EMERGENCY MEDICAL TECHNICIAN (EMT) OPTIONAL SCOPE SKILLS PURPOSE To establish the initial application and procedure process for an EMT to become accredited in Yolo County Emergency Medical Services Agency (YEMSA) Optional Scope skill(s). The EMT Optional Scope skill(s) available in the YEMSA Region are: I. King Airway, II. Administration of Epinephrine by auto-injector for suspected anaphylaxis and/or severe asthma, III. Administration of Atropine and Pralidoxime Chloride by auto-injector (Mark-1/DuoDote Kit) or preloaded syringe for nerve agent exposure. IV. Administration of Naloxone for suspected narcotic overdose. AUTHORITY Health & Safety Code, Division 2.5, Chapter 2, 1797.80, 1797.90 Health & Safety Code, Division 2.5, Chapter 3, Article 5, 1797.170, 1797.177 Health & Safety Code, Division 2.5, Chapter 4, Article 1, 1797.220 Health & Safety Code, Division 2.5, Chapter 5, 1798.2 Health & Safety Code, Division 2.5, Chapter 6, Article 1, 1798.104 California Code of Regulations, Title 22, Division 9, Chapter 2, Article 2, 100064 POLICY It is the policy of YEMSA that EMT personnel shall fulfill all eligibility requirements to utilize any EMT Optional Scope skill(s). Upon successful accreditation, EMT personnel shall maintain accreditation, as defined in this policy. EMTs utilizing any EMT Optional Scope skill(s), shall meet all the requirements of this policy. PROCEDURE I. Optional Scope skill(s) A. In addition to the activities authorized by the California Code of Regulations, Title 22, Division 9, Chapter 2, Article 2, 100063, YEMSA may establish policies and procedures for local accreditation of an EMT student or certified EMT to perform any or all of the following Optional Scope skills specified in this section. 1. Accreditation for EMTs to practice Optional Scope skill(s) shall be limited to those whose certificate is active and are employed within the jurisdiction of YEMSA by an employer who is part of the organized Emergency Medical Service (EMS) system. B. Use of perilaryngeal airway adjuncts. 1. Training in the use of perilaryngeal airway adjuncts shall consist of not less than five (5) hours to result in the EMT being competent in the use of the device and airway control. Included in the above training hours shall be the following topics and skills: Effective Date: January 1, 2017 Page 1 of 7
a. Anatomy and physiology of the respiratory system. b. Assessment of the respiratory system. c. Review of basic airway management techniques, which includes manual and mechanical. d. The role of the perilaryngeal airway adjuncts in the sequence of airway control. e. Indications and contraindications of the perilaryngeal airway adjuncts. f. The role of pre-oxygenation in preparation for the perilaryngeal airway adjuncts. g. Need for appropriate personal protective equipment and scene safety awareness h. Perilaryngeal airway adjuncts insertion and assessment of placement. i. Methods for prevention of basic skills deterioration. j. Alternatives to perilaryngeal airway adjuncts. 2. At the completion of initial training, the student shall complete a competency-based written and skills examination for airway management which shall include: a. The use of basic airway equipment. b. Techniques and use of perilaryngeal airway adjuncts. c. Using universal precautions and Body Substance Isolation (BSI) procedures during placement. 3. YEMSA shall establish policies and procedures for skills competency by Emergency Medical Services Quality Improvement Program (EMSQIP). C. Administration of Naloxone for suspected narcotic overdose. 1. Training in the administration of naloxone shall consist of no less than two (2) hours to result in the EMT being competent in the administration of naloxone and managing a patient of a suspected narcotic overdose. Included in the training hours listed above shall be the following topics and skills: a. Common causative agents b. Assessment findings c. Management to include but not be limited to: i. Need for appropriate personal protective equipment and scene safety awareness d. Profile of Naloxone to include, but not be limited to: i. Indications ii. Contraindications iii. Side/ adverse effects iv. Routes of administration v. Dosages e. Mechanisms of drug action f. Calculating drug dosages Effective Date: January 1, 2017 Page 2 of 7
g. Medical asepsis h. Disposal of contaminated items and sharps 2. At the completion of this training, the student shall complete a competency based written and skills examination for administration of naloxone which shall include: a. Assessment of when to administer naloxone, b. Managing a patient before and after administering naloxone, c. Using universal precautions and BSI procedures during medication administration, d. Demonstrating aseptic technique during medication administration, e. Demonstrate preparation and administration of parenteral medications by a route other than intravenous. f. Proper disposal of contaminated items and sharps. 3. YEMSA shall establish policies and procedures for skills competency by EMSQIP. D. Administration of Epinephrine by auto-injector for suspected anaphylaxis and/or severe asthma. 