Ohio Administrative Code|Rule 4765-17-03 | Paramedic scope of practice.

                                                
(A)  In addition to the skills listed in
		  rules 4765-12-04, 4765-15-04 and 4765-16-04 of the Administrative Code, and in
		  accordance with section 4765.39 of the Revised Code, a paramedic may perform
		  the following emergency medical services only pursuant to the written or verbal
		  authorization of a physician or of the cooperating physician advisory board, or
		  authorization transmitted through a direct communication device by a physician,
		  physician assistant designated by a physician, or registered nurse designated
		  by a physician, or in accordance with written protocols as specified in
		  division (C) of section 4765.39 of the Revised Code:
(1) Orotracheal intubation;
(2) Nasotracheal intubation;
(3) Cricothyrotomy
			 (surgical);
(4) Cricothyrotomy (needle);
(5) Dual lumen
			 airways;
(6) Extraglottic
			 airways;
(7) