††††† 202 KAR 7:701. Scope of practice matters.

 

††††† RELATES TO: KRS 311A.135, 311A.140, 311A.160, 311A.165, 311A.170, 311A.175

††††† STATUTORY AUTHORITY: KRS 311A.020, 311A.025, 311A.030, 311A.135, 311A.140, 311A.160, 311A.165, 311A.170

††††† NECESSITY, FUNCTION, AND CONFORMITY: KRS 311A.025, 311A.030, 311A.135, 311A.140, 311A.160, 311A.165, and 311A.170 require the board to promulgate administrative regulations relating to the scope of practice for individuals certified or licensed by the board. This administrative regulation establishes those scopes of practice.

 

††††† Section 1. First Responder. (1) In addition to the skills and procedures outlined in the 1995 edition of the United States Department of Transportation National Standard Curriculum for Emergency Medical Technician - First Responders, first responders certified by the board shall be eligible to perform the following supplemental procedures:

††††† (a) Utilization of oxygen;

††††† (b) Obtaining blood pressures;

††††† (c) Utilization of an automatic external defibrillator; and

††††† (d) Cervical spine and spinal immobilization.

††††† (2) To be eligible to perform the supplemental procedures, a first responder shall have been trained and educated utilizing the "Kentucky Required Mandatory Supplemental Curricula for the First Responder."

††††† (3) An out-of-state first responder may perform any skill or procedure that the first responder may use in the state in which the first responder is certified subject to the first responder being called upon to assist in providing medical and related care during a disaster or emergency pursuant to KRS 39A.050, the Emergency Management Assistance Compact, or an agreement made pursuant to KRS Chapter 39A.

 

††††† Section 2. EMT. (1) In addition to the skills and procedures outlined in the 1994 edition of the United States Department of Transportation National Standard Curriculum for Emergency Medical Technician - Basic, EMTs certified by the board shall be eligible to perform the following supplemental procedures:

††††† (a) Identification of correct placement of an endotracheal tube, including the use of end tidal CO2 monitoring;

††††† (b) Secure an endotracheal tube that has been inserted by appropriately licensed personnel;

††††† (c) Set up and troubleshoot potential problems with a cardiac monitor;

††††† (d) Select and apply cardiac electrodes;

††††† (e) Apply a pulse oximeter and obtain pulse oximetry readings;

††††† (f) Troubleshoot potential problems with a pulse oximeter;

††††† (g) Obtain an appropriate sample for and obtain a blood glucose reading;

††††† (h) Troubleshoot potential problems with a glucose-monitoring device;

††††† (i) Shut off the flow of a preestablished intravenous infusion; and

††††† (j) Care for an intravenous infusion site where a catheter has been dislodged or removed.

††††† (2) To be eligible to perform each of the supplemental procedures, an EMT shall have been trained and educated utilizing:

††††† (a) "Kentucky Required Mandatory Supplemental Curriculum for Emergency Medical Technician (EMT) Initial Training in Advanced Airway Management;"

††††† (b) "Kentucky Ambulance Service Specific Continuing Education Curriculum for the Emergency Medical Technician (EMT) using a noninvasive monitoring device - Application of Electrocardiogram Electrodes and Monitor;"

††††† (c) "Kentucky Ambulance Service Specific Continuing Education Curriculum for the Emergency Medical Technician (EMT) using a noninvasive monitoring device - Application of Pulse Oximetry;"

††††† (d) "Kentucky Ambulance Service Specific Continuing Education Curriculum for the Emergency Medical Technician (EMT) in Blood Glucose Analysis;"

††††† (e) "Kentucky Required Mandatory Supplemental Curriculum for Emergency Medical Technician (EMT) Initial Training in the Monitoring, Maintaining, and Discontinuing of Preestablished Patient Intravenous Infusions in Prehospital, Interfacility, and Facility-to-Home Encounters;" and

††††† (f) "Kentucky Ambulance Service Specific Continuing Education Curriculum for the Emergency Medical Technician (EMT) using a noninvasive monitoring device - Application of End Tidal Carbon Dioxide Monitoring."

††††† (3) An EMT shall adhere to the protocols issued by the employer except if:

††††† (a) The medical director or on-line medical control physician orders otherwise;

††††† (b) Compliance is not in the medical best interest of the patient; or

††††† (c) The EMT does not have the equipment or medication to adhere to the protocol.