1. Training in the administration of epinephrine shall consist of no less than two (2) hours to result in the EMT being competent in the administration of epinephrine and managing a patient of a suspected anaphylactic reaction and/or experiencing severe asthma symptoms. Included in the training hours listed above shall be the following topics and skills: a. Common causative agents b. Assessment findings c. Management to include but not be limited to: i. Need for appropriate personal protective equipment and scene safety awareness d. Profile of epinephrine to include, but not be limited to: i. Indications ii. Contraindications iii. Side/adverse effects iv. Administration by auto-injector v. Dosages vi. Mechanisms of drug action e. Medical asepsis f. Disposal of contaminated items and sharps 2. At the completion of this training, the student shall complete a competency based written and skills examination for administration of epinephrine which shall include: a. Assessment of when to administer epinephrine, b. Managing a patient before and after administering epinephrine, Effective Date: January 1, 2017 Page 3 of 7
c. Using universal precautions and BSI procedures during medication administration, d. Demonstrating aseptic technique during medication administration, e. Demonstrate preparation and administration of epinephrine by autoinjector. f. Proper disposal of contaminated items and sharps. 3. YEMSA shall establish policies and procedures for skills competency by EMSQIP. E. Administer the medications listed in this subsection. 1. Using prepackaged products, the following medications may be administered: a. Atropine b. Pralidoxime Chloride 2. This training shall consist of no less than two (2) hours of didactic and skills laboratory training. In addition basic weapons of mass destruction training is recommended. Training in the profile of medicines listed in subsections (a and b) shall include, but not be limited to: a. Indications b. Contraindications c. Side/adverse effects d. Routes of administration e. Dosages f. Mechanisms of drug action g. Disposal of contaminated items and sharps h. Medication administration. 3. At the completion of this training, the student shall complete a competency based written and skills examination for the administration of medications listed in this subsection which shall include: a. Assessment of when to administer these medications, b. Managing a patient before and after administering these medications, c. Using universal precautions and BSI procedures during medication administration, d. Demonstrating aseptic technique during medication administration, e. Demonstrate the preparation and administration of medications by the intramuscular (IM) route f. Proper disposal of contaminated items and sharps. 4. YEMSA shall establish policies and procedures for skills competency by EMSQIP. Effective Date: January 1, 2017 Page 4 of 7
F. The YEMSA Medical Director shall develop a plan for each Optional Scope skill allowed. The plan shall, at a minimum, include the following: 1. A description of the need for the use of the Optional Scope skill. 2. A description of the geographic area within which the Optional Scope skill will be utilized, except as provided in the California Code of Regulations, Title 22, Division 9, Chapter 2, Article 2, 100064.1. 3. A description of the data collection methodology which shall also include an evaluation of the effectiveness of the Optional Scope skill. 4. The policies and procedures to be instituted by YEMSA regarding medical control and use of the Optional Scope skill. 5. YEMSA shall develop policies for accreditation action, pursuant to the California Code of Regulations, Title 22, Division 9, Chapter 6, for individuals who fail to demonstrate competency. G. The YEMSA Medical Director who accredits EMTs to perform any Optional Scope skill shall: 1. Establish policies and procedures for the approval of service provider(s) utilizing approved Optional Scope skill(s). 2. Approve and designate selected Base Hospital(s) as YEMSA deems necessary to provide direction and supervision of accredited EMTs in accordance with policies and procedures established by YEMSA. 3. Establish policies and procedures to collect, maintain and evaluate patient care records. 4. Establish an EMSQIP. EMSQIP means a method of evaluation of services provided, which includes defined standards, evaluation of methodology(ies) and utilization of evaluation results for continued system improvement. Such methods may include, but not be limited to, a written plan describing the program objectives, organization, scope and mechanisms for overseeing the effectiveness of the program. 5. Establish policies and procedures for additional training necessary to maintain accreditation for each of the Optional Scope skill(s) contained in this section, if applicable. H. The YEMSA Medical Director may approve an Optional Scope Medical Director to be responsible for accreditation and any or all of the following requirements: 1. Approve and monitor training programs for Optional Scope skills including refresher training within the jurisdiction of YEMSA. 2. Establish policies and procedures for continued competency in the optional skill which will consist of organized field care audits, periodic training sessions and/or structured clinical experience. I. The Optional Scope Medical Director may delegate the specific field care audits, training, and demonstration of competency, if approved by the YEMSA Medical Director, to a Physician (MD), Registered Nurse (RN), Physician Assistant (PA), or Paramedic, or Advanced EMT, licensed or certified in California or a MD licensed in another state immediately adjacent to YEMSA s jurisdiction. J. An EMT accredited in an Optional Scope skill may assist in demonstration of competency and training of that skill. Effective Date: January 1, 2017 Page 5 of 7
