Creating a Scope of Practice Model that Meets the Needs of Today’s EMS Systems

Should an EMT be able to administer continuous positive airway pressure (CPAP)? What hemorrhage control procedures are appropriately used by which levels of EMS providers?

As the needs of communities, the quality of EMS research, and other key factors change, national, state and local EMS organizations grapple with defining the scopes of practice for EMS practitioners at different certification levels. Many turn to the National EMS Scope of Practice Model, published in 2007, for guidance.

Recognizing the need to update that model, a group of experts has released a draft of revisions to the Practice Model specifically regarding five topics:

  • Use of opioid antagonists at the BLS level
  • Therapeutic hypothermia following cardiac arrest
  • Pharmacological pain management following an acute traumatic event
  • Hemorrhage control
  • Use of CPAP/BiPAP at the EMT level

Those updates are included in a partial draft of the revised Practice Model that is currently posted for public comment and feedback on the project website. The comment period for this draft will close on October 7. Comments from the EMS community are critical to the success of this project.

“I think some of the new things that people will find is that decisions being made about what level of provider does what interventions are much more based on scientific evidence than the they were in the 2007 version,” said Dan Manz, former state EMS director in Vermont and the NASEMSO project advocate for the Scope of Practice effort. “That’s a cause for celebration in my book because there is simply more evidence in 2017 than there was in 2007.”

The draft also includes lists of other potential topics to be addressed, such as spinal motion restriction, ultrasound and capnography. Many of the topics listed came directly from public input, and have not been deliberated yet at length by the experts participating in the project. Future drafts of the Practice Model will include more discussion of some of these additional items.

The project’s Expert Panel includes members representing a range of stakeholders from the EMS community. They took a methodical and comprehensive approach to reviewing the published scientific literature on the five priority items before recommending the draft changes to the scope. Moving forward they will consider whether other changes to the model are necessary as well.

Another topic discussed by the panel was how often the Scope of Practice Model should be reexamined and the possibility of developing a process for making quick revisions when necessary.

“We need a way to change the Scope of Practice when something changes in the EMS environment,” Manz explained.