Guam § 84124 - EMS Scope of Practice.

§ 84124. EMS Scope of Practice.

(a) Principles:

(1) In order to function as an EMS Provider, an

individual must be certified/licensed from the Department of

Public Health and Social Services Office of Emergency

Medical Services as an NREMR, NREMT, NRAEMT or

NRP.

(2) EMS Providers are responsible to adhere to the

scope of practice while functioning as an EMS Provider on

Guam.

(3) During training, while at the scene of an

emergency, during transport of the sick or injured, or during

interfacility transfer, a certified EMS Provider or supervised

EMS provider student is authorized to do any of the

following:

(b) Policies:

(1) Scope of Practice of a National Registry

Emergency Medical Responder:

(A) conduct primary and secondary patient

examinations;

(B) take and record vital signs;

(C) utilize non-invasive diagnostic devices in

accordance with manufacturer’s recommendation;

(D) open and maintain an airway by positioning

the patient’s head;

(E) provide external cardiopulmonary

resuscitation and obstructed airway care for infants,

children, and adults;

(F) provide immobilization care for

musculoskeletal injuries;

(G) assist with prehospital childbirth;

(H) complete a clear and accurate prehospital

emergency care report form on all patient contacts and

provide a copy of that report to the senior emergency

medical services provider with the transporting

ambulance;

(I) administer medical oxygen;

(J) maintain an open airway through the use of:

(i) a nasopharyngeal airway device;

(ii) a noncuffed oropharyngeal airway

device;

(iii) a pharyngeal suctioning device;

(K) operate a bag mask ventilation device with

reservoir;

(L) provide care for suspected medical

emergencies, including administering liquid oral

glucose for hypoglycemia;

(M) prepare and administer aspirin by mouth for

suspected myocardial infarction (MI) in patients with no

known history of allergy to aspirin or recent

gastrointestinal bleed;

(N) prepare and administer epinephrine by

automatic injection device for anaphylaxis; and

(O) perform cardiac defibrillation with an

automatic or semi-automatic defibrillator.

(2) Scope of Practice of a National Registry

Emergency Medical Technician:

(A) evaluate the ill and injured;

(B) render basic life support, rescue, and

emergency medical care to patients;

(C) obtain diagnostic signs to include, but not be

limited to, temperature, blood pressure, pulse and

respiration rates, pulse oximetry, level of consciousness,

and pupil status;

(D) perform cardiopulmonary resuscitation

(CPR), including the use of mechanical adjuncts to basic

cardiopulmonary resuscitation;

(E) administer oxygen;

(F) use the following adjunctive airway and

breathing aids:

(i) oropharyngeal airway;

(ii) nasopharyngeal airway;

(iii) suction devices;

(iv) basic oxygen delivery devices for

supplemental oxygen therapy including, but not

limited to, humidifiers, partial rebreathers, and

venturi masks; and

(iv) manual and mechanical ventilating

devices designed for prehospital use including

continuous positive airway pressure;

(G) use various types of stretchers and spinal

motion restriction or immobilization devices;

(H) provide initial prehospital emergency care to

patients, including, but not limited to:

(i) bleeding control through the application

of tourniquets;

(ii) use of hemostatic dressings from a list

approved by the Authority;

(iv) spinal motion restriction or

immobilization;

(iv) seated spinal motion restriction or

immobilization;

(v) extremity splinting; and

(vi) traction splinting;

(I) administer oral glucose or sugar solutions;

(J) extricate entrapped persons;

(K) perform field triage;

(L) transport patients;

(M) apply mechanical patient restraint;

(N) set up for ALS procedures, under the direction

of an Advanced EMT or Paramedic;

(O) perform automated external defibrillation;.

(P) assist patients with the administration of

physician-prescribed devices including, but not limited

to, patient-operated medication pumps, sublingual

nitroglycerin, and self-administered emergency

medications, including epinephrine devices;

(Q) administer naloxone or other opioid

antagonist by intranasal and/or intramuscular routes for

suspected narcotic overdose;

(R) administer epinephrine by auto-injector for

suspected anaphylaxis and/or severe asthma;

(S) perform finger stick blood glucose testing;

and

(T) administer over the counter medications,

when approved by the Medical Director, including, but

not limited to:

(i) aspirin.

(U) The scope of practice of an EMT shall not

exceed those activities authorized in this Section.

(V) Special Procedures: Institute intraosseous

(IO) needles or catheters for cardiac arrest patients if

specifically trained and authorized by a local agency

EMS Medical Director.

