Read NC DHSR OEMS: NCMB Approved Med Skills for EMS Personnel v10182008 text version

North Carolina Medical Board

Approved Medications for Credentialed EMS Personnel

EMS personnel at any level who administer medications must do so within an EMS system that provides medical oversight. Personnel must follow written treatment protocols and must complete appropriate medical education. All EMS System protocols and policies must be reviewed and approved by the Medical Director of the Office of EMS.

Medications ACE inhibitors acetaminophen adenosine aminophylline amiodarone antibiotics anti-emetic preparations aspirin atropine barbiturates benzodiazepine preparations beta agonist preparations beta blockers bretylium calcium channel blockers calcium chloride/gluconate charcoal clonidine clopidogrel crystalloid solutions cyanide poisoning antidote kit digoxin diphenhydramine dobutamine dopamine epinephrine etomidate flumazenil furosemide glucagon glucose solutions heparin (unfractionated and low molecular weight) histamine 2 blockers hydroxocobalamin immunizations insulin ipratropium isoproterenol lidocaine magnesium sulfate mannitol methylene blue milrinone

Last revision: October 18, 2008

Previous revisions 11/2007, 05/2006; 06/2005; 12/2004.

MR

EMT X

EMT-I X

X4

X X4 X2

X X4 X

X

X X

X3 X1 X1

X X

X X X X X6 X

EMT-P X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X6 X X X X X X X X

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Medications narcotic analgesics narcotic antagonists nasal spray decongestant nesiritide nitroglycerin nitroprusside sodium nitrous oxide non-prescription medications non-steroidal anti-inflammatory norepinephrine oxygen oxytocin paralytic agents phenothiazine preparations phenytoin preparations plasma protein fraction platelet g-II/IIIa inhibitors potassium chloride pralidoxime procainamide procaine proparacaine proton pump inhibitors sodium bicarbonate steroid preparations thiamine thrombolytic agents topical hemostatic agents Total Parenteral Nutrition tuberculosis skin test valproic acid vasopressin whole blood and components ziprasidone

1

MR

EMT X7 X X2 X X

EMT-I X X X X X X5

X5

X5

X4

X4

X4

X X X X X6 X

EMT-P X X X X X X X X X X X5 X X X X X X X X X X X X X X X X X X X6 X X X X

MR and EMT use of epinephrine is limited to the treatment anaphylaxis and may be administered only by auto injector. 2 EMT use of beta-agonists and nitroglycerine is limited to patients who currently are prescribed the medication. EMTs may administer these medications from EMS supplies. EMT use of beta-agonists may be through any inhaled method of medication administration. 3 EMT administration of diphenhydramine is limited to the oral route. 4 As a component of preparedness for domestic terrorism, EMS personnel, public safety officers, and other first responders recognized by the EMS system, may carry, selfadminister, or administer to a patient atropine and/or pralidoxime, based on written protocols and medical direction. All personnel except for EMT-Ps must administer these medications by an auto injector. 5 Administration of oxygen does not require medical direction. 6 Administration of immunizations and TB skin tests are not limited to public health initiatives. 7 EMT administration of naloxone is limited to the intra-nasal route.

Last revision: October 18, 2008

Previous revisions 11/2007, 05/2006; 06/2005; 12/2004.

2

North Carolina Medical Board

Approved Skills for Credentialed EMS Personnel

EMS personnel performing these skills must do so within an EMS system. Personnel must follow written treatment protocols and must complete appropriate medical education. All EMS System protocols and policies must be reviewed and approved by the Medical Director of the Office of EMS.

Skills 12-Lead ECG acquisition & transmission 12-Lead ECG interpretation Airway-Blind Insertion Device Airway-CPAP Airway-Cricothyrotomy-Needle Airway-Cricothyrotomy-Surgical Airway-Intubation Airway-Rapid sequence induction Airway-Suction Airway-Tracheostomy tube change Arterial Access-Blood Draw Arterial Line maintenance Capnography (waveform) Carbon Monoxide Measurement (non-invasive) Cardiac Pacing-External Cardiopulmonary Resuscitation Cardioversion Carotid Massage Central Venous Pressure line maintenance Chest Compression-External Device Chest Decompression-Needle Chest Tube Maintenance Defibrillation-Automated Defibrillation-Manual Epidural Catheter maintenance Gastric Intubation Glucose Measurement Intra-Ventricular Catheter maintenance Intubation Confirmation-Capnometry (color) Intubation Confirmation-Esophageal Bulb Medication Administration Orthostatic Blood Pressure Oxygen Administration Patient Assessment Pulse Oximetry Reperfusion Checklist Respirator Operation Restraints Spinal Immobilization Splinting Stroke Screen Swan-Ganz Catheter maintenance Thermometer (oral & rectal with low temperature capability)

Last revision: October 18, 2008

Previous revisions 11/2007, 05/2006; 06/2005; 12/2004.

EMD

MR

EMT X X2

EMT-I X X X X

X

X

X

X X

X X X

X X X

X X X X

X

X

X X X X3 X X X X X X X X X X X

X3 X X X X X X X X X X

X3 X X X X X X X X X X X

EMT-P X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X3 X X X X X X X X X X X X

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Skills Urinary Catheterization Venous Access-Blood Draw Venous Access-Existing catheters Venous Access-Femoral Line Venous Access-Intraosseous Venous Access-Peripheral Ventilator Operation Wound Care Pre-arrival instructions to callers Determine and dispatch appropriate EMS system resources

1

EMD

MR

EMT

EMT-I X

X X1 X1 X X X

EMT-P X X X X X X X X

All EMD skills must be performed in EMS systems with medical oversight and written EMD protocols. 2 EMTs using blind insertion airway devices must be functioning in EMS systems with medical direction and written treatment protocols. 3 EMS personnel at any level who administer medications must do so within an EMS system that provides medical oversight. Personnel must follow written treatment protocols and must complete appropriate medical education. All EMS System protocols and policies must be reviewed and approved by the Medical Director of the Office of EMS. The approved medication list is found at the beginning of this document. The administration of oxygen does not require medical direction.

Last revision: October 18, 2008

Previous revisions 11/2007, 05/2006; 06/2005; 12/2004.

4

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