EDUCATION STANDARDS
The Scope of Practice does not have regulatory authority, but provides guidance to States.
Adherence to the Scope of Practice would increase uniformity in EMS practice throughout this country and facilitate reciprocity between States. Leadership for this project was delegated to the National Association of State EMS Officials and funded by NHTSA and HRSA. The Scope of Practice does not have regulatory authority, but provides guidance to States. Adherence to the Scope of Practice would increase uniformity in EMS practice throughout this country and facilitate reciprocity between States. Leadership for this project was delegated to the National Association of State EMS Officials and funded by NHTSA and HRSA.
Further, the document describes each level of licensure as distinct and distinguished by unique
“skills, practice environment, knowledge, qualifications, services provided, risk, level of supervisory responsibility, and amount of autonomy and judgment/critical thinking/decision making.”
The Standards also assume there is a progression in practice from the Emergency Medical Responder level to the Paramedic level. That is, licensed personnel at each level are responsible for all knowledge, judgments, and behaviors at their level and at all levels preceding their level.
For example, a Paramedic is responsible for knowing and doing everything identified in that specific area, as well as knowing and doing all tasks in the three preceding levels.
Preparatory Includes
EMR
Uses simple knowledge of the EMS system, safety/well-being of the EMR, medical/legal issues at the scene of an emergency while awaiting a higher level of care.
EMT
Applies fundamental knowledge of the EMS system, safety/well-being of the EMT, medical/legal and ethical issues to the provision of emergency care.
AEMT(Same as EMT)
Applies fundamental knowledge of the EMS system, safety/well-being of the AEMT, medical/legal and ethical issues to the provision of emergency care.
Paramedic
Integrates comprehensive knowledge of EMS systems, the safety/well-being of the
paramedic, and medical/legal and ethical issues which is intended to improve the health of EMS personnel, patients, and the community.
EMS Systems Emergency Medical Responder (EMR)
Simple depth, simple breadth
• The Emergency Medical Services (EMS) System o The Current EMS Systems
o National Highway Traffic Safety Administration (NHTSA) is Lead Coordinating Agency
o Access to EMS o Education
o Authorization to Practice
• Roles, Responsibilities, and Professionalism of EMS Personnel o Roles and Responsibilities
o Professionalism
• Quality Improvement
o Dynamic System for Continually Evaluating and Improving Care EMT: EMR Material PLUS:
Simple depth, foundational breadth
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:
• The Emergency Medical Services System o History
o NHTSA Technical Assistance Program Assessment Standards o Access to Emergency Medical Services
o Education
o Authorization to Practice
• Roles, Responsibilities, and Professionalism of EMS Personnel o Roles and Responsibilities
o Professionalism
• Quality Improvement
o System for Continually Evaluating and Improving Care o Continuous Quality Improvement (CQI)
o Dynamic Process
• Patient Safety
o Significant – One of the Most Urgent Health Care Challenges o High-Risk Activities
o How Errors Happen o Preventing Errors
Advanced EMT (AEMT): EMT Material PLUS:
Fundamental depth, foundational breadth
The AEMT Instructional Guidelines in this section include all the topics and material at the EMT level PLUS the following material:
• Quality Improvement
o System for Continually Evaluating and Improving Care o Continuous Quality Improvement (CQI)
o Dynamic Process
• Patient Safety
o Significant – One of the Most Urgent Health Care Challenges
o Incidence – IOM report “To Err is Human” Up to 98,000 patients die due to medical errors
o High Risk Activities o How Errors Happen o Preventing Errors
• Education
o Levels of EMS licensures
o National EMS Education Agenda for the Future: A Systems Approach
• Authorization to Practice
o Legislative Decisions on Scope of Practice o State EMS Office Oversight
o Medical Oversight o Local Credentialing
o Employer Policies and Procedures
• Integration with Other Professionals and Continuity of Care o Medical Personnel
o Law Enforcement
o Emergency Management o Home Healthcare Providers o Other Responders
• Maintenance of Certification and Licensure o Personal Responsibility
o Continuing Education
o Skill Competency Verification o Criminal Implications
o Fees
Paramedic: AEMT Material PLUS:
Fundamental depth, foundational breadth
• History of EMS
Complex depth, comprehensive breadth
• EMS Systems
• Roles/responsibilities/professionalism of EMS personnel
• Quality Improvement
• Patient Safety
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• History of EMS
o EMS prior to World War I
o EMS between World War I and II o Post World War II
• EMS Systems
o Components of the EMS System o Chain of survival
o Service Types o Trauma Systems o Medical Direction
• Roles/Responsibilities/Professionalism of EMS Personnel o Roles and Responsibilities
o Leadership/Affective Characteristics o Administration
o Credentialing
o Less Traditional Roles o Operational Responsibilities o Education
o Professionalism
o Affective characteristics
• Quality Improvement
o System for continually evaluating and improving care o Continuous quality improvement (CQI)
o Dynamic process
• Patient Safety
o Significant – one of the most urgent health care challenges
o Incidence – IOM report “To Err is Human” up to 98,000 patients die due to medical errors
o High risk activities o How errors happen o Preventing Errors
Research
EMR
Simple depth, simple breadth
• Impact of research on EMR care
• Data collection
EMT: EMR Material PLUS:
Simple depth, simple breadth
• Evidence-based decision making
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level plus the following material:
• Evidence-Based Decision-Making
o Traditional medical practice is based on medical knowledge, intuition, and judgment.
