EMS Scope of Practice

About the EMS Scope of Practice

The EMS Scope of Practice is the official accepted set of permissions of care allowed for each type of EMS provider level. The current scope of practice was adopted by the Indiana EMS Commission in November 2019 (effective March 1, 2020), with a few updates over the following years.

Legend

Color or Symbol	Meaning
X	NHTSA 2018 EMS Scope of Practice
Blue	Current Indiana EMS Scope of Practice
Red	Approved by the EMS Commission at the January 2020 Meeting
Green	Approved by the EMS Commission at the September 2020 Meeting

Skills: Airway, Ventilation and Oxygenation
Skill	EMR	EMT	AEMT	Paramedic	Notes
Airway - nasal		X	X	X	Nasal airways were added at the EMR level. This is already being taught. IDHS to provide education at the EMR level.
Airway - oral	X	X	X	X
Airway - supraglottic			X	X
Bag-valve-mask (BVM)	X	X	X	X
CPAP		X	X	X	CPAP was added at the EMT and AEMT level. IDHS to provide education at these provider levels.
Chest decompression - needle				X
Chest tube placement - assist only				X
Chest tube - monitoring and management				X
Cricothyrotomy				X
End tidal CO2 monitoring and interpretation of waveform capnography			X	X	ETCO2 monitoring and waveform capnography added at the EMT and AEMT levels. IDHS to provide education at these provider levels.
Gastric decompression - NG Tube				X
Gastric decompression - OG Tube				X
Head tilt - chin lift	X	X	X	X
Endotracheal intubation				X
Jaw-thrust	X	X	X	X
Mouth-to-barrier	X	X	X	X
Mouth-to-mask	X	X	X	X
Mouth-to-mouth	X	X	X	X
Mouth-to-nose	X	X	X	X
Mouth-to-stoma	X	X	X	X
Airway Obstruction - dislodgement by direct laryngoscopy				X
Airway Obstruction - manual dislodgement techniques	X	X	X	X
Oxygen therapy - High flow nasal cannula				X	Clarification that this was listed for purposes of high flow respiratory support systems.
Oxygen therapy - Humidifiers		X	X	X
Oxygen therapy - Nasal cannula	X	X	X	X
Oxygen therapy - Non-rebreather mask	X	X	X	X
Oxygen therapy - Partial rebreather mask		X	X	X
Oxygen therapy - Simple face mask		X	X	X
Oxygen therapy - Venturi mask		X	X	X
Pulse oximetry		X	X	X	Pulse oximetry was added at the EMR level. IDHS to provide education at this provider level.
Suctioning - Upper airway	X	X	X	X
Suctioning - tracheobronchial of an intubated patient			X	X

Skills: Cardiovascular, Circulation
Skill	EMR	EMT	AEMT	Paramedic	Notes
Cardiopulmonary resuscitation (CPR)	X	X	X	X
12 lead ECG acquisition and transmission		X	X	X
12 lead electrocardiogram (interpretive)				X
Cardiac monitoring (3 lead - continuous)				X
Cardioversion - electrical				X
Defibrillation - automated/semi-automated	X	X	X	X
Defibrillation - manual				X
Hemorrhage control - direct pressure	X	X	X	X
Hemorrhage control - tourniquet	X	X	X	X
Hemorrhage control - wound packing	X	X	X	X
Transvenous cardiac pacing - monitoring and maintenance				X
Mechanical CPR device	X	X	X	X	Mechanical CPR device: Requires medical director approval, protocol and training along within a written agreement between non-transport providers and transport providers when they both respond.
Telemetric monitoring devices transmission of clinical data including video		X	X	X	Telemetric monitoring devices: EMTs and AEMTs may transmit data for interpretation while paramedics may interpret the data.
Transcutaneous pacing				X

Skills: Splinting, Spinal Motion Restriction (SMR), Patient Restraint
Skill	EMR	EMT	AEMT	Paramedic	Notes
Cervical collar	X	X	X	X
Long spine board		X	X	X	Long spine board was added at the EMR level.
Manual cervical stabilization	X	X	X	X
Seated SMR (KED, etc.)		X	X	X
Extremity stabilization - manual	X	X	X	X
Extremity splinting	X	X	X	X
Splint - traction		X	X	X
Mechanical patient restraint		X	X	X
Emergency moves for endangered patients	X	X	X	X

