(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)
(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
(C)
(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
(D)
(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 prepositioned 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.
Notes
Ohio Admin. Code
4765-16-04
Effective:
1/1/2024
Five Year Review (FYR) Dates:
9/26/2023 and
08/01/2028
Promulgated
Under: 119.03
Statutory Authority: 4765.11, 4765.38
Rule Amplifies: 1547.11, 4506.17, 4511.19, 4765.38
Prior Effective Dates: 03/23/2003, 05/29/2008, 12/02/2010,
02/06/2012, 10/18/2013, 06/15/2018,
04/01/2020