EMT-1 Expanded Scope
Los Angeles County EMT-1
Expanded Scope of Practice
Los Angeles County EMT-1 Expanded scope of practice
Implementation

February 28, 1997 became policy(#802)
(revised February 01, 2011)

May 30, 1997 after this date all EMT-1’s
certified or recertified in LA County
must have attended EMT-1 expanded
scope training.
Los Angeles County EMT-1 Expanded scope of practice
Title 22
State Scope of Practice

What 2 drugs?

IV monitoring - NO ADDITIVES
Los Angeles County EMT-1 Expanded scope of practice
IV monitoring
 may
monitor, maintain, & adjust a
preset rate of flow.
 shut
off IV if there are signs of
infiltration.
Los Angeles County EMT-1 Expanded scope of practice
Expanded Scope
 Los
Angeles County only
 Policy
802
 If
finer points of this policy are
difficult to remember use cheat
cards!
Los Angeles County EMT-1 Expanded scope of practice
Assists with MEDS
EMT-1’s may assist the patient or allow
the patient to self administer the
following medications:
Nitroglycerin
Epinephrine
Bronchodilator inhaler
Los Angeles County EMT-1 Expanded scope of practice
Parameters
1- The 3 medications - What are they?
2- patient condition must indicate use
(specifically & conclusively)
3- must be prescribed to patient
4- must be patient’s own medication
5- doses PTA count
Los Angeles County EMT-1 Expanded scope of practice
WARNING

YOU ARE NEVER ALLOWED TO
CARRY THESE MEDICATIONS ON
THE UNIT OR IN YOUR JUMP KIT.

If you are told otherwise IT IS WRONG.
Los Angeles County EMT-1 Expanded scope of practice
If you administer...
You must have an ALS unit enroute.
or
 The patient must be transported
immediately to the nearest* hospital .


Never treat & release - this is
emergency supportive therapy.
* most accessible
Los Angeles County EMT-1 Expanded scope of practice
Review of Drug Routes
IV – Intravenous
 SL – Sublingual
 PO – By mouth
 IM – Intramuscular
 SQ or SC - Subcutaneous
 IO - Interosseous
 Transcutaneous
 IN – Inhaled
 PR – Per rectum

Los Angeles County EMT-1 Expanded scope of practice
Review of DICCE
D
– Dose
 I - Integrity
 C - Concentration
 C - Clarity
 E – Expiration Date
Los Angeles County EMT-1 Expanded scope of practice
Nitroglycerin
Indication:
Route:
Chest pain
sub lingual
Repeat:
Max of 3 doses
Contraindication:
BP less than 100 systolic
Viagra w/in 24 hrs
3 doses prior to arrival
Head injury
Los Angeles County EMT-1 Expanded scope of practice
Note

comes in tablet, spray or skin patch

always check blood pressure after
administration.
Los Angeles County EMT-1 Expanded scope of practice
Epinephrine auto injector
Indication:
severe allergic reaction
Repeat:
as prescribed
Route:
IM
Site:
upper-outer thigh only!
Los Angeles County EMT-1 Expanded scope of practice
Note
there are several brands
 1 dose only
 injection into buttocks, arm, hands, will
result in inadequate absorption & soft
tissue damage.
 IV admin. could cause MI or CVA
 Side effects: tachycardia, pallor,
dizziness, chest pain, headache, n/v

Los Angeles County EMT-1 Expanded scope of practice
Bronchodilator Inhalers
Indications:
Dyspnea, associated with
bronchospasm (asthma,
bronchitis, COPD)
Repeat:
as prescribed
Contra:
patient unable to use device
maximum doses taken PTA
Los Angeles County EMT-1 Expanded scope of practice
Notes

In cold environment

Inhale slowly and continuously
Los Angeles County EMT-1 Expanded scope of practice
Commonly Prescribed
Bronchodilators

albuterol - terbutaline - metaproterenol

Proventil - Ventolin - Bronkosol - Bronkometer
- Alupent – Meteprel - Brethine ...
Los Angeles County EMT-1 Expanded scope of practice
Form / devices include
Inhaler
 Inhaler with a spacer
 hand held nebulizer*
 Pulmonaid device*

* patient or caretaker must set up if EMT
is unfamiliar with equipment.
Los Angeles County EMT-1 Expanded scope of practice
Document properly

Assessment AND THE FOLLOWING:
medicine prescribed by MD
 medicine is patient’s
 other factors
 VITALS & REASSESSMENT after
treatment

Los Angeles County EMT-1 Expanded scope of practice
IV monitoring
Additives
Los Angeles County EMT-1 Expanded scope of practice
Monitor IV with additives
 Folic
acid - 1mg / 1000ml max
 Multivitamins - 1 vial /1000ml max
 Magnesium Sulfate –
2grams/1000ml (in conjunction
w/MVI
 Thiamin - 100mg / 1000ml max
monitor, maintain, & adjust a TKO
rate of flow.
Los Angeles County EMT-1 Expanded scope of practice
Additives requiring an
infusion pump
 Potassium
chloride
 Total Parental Nutrition (TPN)
These additives may not be transported
without an infusion pump
Los Angeles County EMT-1 Expanded scope of practice
Patient Controlled Infusion
Pumps
may be implanted or external
 may only be activated by patient or
caregiver.
 transport locked


Insulin - Demerol - Morphine
Los Angeles County EMT-1 Expanded scope of practice
Other Devices..
Central lines
 Indwelling vascular access device

Los Angeles County EMT-1 Expanded scope of practice
MAY NOT TRANSPORT
1 - Central venous monitoring devices*
2 - Swan Ganz catheters
3 - Arterial lines
Los Angeles County EMT-1 Expanded scope of practice
Chemotherapy

There are risks

Exposures can occur from IV leakage or
spills
Los Angeles County EMT-1 Expanded scope of practice
Acute Risks of Exposure
 Irritation
 Burning
 Tissue
destruction
Los Angeles County EMT-1 Expanded scope of practice
Chronic Risks of Exposure
 Genetic
damage
 Birth defects
 Cancer
Los Angeles County EMT-1 Expanded scope of practice
Precautions

Wear protective clothing - universal
precautions.

Nursing mothers should not have any
contact with patient.

HAVE A SPILL KIT
Los Angeles County EMT-1 Expanded scope of practice
Contents of Spill Kit
2 pairs of gloves - thick (.007 inch)
 gown & shoe covers
 goggles
 mask
 disposal bags & equipment

Los Angeles County EMT-1 Expanded scope of practice
First Aid
Skin
wash immediately with
soap & water.
Eyes
flush with normal saline
or water for 5 minutes.
Los Angeles County EMT-1 Expanded scope of practice
THE END
Next?
Los Angeles County EMT-1 Expanded scope of practice