours on medical emergencies to include education on each of the following:

(a) Blood chemistry analysis;

(b) Morgan lens.

(4) Four hours on geriatric issues;

(5) A minimum of one hour on identifying and interacting with individuals with dementia;

(6) Six hours on cardiac emergencies to include education on thrombolytic initiation and monitoring;

(7) Four hours on airway and ventilation to include education on positive end-expiratory pressure;

(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 testing, 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
Prior Effective Dates: 10/18/2013