o High-Quality Patient Care Should Focus on Procedures Proven Useful in Improving Patient Outcomes
o The Challenge for EMS Is the Relative Lack of Prehospital Research o Evidence-Based Decision-Making Technique
AEMT: Same as Previous Level
Paramedic: AEMT Material PLUS:
Fundamental depth, foundational breadth
• Research principles to interpret literature and advocate evidence-based practice
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level, PLUS the following material:
• Research Principles to Interpret Literature and Advocate Evidence-Based Practice o Introduction to Research
o Importance of Research in EMS o Types of Research
o Ethical Considerations in Research o Literature Review
o Statistics
o Relating Research to EMS o Evidence-based decision making
Workforce Safety and Wellness EMR
Simple depth, simple breadth
• Standard Safety Precautions
o Baseline Health Assessment o Hand washing
o Adherence to Standard Precautions/OSHA Regulation o Safe Operation of EMS/Patient Care Equipment o Environmental Control
o Occupational Health and Blood borne Pathogens
• Personal Protective Equipment
o Exposure to Diseases Spread Through Blood or Body Fluids or by Respiratory Droplets Are Best Prevented by the Use of Standard Precautions
o Standard Precautions
o What to do if an exposure occurs o Soiled equipment or vehicles
• Stress Management
o Many EMS Situations Can Be Stressful for EMS Personnel o EMR Should Be Supportive
o During and Immediately After a Stressful Incident o Recognize the Warning Signs of Personal Stress o Strategies to Manage Personal Stress
o Dealing With Death and Dying
• Prevention of Response-Related Injuries o Exposure to Infectious Diseases o Injury Prevention
• Lifting and Moving Patients o Body Mechanics
o Know Your Own Physical Limitations o Emergency Moves
o Positioning Patients o Restraint
EMT: EMR Material PLUS:
Fundamental depth, foundational breadth
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level plus the following material:
• Standard Safety Precautions o Hand washing
o Adherence to Standard Precautions/OSHA Regulation o Safe Operation of EMS/Patient Care Equipment o Environmental Control
o Occupational Health and Blood borne Pathogens
• Personal Protective Equipment
• Stress Management
o Types of Stress Reactions o Stress Management
o Dealing With Death and Dying (stages)
• Prevention of Work-Related Injuries o Vehicle restraint systems o Safe lifting techniques o Adequate sleep
o Physical fitness and nutrition o Hazard awareness
o Adherence to Standard Precautions/OSHA regulations
o Disease transmission prevention
• Lifting and Moving Patients o Lifting techniques
o Safe Lifting of Cots and Stretchers o Techniques
o Equipment
o Patient Positioning o Medical Restraint
o Personnel Considerations
• Disease Transmission
• Wellness Principles
o Physical Wellbeing o Mental Wellbeing AEMT: Same as Previous Level
Paramedic: AEMT Material PLUS:
Complex depth, comprehensive breadth
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level, PLUS the following material:
• Provider safety and wellbeing
• Standard safety precautions
• Personal protective equipment
• Stress management
• Dealing with death and dying
• Prevention of work related injuries
• Lifting and moving patients
• Disease transmission
• Wellness principles
• Provider Safety and Well-Being
• Standard safety precautions o Handwashing
o Adherence to standard precautions/OSHA regulations o Safe operation of EMS/patient care equipment
o Environmental control
o Occupational health and bloodborne pathogens
• Personal Protective Equipment
• Stress Management
o Types of stress reactions o Stress management
o Dealing with death and dying
o Stages of death and dying
• Prevention of Work-Related Injuries o Vehicle restraint systems o Safe lifting techniques o Adequate sleep
o Physical fitness and nutrition o Hazard awareness
o Adherence to standard precautions/OSHA regulations
o Disease transmission prevention -- communicable versus blood borne o Lifting and moving patients
o Lifting techniques
o Safe lifting of cots and stretchers.