††††† (4) Any deviation from an approved protocol shall be documented. The documentation shall be maintained as a part of the ambulance run form and as required by 202 KAR 7:501, Section 5(1)(c).

††††† (5) An out-of-state EMT may perform any skill or procedure that the EMT may use in the state in which the EMT is certified subject to the EMT being called upon to assist in providing medical and related care during a disaster or emergency pursuant to KRS 39A.050, the Emergency Management Assistance Compact, or an agreement made pursuant to KRS Chapter 39A.

 

††††† Section 3. Paramedic Students and Paramedic Graduates. (1) During the didactic, laboratory, and clinical portions of a paramedic course, a paramedic student may perform any skill or procedure, or administer any medication within the scope of practice for a paramedic as defined by KRS 311A.170, if:

††††† (a) The student has been trained and educated to perform the skill or procedure or administer the medication; and

††††† (b) Is permitted to perform the skill or procedure in writing or by direct order of the medical director of the paramedic course.

††††† (2) During the field internship, a paramedic student may perform any skill or procedure, or administer any medication within the scope of practice for a paramedic as defined by KRS 311A.170, if:

††††† (a) The student has written permission by the medical director of the paramedic course to perform the skill or procedure;

††††† (b) The permission is filed with the paramedic course coordinator of the paramedic course; and

††††† (c) The medical director and director of the ambulance service each give written permission to the paramedic student or paramedic graduate to participate in a field internship with their service.

††††† (3) This administrative regulation shall not be construed to allow a first responder student, EMT student, paramedic student, or paramedic graduate to perform any skill or procedure without direct supervision by a physician, registered nurse, or paramedic any of whom shall be licensed in the Commonwealth of Kentucky, except for out-of-state clinical or field rotations specifically approved by the board.

 

††††† Section 4. Paramedic. (1) Paramedics may perform any of the skills and procedures outlined in the 1998 edition of the United States Department of Transportation National Standard Curriculum for Emergency Medical Technician - Paramedic.

††††† (2) A paramedic shall adhere to the protocols issued by the employer and approved by the board except if:

††††† (a) The medical director or on-line medical control physician orders otherwise;

††††† (b) Compliance is not in the medical best interest of the patient; or

††††† (c) The paramedic does not have the equipment or medication to adhere to the protocol.

††††† (3) Any deviation from an approved protocol shall be documented. The documentation shall be maintained as a part of the ambulance run form and as required by 202 KAR 7:501, Section 5(1)(c).

††††† (4) A paramedic functioning in their position of employment may perform any procedure or administer medications authorized by KRS 311A.170, or this administrative regulation, at any location within the Commonwealth subject to the written approval of, and limitations set forth by the paramedicís medical director and the paramedicís employer. A paramedic performing skills or procedures outside of the normal response area for the paramedic shall accompany and assist with or continue treatment for the patient until the patient is accepted by a receiving hospital, an ALS ground or licensed ALS air ambulance provider, or care is transferred to another licensed paramedic, receiving facility RN, advanced registered nurse practitioner, or physician.

††††† (5) An off-duty paramedic may perform any procedure or administer medications authorized by KRS 311A.170, or this administrative regulation, at any location within the Commonwealth subject to the written approval of, and limitations set forth by the paramedicís medical director and, if appropriate, the paramedicís employer; or the paramedic may render care subject to the limitations of their scope of practice at any location, if ordered to do so by a duly licensed physician. A paramedic performing skills or procedures outside of the normal response area for the paramedic shall accompany and assist with or continue treatment for the patient until the patient is accepted by a receiving hospital, an ALS ground or licensed ALS air ambulance provider, or care is transferred to another licensed paramedic, hospital emergency department, RN, advanced registered nurse practitioner, or physician.

††††† (6) An out-of-state paramedic may perform any skill, procedure, or administer any medications that the paramedic may use in the state in which the paramedic is certified or licensed, subject to:

††††† (a) Control of the out-of-state paramedic's medical director or protocols; and

††††† (b) The following conditions and limitations:

††††† 1. An out-of-state paramedic is transporting a patient from out-of-state to a Kentucky medical facility or other location in Kentucky;

††††† 2. An out-of-state paramedic is transporting a patient from out of state through Kentucky to another location out of state; or

††††† 3. An out-of-state paramedic is called upon to assist in providing medical and related care during a disaster or emergency pursuant to KRS 39A.050, the Emergency Management Assistance Compact, or an agreement made pursuant to KRS Chapter 39A.

