EMTs: Medications and Scope of Practice

The scope of practice for Emergency Medical Technicians (EMTs) can vary widely, depending on several factors, including the state they are working in, local medical direction, and their level of training. This article provides a detailed overview of the medications EMTs can administer and the tasks they are allowed to perform, based on the latest research and practical experience.

Medications Administered by EMTs

The specific medications an EMT can administer vary from state to state. In some cases, EMTs are trained to administer a wide range of drugs, while in others, their scope is much more limited. Let’s take a closer look at the medications that EMTs may be able to give.

Vasopressors: These are drugs used to increase blood pressure, such as adrenaline (epinephrine).

Anticoagulants and Anti-Platelet Aggregators: Medications that help prevent blood clots, like heparin and aspirin.

Vasodilators: Drugs that help relax blood vessels and improve blood flow, such as nitroprusside.

Anti-dysrhythmics: Medications used to manage heart rhythm abnormalities, like lidocaine.

Analgesics: Pain relievers such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs).

Electrolytic Fluids: Intravenous fluids used to restore electrolyte balance, such as saline or dextrose in water (D5W).

Opioid Pain Killers: Strong pain relievers such as morphine or fentanyl.

Antihistamines: Drugs used to treat allergies, like diphenhydramine (Benadryl).

Antiemetics: Drugs used to stop nausea and vomiting, like ondansetron (Zofran).

Antipyretics: Medications used to reduce fever, such as ibuprofen.

Neuromuscular Paralytics: Drugs that help relax muscles, like vecuronium.

Reversal Agents: Medications that reverse the effects of other drugs, such as naloxone (Narcan) for reversing opioid overdoses.

Organophosphate Antidotes: Drugs used to treat organophosphate poisoning, like pralidoxime.

Parasympathomimetics: Drugs that stimulate parasympathetic nerve activity, such as atropine.

Non-titratable and Titratable Medications

EMTs are also trained to administer both non-titratable and titratable medications. Some examples include:

Heparin: A non-titratable anticoagulant. Potassium: A non-titratable electrolyte. Propofol: A titratable sedative often used during surgical procedures. Metoprolol: A titratable beta-blocker used to manage heart rhythm and blood pressure. Dobutamine: A titratable vasopressor used to increase heart contractility. Protonix: A titratable proton pump inhibitor used to reduce stomach acid. TPN (Total Parenteral Nutrition): A titratable intravenous nutrient solution.

Specific Examples

To provide specific examples, here are the allowable medications for EMTs in a few states:

Tennessee: EMTs can administer aspirin, nitroglycerin, and oxygen. Ohio: EMTs in the author's system were trained to give several medications, including aspirin, Narcan (naloxone), and oxygen. My County in the 2010s: EMTs could give oral glucose, epinephrine injectors (EpiPens), oxygen, aspirin, nitroglycerin, and albuterol inhalers.

Scope of Practice for EMTs in Different Settings

The scope of practice for EMTs can also vary significantly depending on whether they are working in an ambulance or a hospital. Here’s a breakdown:

In an Ambulance: EMTs may be trained to administer a wider range of medications and procedures, but even in this setting, they are limited in some cases. For example, while they may be able to intubate a patient or perform an EKG, they typically cannot give intravenous (IV) medications unless they are under specific circumstances, such as using an EpiPen for anaphylaxis. In a Hospital: EMTs generally have a more limited scope of practice in the hospital. While they can perform some tasks such as starting IVs and drawing blood, they cannot typically administer medications or do advanced airway techniques. The scope of practice for paramedics, on the other hand, follows a similar pattern but with different levels of training and authorization.

Insights from Other Providers

The author shares insights from other healthcare professionals, such as paramedics and nurses, to provide a more comprehensive view of the scope of practice:

Paramedics: While paramedics can perform a wide range of tasks on the ambulance, they are limited in the hospital setting. They can only administer oxygen and, in some cases, assistive medications like Narcan for opioid overdoses. Nurses: Even nurses, who have a broader scope of practice, are limited in their ability to perform certain tasks in the emergency room if they are not supervised by a doctor. This highlights the collaborative nature of modern emergency care.

Conclusion

The scope of practice for EMTs, paramedics, and other healthcare professionals is complex and varies significantly depending on the training and authorization they have. As emergency medical services evolve, so too does the range of tasks and medications that EMTs are allowed to administer.

Key Takeaways:- Medications and procedures that EMTs can administer vary widely from state to state.- There are both non-titratable and titratable medications that EMTs can give.- The scope of practice for EMTs in an ambulance and a hospital can differ significantly.