(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
(C)
(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) Carotid
massage;
(16)(15) Twelve-lead
electrocardiogram performance and interpretation;
(17)(16) Administration of
nitroglycerin;
(18)(17) Administration of
aerosolized or nebulized medication;
(19)(18) Epinephrine
administration via intravenous or intraosseous route;
(20)(19)
Placement of nasogastric or orogastric tubes;
(21)(20) Administration of
other medications pursuant to written protocols;
(22)(21) Intravenous
infusion pump;
(23)(22) Blood chemistry
analysis;
(24)(23) Thrombolytic
therapy initiation and monitoring;
(25)(24) Immunizations for
influenza to firefighters, EMTs, AEMTs, or paramedics in accordance with
section 4765.391 of the Revised
Code;
(26)(25) Maintenance of
medicated intravenous fluids;
(27)(26) Maintenance of
blood administration;
(28)(27) Eye irrigation
morgan lens;
(29)(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
(D)
(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;
(30)(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;
(31)(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 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 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.
Notes
Ohio Admin. Code
4765-17-03
Effective:
1/1/2024
Five Year Review (FYR) Dates:
8/29/2023 and
08/01/2028
Promulgated
Under: 119.03
Statutory Authority: 4765.11, 4765.39
Rule Amplifies: 1547.11, 4506.17, 4511.19, 4765.39, 4765.391
Prior Effective Dates: 03/23/2003, 05/29/2008, 12/02/2010,
02/06/2012, 10/18/2013, 06/15/2018, 04/01/2020,
01/01/2021