Allowable Skills:

1. All items in the EMS First Responder scope of practice.

The following allowed skills, procedures, and drugs may be performed without medical direction:

1. emergency procedures as taught in standard EMT-B courses.
2. splinting
3. wound management

Medical direction is required for the following items:

Allowable Skills:

1. Use of multi-lumen airways (examples: PTLA and Combi-tube)
2. Pneumatic anti-shock garment.*

Allowable Drugs and Routes:

1. activated charcoal by oral route*
2. acetaminophen by oral route in pediatric patients with fever.

Service Medical Director Approved:

1. Transport of patients with nasogastric tubes, urinary catheters, heparin/saline locks, PEG tubes, or vascular access devices intended for outpatient use.
2. Administration of naloxone by subcutaneous (SQ), intramuscular (IM), OR intranasal (IN) route.
3. Administer the following drugs under on-line medical control. When on-line medical control is unavailable, administration is allowed under off-line medical control if the licensed provider is working under medical direction using approved written medical protocols.
   1. Patient's own bronchodilator using pre-measured or metered dose inhalation device.
   2. Epinephrine, 1:1000, no single dose greater than 0.3ml, subcutaneous or intramuscular injection with pre-measured syringe or 0.3 ml TB syringe for anaphylaxis or status asthmaticus refractory to other treatments.
   3. Administer a patient's own nitroglycerine for unrelieved chest pain, with on-line medical control only.

Prior to accomplishing a new skill, technique, medication, or procedure, it shall be documented by the service director, medical director, or approved EMS training institution that the EMS provider has been appropriately trained to perform those new skills, techniques, medications, or procedures.

Service Medical Director Approved: Prior to utilizing any skill, technique, medication or procedure designated as Service Medical Director Approved, it shall be documented by the service director, medical director, or approved EMS training institution that the EMS provider has been appropriately trained to perform the skills, techniques, medications or procedures. Additionally, each EMS provider must have a signed authorization from the service's medical director on file at the EMS service's headquarters or administrative offices.

Personnel with a limited licensure may not utilize items designated as Service Medical Director Approved.

[7.27.2.14 NMAC -Rp, 7.27.2.14 NMAC, 01/01/2006]