California Code of Regulations › Title 22 - Social Security › Division 9 - Prehospital Emergency Medical Services › Chapter 4 - Emergency Medical Technician-Paramedic › Article 2 - General Provisions › Section 100146 - Scope of Practice of Paramedic

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A paramedic
				  may perform any activity identified in the scope of practice of an EMT in Chapter 2
				  of this Division, or any activity identified in the scope of practice of an Advanced
				  EMT (AEMT) in Chapter 3 of this Division without requiring a separate
				  certification.
(b) A licensed paramedic
				  shall be affiliated with an approved paramedic service provider in order to perform
				  the scope of practice specified in this Chapter.
(c) A paramedic student or a licensed paramedic,
				  as part of an organized EMS system, while caring for patients in a hospital as part
				  of his/her training or continuing education (CE) under the direct supervision of a
				  physician, registered nurse, or physician assistant, or while at the scene of a
				  medical emergency or during transport, or during interfacility transfer, or while
				  working in a small and rural hospital pursuant to Section
				  1797.195
				  of the Health and Safety Code, may perform the following procedures or administer
				  the following medications when such are approved by the medical director of the
				  LEMSA and are included in the written policies and procedures of the LEMSA.
(1) Basic Scope of Practice:
(A) Utilize electrocardiographic devices and
				  monitor electrocardiograms, including 12-lead electrocardiograms (ECG).
(B) Perform defibrillation, synchronized
				  cardioversion, and external cardiac pacing.
(C) Visualize the airway by use of the
				  laryngoscope and remove foreign body(ies) with Magill forceps.
(D) Perform pulmonary ventilation by use of lower
				  airway multi-lumen adjuncts, the esophageal airway, perilaryngeal airways, stomal
				  intubation, and adult oral endotracheal intubation.
(E) Utilize mechanical ventilation devices for
				  continuous positive airway pressure (CPAP)/bi-level positive airway pressure (BPAP)
				  and positive end expiratory pressure (PEEP) in the spontaneously breathing
				  patient.
(F) Institute intravenous (IV)
				  catheters, saline locks, needles, or other cannulae (IV lines), in peripheral veins
				  and monitor and administer medications through pre-existing vascular
				  access.
(G) Institute intraosseous (IO)
				  needles or catheters.
(H) Administer IV
				  or IO glucose solutions or isotonic balanced salt solutions, including Ringer's
				  lactate solution.
(I) Obtain venous
				  blood samples.
(J) Use laboratory
				  devices, including point of care testing, for pre-hospital screening use to measure
				  lab values including, but not limited to: glucose, capnometry, capnography, and
				  carbon monoxide when appropriate authorization is obtained from State and Federal
				  agencies, including from the Centers for Medicare and Medicaid Services pursuant to
				  the Clinical Laboratory Improvement Amendments (CLIA).
(K) Utilize Valsalva maneuver.
(L) Perform percutaneous needle
				  cricothyroidotomy.
(M) Perform needle
				  thoracostomy.
(N) Perform nasogastric
				  and orogastric tube insertion and suction.
(O) Monitor thoracostomy tubes.
(P) Monitor and adjust IV solutions containing
				  potassium, equal to or less than 40 mEq/L.
(Q) Administer approved medications by the
				  following routes: IV, IO, intramuscular, subcutaneous, inhalation, transcutaneous,
				  rectal, sublingual, endotracheal, intranasal, oral or topical.
(R) Administer, using prepackaged products when
				  available, the following medications:
1. 10%, 25%
				  and 50% dextrose;
2. activated
				  charcoal;
3. adenosine;
4. aerosolized or nebulized beta-2 specific
				  bronchodilators;
5.
				  amiodarone;
6. aspirin;
7. atropine sulfate;
8. pralidoxime chloride;
9. calcium chloride;
10. diazepam;
11. diphenhydramine hydrochloride;
12. dopamine hydrochloride;
13. epinephrine;
14. fentanyl;
15. glucagon;
16. ipratropium bromide;
17. lorazepam;
18. midazolam;
19. lidocaine hydrochloride;
20. magnesium sulfate;
21. morphine sulfate;
22. naloxone hydrochloride;
23. nitroglycerine preparations, except IV, unless
				  permitted under (c)(2)(A) of this section;
24. ondansetron;
25. sodium bicarbonate;
26. tranexamic acid;
27. ketamine;
28. ketorolac;
29. acetaminophen IV.
(S) In addition to the approved paramedic scope of
				  practice, the CCP or FP may perform the following procedures and administer
				  medications, as part of the basic scope of practice for interfacility transports,
				  when approved by the LEMSA medical director.
1.
				  set up and maintain thoracic drainage systems;
2. set up and maintain mechanical
				  ventilators;
3. set up and maintain IV
				  fluid delivery pumps and devices;
4.
				  blood and blood products;
5.
				  glycoprotein IIB/IIIA inhibitors;
6.
				  heparin IV;
7. nitroglycerin
				  IV;
8. norepinephrine;
9. thrombolytic agents;
10. maintain total parenteral nutrition;