K. In order to be accredited to utilize an Optional Scope skill, an EMT shall demonstrate competency through passage, by pre-established standards, developed and/or approved by YEMSA, of a competency-based written and skills examination which tests the ability to assess and manage the specified condition. L. During a mutual aid response into another jurisdiction, an EMT may utilize the Scope of Practice for which s/he is trained, certified and accredited according to the policies and procedures established by his/her certifying or accrediting Local Emergency Medical Service Agency (LEMSA). ACCREDITATION PROCESS I. In order to be eligible for initial accreditation, an individual shall meet/complete all of the following: A. Affiliation with an approved EMT Optional Scope Service Provider. B. Current and valid certification, within California, as an EMT. C. Current and valid Cardiopulmonary Resuscitation (CPR) certification card which is taught to the curriculum standards of the 2010 American Heart Association (AHA) Basic Life Support (BLS) for Healthcare Providers CPR/Automated External Defibrillator (AED) Program, or equivalent level. D. Successful completion of a YEMSA approved EMT Optional Scope training program for which the EMT is applying for, at local approved provider agency. E. Successful completion of the YEMSA EMT Optional Scope accreditation written and skills examinations, or an approved written and skills examination at a local provider agency. II. III. Maintaining Accreditation: A. An authorized individual shall meet/complete all of the following requirements on an ongoing basis: 1. Maintain EMT certification. 2. Maintain certification in CPR which is taught to the curriculum standards of the 2015 AHA BLS for Healthcare Providers CPR/AED Program, or equivalent level. 3. Maintain compliance to demonstration of EMT Optional Scope skill proficiency requirements. Accreditation in an EMT Optional Scope skill shall be concurrent with the applicants EMT certification. Their Optional Scope skill expiration date shall be the same expiration date as stated on their California EMT certificate. Note: An accredited individual who fails to maintain YEMSA accreditation requirements shall not utilize the optional skill until all requirements are met. A. Eligible candidates shall complete/meet the following: 1. Initial YEMSA Accreditation: a. Complete a YEMSA application form. b. Furnish a copy of current California EMT certification card. c. Submit proof of affiliation with an approved EMT Optional Scope Service Provider. d. Submit proof of successful completion of a YEMSA approved EMT Optional Scope training program for which the EMT is applying for. e. Submit proof of successful completion of the YEMSA Optional Scope Effective Date: January 1, 2017 Page 6 of 7
accreditation written and skills examination. 2. Renewal of EMT Optional Scope Accreditation: a. In addition to the above requirements in items (A 1-5), eligible candidates shall submit documentation verifying: i. Compliance to every six (6) months demonstration of EMT Optional Scope skill(s) competency requirements. b. Accreditation action for failure to demonstrate competency of an EMT Optional Scope skill(s): i. An EMT who fails to demonstrate competency of an EMT Optional Scope skill may have his/her EMT Optional Scope skill accreditation denied, suspended, revoked or placed on probation. c. In such instances, all procedures and processes included in the YEMSA policies EMT Actions or EMT Optional Scope Accreditation Actions will be followed. CROSS REFERENCES Emergency Medical Technician (EMT) Scope of Practice Emergency Medical Technician (EMT) Process Emergency Medical Technician (EMT) Actions Emergency Medical Technician (EMT) Continuing Education (CE) Requirement Overview Emergency Medical Technician (EMT) Recertification Process Emergency Medical Technician (EMT) Optional Scope Accreditation Actions Emergency Medical Technician (EMT) Application Emergency Medical Technician (EMT) Skills Competency Verification Form Emergency Medical Technician (EMT) Status Report Continuous Quality Improvement (CQI) Program Service Provider Requirements & Responsibilities for Emergency Medical Technician (EMT) Optional Scope Service Provider Emergency Medical Technician (EMT) Optional Scope Competency Documentation Record King Airway Nerve Agent Treatment Effective Date: January 1, 2017 Page 7 of 7