o Power lift or squat lift position o Power grip
o Back in locked-in position o Carrying
o Reaching
o Pushing and pulling guidelines o Equipment
• Disease Transmission
• Wellness Principles
o Physical Wellbeing o Mental Wellbeing
Documentation EMR
Simple depth, simple breadth
• Recording patient findings o Prehospital Care Report o Document
EMT: EMR Material PLUS:
Fundamental depth, foundational breadth
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:
• Principles of Medical Documentation and Report Writing o Minimum Dataset
o Prehospital Care Report
o Documentation of Patient Refusal
o Special Situations/Reports/Incident Reporting
AEMT: EMT Material PLUS:
Complex depth, foundational breadth
The AEMT Instructional Guidelines in this section include all the topics and material at the EMT level PLUS the following material:
• Principles of Medical Documentation and Report Writing o Minimum Data Set
o Prehospital Care Report
o Documentation of Patient Refusal
o Special Situations/Reports/Incident Reporting
Paramedic: AEMT Material PLUS:
Complex depth, comprehensive breadth
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• Principles of medical documentation and report writing o Minimum Data Set
o Prehospital Care Report o Falsification Issues
o Documentation of Patient Refusal
o Special Situations/Reports/Incident Reporting o Reason for Transfer
o Treatment Prior to Arrival o Full Assessment
o Treatment Provided En Route o Condition on Arrival
EMS System Communication EMR
Simple depth, simple breadth
• Communication needed to o Call for Resources
o Transfer care of the patient o Interact within the team structure
EMT: EMR Material PLUS:
Simple depth, simple breadth
• EMS Communication System o System Components
o Radio Communications
• Communication With Other Health Care Professionals o Communication With Medical Control
o Communication with Receiving Facilities o System Maintenance
o Phone/Cellular Communications
• Team Communication and Dynamics o Communication
o Interpersonal Communication
o Communication With Hearing-Impaired, Non-English Speaking Populations and Use of Interpreters—Be Positioned to Address Any of These Special Situations
AEMT: EMT Material PLUS:
Fundamental depth, foundational breadth
The AEMT Instructional Guidelines in this section include all the topics and material at the EMT level PLUS the following material:
• EMS Communication System o System Components o Radio Communications
• Communicating with Other Health Care Professionals o Communication with Medical Control
o Communication with Receiving Facilities o System Maintenance
o Phone/Cellular Communications
• Team Communication and Dynamics
Paramedic: AEMT Material PLUS:
Complex depth, comprehensive breadth
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• EMS Communication System o System Components o Radio Communications
• Communicating with other health care professionals o Communication with Medical Control o Communication with Receiving Facilities o System Maintenance
o Phone/Wireless Communications
• Team communication and dynamics o Source
o Encoding o Message o Decoding o Receive o Feedback
Therapeutic Communication EMR
Simple depth, simple breadth
• Principles of Communicating With Patients in a Manner That Achieves a Positive Relationship
o Factors for Effective Communication o Interviewing Techniques
EMT: EMR Material PLUS:
Simple depth, simple breadth
Principles of communicating with patients in a manner that achieves a positive relationship
• Adjusting communication strategies for age, stage of development, patients with special needs, and differing cultures
Fundamental depth, foundational breadth
• Interviewing techniques
• Verbal defusing strategies
• Family presence issues
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:
• Principles of Communicating With Patients in a Manner That Achieves a Positive Relationship
o Adjusting Communication Strategies o Interviewing Techniques
o Verbal Defusing Strategies o Family Presence Issues
• Communication
o Communication Process and Components
• Types of Responses o Facilitation o Silence o Reflection o Empathy o Clarification o Confrontation o Interpretation o Explanation o Summary
• Developing Patient Rapport o Put the Patient at Ease o Put Yourself at Ease
• Strategies to Ascertain Information
o Obtaining Information on Complaints
• Special Interview Situations
o Patients Unmotivated to Talk
o Patients Under the Influence of Street Drugs or Alcohol o Communication With Elderly
o Communication With Pediatric Patient
AEMT: EMT Material PLUS:
Simple depth, simple breadth
