1. All items in the EMT-Basic scope of practice
2. Medical direction is required for all items in the EMT-Intermediates scope of practice.
3. Allowable Skills:
1. peripheral venous puncture.
2. blood drawing.
3. Intraosseous tibial infusions in pediatric patients. (may be used only after two peripheral intravenous attempts have failed or if there is no reasonable possibility of securing peripheral intravenous access. Limited to one attempt, unless second attempt authorized by online medical control at the receiving institution).
4. Administration of approved medications via the following routes:
1. intravenous
2. nebulized inhalation
3. sublingual
4. Intradermal
5. Intraosseous tibial infusions in pediatric patients
6. endotracheal (for administration of epinephrine only, under the direct supervision of an EMT-Paramedic, or if the EMS service has an approved special skill for endotracheal intubation).
7. I.V. fluid therapy (except blood or blood products0.
8. 50% Dextrose - intravenous
9. Epinephrine (1:1000), subcutaneous for anaphylaxis and known asthmatics in severe respiratory distress (no single dose greater than 0.3 cc).
10. Epinephrine (1:10,000) in pulseless cardiac arrest for both adult and pediatric patients. In pediatric patients may be given IO in 1:1000 concentration per PALS protocols. Epinephrine may be administered via the endotracheal tube in accordance with ACLS and PALS guidelines.
11. Nitroglycerin (sublingual) for chest pain associated with suspected acute coronary syndromes. Must have intravenous access established prior to administration.
12. Morphine, for use in pain control with approval of on-line medical control.
13. Diphenhydramine for allergic reactions.
14. Glucagon, to treat hypoglycemia in diabetic patients when intravenous access is not obtainable.
15. Promethazine.
16. Oral Steroids for reactive airway disease/acute asthma exacerbation.
1. Drugs Allowed for Monitoring During Transport:
   1. Monitoring I.V. solutions duringtransport that contain potassium (not to exceed 20 mEq/1000cc or more than 10 mEq/hour.
2. Immunizations and Biologicals: Administration of Immunizations, Vaccines, Biologicals, and TB skin testing is authorized under the following circumstances:
   1. To the general public as part of a department of Health initiative or emergency response, utilizing Department of Health protocols. The administration of immunizations is to be under the supervision of a public health physician, nurse or other authorized public health provider.
   2. Administer vaccines to EMS and public safety personnel.
   3. TB skin tests may be applied and interpreted if the licensed provider has successfully completed required Department of Health training.
   4. In the event of disaster or emergency, the State EMS Medical Director or Chief Medical Officer for the Department of Health may temporarily authorize the administration of other immunizations, vaccines, biologicals, or tests not listed above.

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, 7.27.2.15 NMAC,1/01/2006]

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