Scope of practice of NREMT
The scope of medical practice for EMTs is regulated by state law, and can vary significantly both among states as well as inside states. In general, EMTs provide what is considered basic life support (BLS) and are limited to essentially non-invasive procedures. Besides employing basic medical assessment skills, typical procedures provided by EMTs include CPR, automated external defibrillation, mechanical ventilation using a bag valve mask, placement of air way adjuncts such as oropharyngeal and nasopharyngeal airways, pulse oximetry, glucose testing using a glucometer, splinting (including spinal immobilization and traction splints), and suctioning. In addition, EMT-Bs are trained to assist patients with administration of certain prescribed medications, including nitroglycerin, metered-dose inhaler such as albuterol, and epinephrine auto injectors such as the EpiPen. EMT-Bs can typically also administer certain non-preprescribed drugs including oxygen, oral glucose, and activated charcoal (usually upon medical direction).[2] In response to the opioid overdose epidemic, states are rapidly changing protocols to permit EMT-Bs to administer naloxone as well. [3] Individually, each state is free to add or subtract to their EMTs scope of practice. For example, EMTs working in California may not administer activated charcoal, an NHTSA approved intervention, under a standard certification. Local emergency medical services (EMS) systems (i.e. counties in California) can apply to the state to implement an extended scope of practice for EMTs that includes activated charcoal[4] as well as other pharmaceutical interventions not normally allowed to be administered by EMTs.