(3) Scope of Practice of a National Registry Advanced

Emergency Medical Technician:

(A) perform all procedures that an EMT may

perform;

(B) initiate peripheral intravenous (IV) lines in

unconscious patients;

(C) maintain peripheral intravenous (IV) lines;

(D) initiate saline or similar locks in unconscious

patients;

(E) draw peripheral blood specimens;

(F) insert an uncuffed pharyngeal airway device

in the practice of airway maintenance. A cuffed

pharyngeal airway device is:

(i) a single lumen airway device designed

for blind insertion into the esophagus providing

airway protection where the cuffed tube prevents

gastric contents from entering the pharyngeal

space; or

(ii) a multi-lumen airway device designed to

function either as the single lumen device when

placed in the esophagus, or by insertion into the

trachea where the distal cuff creates an

endotracheal seal around the ventilatory tube

preventing aspiration of gastric contents;

(G) perform tracheobronchial suctioning of an

already intubated patient; and

(H) prepare and administer the following

medications under specific written protocols authorized

by the Medical Director or direct orders from a licensed

consultant physician:

(i) Physiologic isotonic crystalloid solution

IV or IO;

(ii) Anaphylaxis: epinephrine IM;

(iii) Antidotes: Naloxone hydrochloride SL,

IM, or IV;

(iv) Anti-hypoglycemics: Hypertonic

glucose IV;

(v) Catecholamine: Epinephrine 1:1000;

Epinephrine 1:10,000 IM or IV;

(vi) Parasympathetic Blocker: Atropine IV;

(vii) Nebulized bronchodilators as determined

by the Medical Director;

(viii) Non-Opioid Analgesics for acute

pain as determined by the Medical Director;

(I) prepare and administer immunizations in the

event of an outbreak or epidemic as declared by the

Chief Public Health Officer or designated public health

officer, as part of an emergency immunization program,

under the Medical Director’s standing order;

(J) prepare and administer immunizations for

seasonal and pandemic influenza vaccinations

according to the Chief Public Health Officer’s

recommended immunization guidelines as directed by

the agency’s Medical Director’s standing order;

(K) distribute medications at the direction of the

Medical Director as a component of a mass distribution

effort;

(L) maintain during transport any intravenous

medication infusions or other procedures which were

initiated in a medical facility, if clear and

understandable written instructions for such

maintenance have been provided by the physician at the

sending medical facility;

(M) perform electrocardiographic rhythm

interpretation of ventricular fibrillation, ventricular

tachycardia, pulseless electrical activity, and asystole;

and

(N) perform cardiac defibrillation with a manual

defibrillator.

(4) Scope of Practice of a National Registry

Paramedic:

(A) a paramedic may perform any activity

identified in the scope of practice of an NREMT, or any

activity identified in the scope of practice of an

NRAEMT;

(B) a 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 hospital, may perform the following

procedures or administer the following medications

when such are approved by the Medical Director of the

Guam EMSC, and are included in the written policies

and procedures of the Guam EMSC.

(D) Scope of Practice includes, but is not limited

to:

(i) utilize electrocardiographic devices and

monitor electrocardiograms, including 12- lead

electrocardiograms (ECG);

(ii) perform defibrillation, synchronized

cardioversion, and external cardiac pacing;

(iii) visualize the airway by use of the

laryngoscope and remove foreign bodies with

Magill forceps;

(iv) perform pulmonary ventilation by use of

lower airway multi-lumen adjuncts, the esophageal

airway, perilaryngeal airways, stomal intubation,

and adult oral endotracheal intubation;

(v) 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;

(vi) 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;

(vii) institute intraosseous (IO) needles or

catheters;

(viii) administer IV or IO glucose solutions or

isotonic balanced salt solutions, including Ringer’s

lactate solution;

(ix) obtain venous blood samples;

(x) 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 the Guam EMSC Medical Director;

(xi) utilize Valsalva maneuver;

(xii) perform percutaneous needle

cricothyroidotomy;

(xiii) perform needle thoracostomy;

(xiv)perform nasogastric and orogastric tube

insertion and suction;

(xv) monitor thoracostomy tubes;

(xvi) monitor and adjust IV solutions

containing potassium, equal to or less than 40

mEq/L;

(xvii) administer approved medications by

the following routes: IV, IO, intramuscular,

subcutaneous, inhalation, transcutaneous, rectal,

sublingual, endotracheal, intranasal, oral or topical;

(xviii) administer, using pre-packaged

products when available, the following

medications:

(1) 10%, 25% and 50% dextrose;

(2) activated charcoal;

(3) acetaminophen;

(4) adenosine;

(5) aerosolized or nebulized beta-2

specific bronchodilators;

(6) amiodarone;

(7) aspirin;

(8) ATNAA/MARK 1;

(9) atropine sulfate;

(10) pralidoxime chloride;

(11) calcium chloride;

(12) diazepam;

(13) diphenhydramine hydrochloride;

(14) dopamine hydrochloride;

(15) epinephrine;

(16) fentanyl;

(17) glucagon;

(18) glucose (oral);

(19) haloperidol;

(20) ipratropium bromide;

(21) ketamine;

(22) lorazepam;

(23) midazolam;

(24) lidocaine hydrochloride;

(25) magnesium sulfate;

(26) morphine sulfate;

(27) naloxone hydrochloride;

(28) nitroglycerine preparations (I.V.,

Oral);

(29) norepinephrine;

(30) ondansetron;

(31) sodium bicarbonate;

(32) Tranexamic Acid (TXA).