Skills: Medication Administration - Routes
Skill	EMR	EMT	AEMT	Paramedic	Notes
Aerosolized/nebulized		X	X	X	Must be within scope of practice. Nebulized route of medication administration added at the EMT level for scope of practice approved medications. IDHS to provide education at the EMT level.
Endotracheal tube				X
Inhaled	X	X	X	X
Intradermal				X
Intramuscular		X	X	X	IM Route of medication administration was added last year for IM Epinephrine for anaphylaxis. No additional education needed.
Intramuscular - auto-injector	X	X	X	X
Intranasal			X	X
Intranasal - unit-dosed, premeasured	X	X	X	X
Intraosseous - initiation, peds or adult			X	X
Intravenous			X	X	EMTs may administer COVID and seasonal influenza vaccinations with medical director approval and oversight, training and written protocols.
Mucosal/Sublingual		X	X	X
Nasogastric				X
Oral	X	X	X	X
Rectal				X
Subcutaneous			X	X
Topical				X
Transdermal				X

Skills: Medical Director Approved Medications
Skill	EMR	EMT	AEMT	Paramedic	Notes
Use of epinephrine (auto-injector) for anaphylaxis (supplied and carried by the EMS agency)		X	X	X
Use of auto-injector antidotes for chemical/hazardous material exposures	X	X	X	X
Use of opioid antagonist auto-injector for suspected opioid overdose	X	X	X	X
Immunizations		X	X	X	EMTs may administer COVID and seasonal influenza vaccinations with medical director approval and oversight, training and written protocols.
Inhaled - beta agonist/bronchodilator and anticholinergic for dyspnea and wheezing		X	X	X	AEMT currently limited to only Albuterol. This would add anticholinergic to AEMT and beta agonist and anticholinergic to the EMT level. IDHS to provide education at this level of provider.
Inhaled - monitor patient administered (i.e., nitrous oxide)			X	X
Intranasal - opioid antagonist for suspected opioid overdose	X	X	X	X
Intranasal - hypoglycemic agent - glucagon		X	X	X	Current medications for AEMT limited to glucagon, D50 and saline. EMS Commission discussed expanded scope/formulary at the January 2020 commission meeting and approved these three medications: epinephrine (1:10,000 for cardiac arrest), ondansetron and naloxone.
Intravenous			X	X
Maintain an infusion of blood or blood products				X
Oral aspirin for chest pain of suspected ischemic origin	X	X	X	X	Oral aspirin for EMR limited to chest pain of suspected ischemic origin with medical director approval and oversight, training and written protocols. IDHS to provide education at this provider level.
Oral glucose for suspected hypoglycemia		X	X	X	Oral glucose was added at the EMR level. IDHS to provide education at this provider level.
Oral over the counter (OTC) analgesics for pain or fever		X	X	X	Parenteral analgesia for pain is not approved at the AEMT level for Indiana. The EMS Commission discussed it at the January 2020 commission meeting but did not approve it. IV administration of acetaminophen is the only approved parenteral analgesia at the AEMT level and requires medical director approval and oversight, training and written protocols.
OTC medications, oral and topical		X	X	X	OTC medication administration is already taught; education to be provided locally. Would still require local protocol and medical director approval for the new EMT and AEMT levels.
Parenteral analgesia for pain			X	X
Sublingual nitroglycerin for chest pain of suspected ischemic origin - limited to patient's prescribed medication		X	X	X
Sublingual nitroglycerin for chest pain of suspected ischemic origin			X	X
Thrombolytics				X

Skills: IV Initiation/Maintenance Fluids
Skill	EMR	EMT	AEMT	Paramedic	Notes
Access indwelling catheters and implanted central IV ports				X
Central line - monitoring				X
Intraosseous - initiation, peds or adult			X	X
Intravenous access			X	X
Intravenous initiation - peripheral			X	X
Intravenous - maintenance of non-medicated IV fluids		X	X	X	Acceptable intravenous IV fluids and medicated IV fluids are currently specified in 836 IAC 1-2-3(f) for EMTs. Some limited and allowed by current Indiana scope of practice at EMT and AEMT level.
Intravenous - maintenance of medicated IV fluids		X	X	X

Skills: Miscellaneous
Skill	EMR	EMT	AEMT	Paramedic	Notes
Assisted delivery (childbirth)	X	X	X	X
Assisted complicated delivery (childbirth)		X	X	X
Blood chemistry analysis				X
Blood pressure automated		X	X	X
Blood pressure - manual	X	X	X	X
Blood glucose monitoring		X	X	X
Eye irrigation	X	X	X	X
Eye irrigation - hands-free irrigation using sterile eye irrigation device				X
Patient transport		X	X	X
Venous blood sampling			X	X

EMS Scope of Practice

EMS Scope of Practice

About the EMS Scope of Practice

Legend

Skills: Airway, Ventilation and Oxygenation

Skills: Cardiovascular, Circulation

Skills: Splinting, Spinal Motion Restriction (SMR), Patient Restraint

Skills: Medication Administration - Routes

Skills: Medical Director Approved Medications

Skills: IV Initiation/Maintenance Fluids

Skills: Miscellaneous