††††† (7) A paramedic with a critical care endorsement shall be authorized to perform the skills and procedures included in their education and training subject to authorization by the medical director through established protocols.

 

††††† Section 5. Paramedic Hospital Scope of Practice. (1) Paramedics functioning in the hospital environment shall perform within the scope of practice, as defined in this administrative regulation.

††††† (2) Employment of paramedics in hospital emergency department settings, exclusive of their being employed by air or ground transport components, or both, owned or operated by the hospital, shall be subject to demonstrating knowledge based and clinical competencies at a level satisfactory to the employing hospital and subject to applicable laws and administrative regulations.

††††† (3) The employers shall not dictate practice for a paramedic that exceeds the defined scope of practice. The paramedic shall inform the employing institution or supervising staff of any inability or limitation to perform an ordered skill or procedure based upon:

††††† (a) A lack of knowledge of or training or education in the procedure or skill; or

††††† (b) The order or directive exceeding the paramedicís scope of practice.

††††† (4) Employers may provide education or educational opportunities to expand the documented clinical practice of the paramedic but shall not do so with the intent of requiring the paramedic to perform skills or procedures that exceed their statutorily defined scope of practice while in the hospitalís employ.

††††† (5) Paramedics shall have a duty to:

††††† (a) Maintain strict patient confidentiality;

††††† (b) Provide and assure continuity of care to their patients;

††††† (c) Be patient advocates;

††††† (d) Follow the hospitalís chain of command;

††††† (e) Be knowledgeable and function within the scope of practice of a paramedic;

††††† (f) Be clearly identified as a licensed paramedic while functioning in the hospitalís employ;

††††† (g) Appropriately document on patient care records all interventions, treatments and assessments performed by the paramedic;

††††† (h) Perform patient assessment, which may include triage; and

††††† (i) Institute appropriate therapy in the care of patients subject to the limitation of existing protocols.

 

††††† Section 6. Restriction of Practice. This administrative regulation shall not prohibit the medical director from restricting the scope of practice of any first responder, EMT, or paramedic under their authority through established protocols.

 

††††† Section 7. Exemptions. This administrative regulation shall not prohibit a first responder, EMT or paramedic certified or licensed in another state or registered with NREMT from functioning under their statutory or regulatory scope of practice while assisting with mass casualties, weapons of mass destruction or disaster incidents.

 

††††† Section 8. Incorporated by Reference. (1) The following documents are incorporated by reference.

††††† (a) Kentucky Required Mandatory Supplemental Curricula for the First Responder (April 2002);

††††† (b) Kentucky Required Mandatory Supplemental Curriculum for Emergency Medical Technician (EMT) Initial Training in Advanced Airway Management (04-01);

††††† (c) Kentucky Ambulance Service Specific Continuing Education Curriculum for the Emergency Medical Technician (EMT) Using a Noninvasive Monitoring Device - Application of Electrocardiogram Electrodes and Monitor (04-01);

††††† (d) Kentucky Ambulance Service Specific Continuing Education Curriculum for the Emergency Medical Technician (EMT) Using a Noninvasive Monitoring Device - Application of Pulse Oximetry (04-01);

††††† (e) Kentucky Ambulance Service Specific Continuing Education Curriculum for the Emergency Medical Technician (EMT) in Blood Glucose Analysis (04-01);

††††† (f) Kentucky Required Mandatory Supplemental Curriculum for Emergency Medical Technician (EMT) Initial Training in the Monitoring, Maintaining, and Discontinuing of Preestablished Patient Intravenous Infusions in Prehospital, Interfacility, and Facility-to-home Encounters (04-01); and

††††† (g) Kentucky Ambulance Service Specific Continuing Education Curriculum for the Emergency Medical Technician (EMT) using a noninvasive monitoring device - Application of End Tidal Carbon Dioxide Monitoring (04-01).

††††† (2) This material may be inspected, obtained, or copied, subject to applicable copyright law, at the Office of the Kentucky Board of Emergency Medical Services, 2545 Lawrenceburg Road, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m. (30 Ky.R. 174; Am. 942; 1240; 1501; eff. 11-19-2003.)