Section 100146 - [Operative until 1/1/2025] Scope of Practice of Paramedic(a) A paramedic may perform any activity identified in the scope of practice of an EMT in Chapter 2 of this Division, or any activity identified in the scope of practice of an Advanced EMT (AEMT) in Chapter 3 of this Division without requiring a separate certification.(b) A licensed paramedic shall be affiliated with an approved paramedic service provider in order to perform the scope of practice specified in this Chapter.(c) A paramedic student or a licensed paramedic, as part of an organized EMS system, while caring for patients in a hospital as part of his/her training or continuing education (CE) under the direct supervision of a physician, registered nurse, or physician assistant, or while at the scene of a medical emergency or during transport, or during interfacility transfer, or while working in a small and rural hospital pursuant to Section 1797.195 of the Health and Safety Code, may perform the following procedures or administer the following medications when such are approved by the medical director of the LEMSA and are included in the written policies and procedures of the LEMSA. (1) Basic Scope of Practice: (A) Utilize electrocardiographic devices and monitor electrocardiograms, including 12-lead electrocardiograms (ECG).(B) Perform defibrillation, synchronized cardioversion, and external cardiac pacing.(C) Visualize the airway by use of the laryngoscope and remove foreign body(ies) with Magill forceps.(D) Perform pulmonary ventilation by use of lower airway multi-lumen adjuncts, the esophageal airway, perilaryngeal airways, stomal intubation, and adult oral endotracheal intubation.(E) Utilize mechanical ventilation devices for continuous positive airway pressure (CPAP)/bi-level positive airway pressure (BPAP) and positive end expiratory pressure (PEEP) in the spontaneously breathing patient.(F) Institute intravenous (IV) catheters, saline locks, needles, or other cannulae (IV lines), in peripheral veins and monitor and administer medications through pre-existing vascular access.(G) Institute intraosseous (IO) needles or catheters.(H) Administer IV or IO glucose solutions or isotonic balanced salt solutions, including Ringer's lactate solution.(I) Obtain venous blood samples.(J) Use laboratory devices, including point of care testing, for pre-hospital screening use to measure lab values including, but not limited to: glucose, capnometry, capnography, and carbon monoxide when appropriate authorization is obtained from State and Federal agencies, including from the Centers for Medicare and Medicaid Services pursuant to the Clinical Laboratory Improvement Amendments (CLIA).(K) Utilize Valsalva maneuver.(L) Perform percutaneous needle cricothyroidotomy.(M) Perform needle thoracostomy.(N) Perform nasogastric and orogastric tube insertion and suction.(O) Monitor thoracostomy tubes.(P) Monitor and adjust IV solutions containing potassium, equal to or less than 40 mEq/L.(Q) Administer approved medications by the following routes: IV, IO, intramuscular, subcutaneous, inhalation, transcutaneous, rectal, sublingual, endotracheal, intranasal, oral or topical.(R) Administer, using prepackaged products when available, the following medications: 1. 10%, 25% and 50% dextrose;4. aerosolized or nebulized beta-2 specific bronchodilators;11. diphenhydramine hydrochloride;12. dopamine hydrochloride;19. lidocaine hydrochloride;22. naloxone hydrochloride;23. nitroglycerine preparations, except IV, unless permitted under (c)(2)(A) of this section;(S) In addition to the approved paramedic scope of practice, the CCP or FP may perform the following procedures and administer medications, as part of the basic scope of practice for interfacility transports, when approved by the LEMSA medical director. 1. set up and maintain thoracic drainage systems;2. set up and maintain mechanical ventilators;3. set up and maintain IV fluid delivery pumps and devices;4. blood and blood products;5. glycoprotein IIB/IIIA inhibitors;10. maintain total parenteral nutrition;(2) Local Optional Scope of Practice: (A) Perform or monitor other procedure(s) or administer any other medication(s) determined to be appropriate for paramedic use by the medical director of the LEMSA, that have been approved by the Director of the Authority. Paramedics shall demonstrate competency in performing these procedures and administering these medications through training and successful testing.(B) The medical director of the LEMSA shall submit a written request, Form #EMSA-0391, revised 01/17, incorporated herein by reference, to the Director of the Authority for approval of any procedures or medications proposed for use in accordance with Section 1797.172(b) of the Health and Safety Code prior to implementation.(C) The Authority shall, within fourteen (14) days of receiving Form #EMSA-0391, revised 01/17, notify the medical director of the LEMSA that the form has been received and shall specify what information, if any, is missing.(D) The Director of the Authority, in consultation with the Emergency Medical Services Medical Directors Association of California's (EMDAC) Scope of Practice Committee, shall approve or disapprove the request for additional procedures and/or administration of medications and notify the LEMSA medical director of the decision within ninety (90) days of receipt of the completed request. An approved status shall be in effect for a period of three (3) years. An approved status may be renewed for another three (3) year period, upon the authority's receipt of a written request that includes, but is not limited to, the following information: the utilization of the procedure(s) or medication(s), beneficial effects, adverse reactions or complications, statistical evaluation, and general conclusion.(E) The Director of the Authority, in consultation with the EMDAC Scope of Practice Committee, may suspend or revoke approval of any previously approved additional procedure(s) or medication(s) for cause.(d) The medical director of the LEMSA may develop policies and procedures or establish standing orders allowing the paramedic to initiate any paramedic activity in the approved scope of practice without voice contact for medical direction from a physician, authorized registered nurse, or mobile intensive care nurse (MICN), provided that an EMSQIP is in place as specified in Chapter 12 of this Division.Cal. Code Regs. Tit. 22, § 100146
Note: Authority cited: Sections 1797.107, 1797.172, 1797.185, 1797.192, 1797.195 and 1797.214, Health and Safety Code. Reference: Sections 1797.56, 1797.172, 1797.178 and 1797.185, Health and Safety Code.
Note: Authority cited: Sections 1797.107, 1797.172, 1797.185, 1797.192, 1797.195 and 1797.214, Health and Safety Code. Reference: Sections 1797.56, 1797.172, 1797.178 and 1797.185, Health and Safety Code.
1. Renumbering and amendment of former section 100146 to section 100150, and renumbering and amendment of section 100142 to section 100146 filed 7-10-89; operative 8-9-89 (Register 89, No. 29). For prior history, see Register 84, No. 20.
2. Amendment of subsections (b) and (d) filed 11-4-91; operative 1-1-92 (Register 92, No. 10).
3. Renumbering of former section 100146 to section 100147 and renumbering of former section 100145 to section 100146, including amendment of section heading and section, filed 3-15-99; operative 4-14-99 (Register 99, No. 12).
4. Amendment of subsections (c)-(g), (g)(2), (i) and (k) filed 9-10-2004; operative 10-10-2004 (Register 2004, No. 37).
5. Renumbering of former section 100146 to section 100147 and renumbering and amendment of former section 100145 to section 100146 filed 2-11-2013; operative 4-1-2013 (Register 2013, No. 7).
6. Change without regulatory effect amending subsection (c)(1)(S) filed 2-8-2016 pursuant to section 100, title 1, California Code of Regulations (Register 2016, No. 7).
7. Amendment of subsections (a), (b), (c)(1)(S) and (c)(2)(A)-(d) and amendment of Note filed 1-24-2020; operative 4/1/2020 (Register 2020, No. 4).
8. Amendment of subsection (c)(1)(R)25. and new subsections (c)(1)(R)26.-29. filed 11-22-2023; operative 1/1/2024 (Register 2023, No. 47).The amended version of this section by Register 2024, No. 38, effective 1/1/2025 is not yet available.