The AEMT Instructional Guidelines in this section include all the topics and material at the EMT level PLUS the following material:
• Principles of Communicating With Patients in a Manner That Achieves a Positive Relationship
o Dealing With Difficult Patients
o Most Patients Are More Than Willing to Talk
Paramedic: AEMT Material PLUS:
Complex depth, comprehensive breadth
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level PLUS the following material:
• Principles of communicating with patients in a manner that achieves a positive relationship
o Interpersonal Communication o Factors That Affect Communication o Interviewing Techniques
o Dealing With Difficult Patients o Adjusting Communication Strategies
Medical/Legal and Ethics EMR
Simple depth, simple breadth
• Consent
o Conditions for Consent o Expressed
o Implied
o Emancipated Minor
o Pediatrics o Refusal of Care
• Confidentiality
o Obligation to Protect Patient Information
o Health Information Portability and Accountability Act (HIPAA)
• Advanced Directives
o Do Not Attempt Resuscitation (DNAR) Order o Living Wills
o Surrogate Decision-Makers
• Types of Court Cases o Civil (Tort) o Criminal
• Evidence Preservation
o Emergency medical care of the patient is the EMR’s priority
o Do not disturb any item at the scene unless emergency medical care requires it o Observe and document anything unusual at the scene
o Do not cut through bullet or knife holes in clothing
o Work closely with the appropriate law enforcement authorities
• Statutory Responsibilities
• Mandatory reporting o Varies by State
o Follow State requirements
o Legally Compelled to Notify Authorities o Legal Liability for Failure to Report o Fully Document Objective Findings
• Ethical Principles o Defined
o Decision-Making Models
EMT: EMR Material PLUS:
Fundamental depth, foundational breadth
The EMT Instructional Guidelines in this section include all the topics and material at the EMR level PLUS the following material:
• Consent/Refusal of Care o Consent to Care o Types of Consent
o Legal Complications Related to Consent o Refusal of Care and/or Transportation
• Confidentiality
o Obligation to Protect Patient Information
o Health Information Portability and Accountability Act (HIPAA) o Responsibility Arising From Physician – Patient Relationship o Privileged Communications
o Breach of Confidentiality
• Advanced Directives
o Patient Self-Determination Act
• Tort and Criminal Actions o Criminality
o Civil Tort
o Mandatory Reporting
• Evidence Preservation
• Statutory Responsibilities
• Mandatory Reporting
• Ethical Principle/Moral Obligation
o Morals – concept of right and wrong o Ethics
o Applied Ethics (i.e., Use of Ethical Values) o Ethical Conflicts
AEMT: Same as Previous Level
Paramedic: AEMT Material PLUS:
Complex depth, comprehensive breadth
The Paramedic Instructional Guidelines in this section include all the topics and material at the AEMT level, PLUS the following material:
• Consent/refusal of care
• Confidentiality
• Advanced directives
• Tort and criminal actions
• Statutory responsibilities
• Mandatory reporting
• Health care regulation
• Patient rights/advocacy
• End-of-life Issues
• Ethical principles/moral obligations
• Ethical tests and decision making
• Consent/Refusal of Care o Consent to Care o Types of Consent
o Refusal of Care and/or Transportation
• Confidentiality
o Obligation to Protect Patient Information o HIPAA
o Responsibility Arising From Physician – Patient Relationship o Privileged Communications
o Breach of Confidentiality
• Advanced Directives
o Patient Self-Determination Act
• Tort and Criminal Actions o Basic Legal Concepts o Criminality
o Civil Tort
• Statutory Responsibilities o Medical Practice Act o Medical Direction o Duty to Act
• Mandatory Reporting
o Legally Compelled to Notify Authorities o Arises From Special Relationship With Patient o Legal Liability for Failure to Report
• Health Care Regulation o Scope of Practice o Licensure
o Certification o Credentialing
• Patient Rights/Advocacy o Patient Rights o Patient Advocacy
• End of Life Issues
o Limited Resuscitation
o Withholding Resuscitation and “Obvious Death” Criteria o Termination of Resuscitation
o Organ donation
• Ethical Principles/Moral Obligations
o Morals and Concepts of Right and Wrongs o Ethics
o Applied Ethics and Use of Ethical Values o Ethical Conflicts
• Ethical Tests and Decision Making o Do No Harm
o In Good Faith
o Patient’s Best Interest
• Employment Law
o American with Disabilities Act o Title VII – Civil Rights Act o Amendments to Title VII o Family Medical Leave Act
o Occupational Safety and Health Act o Ryan White Act
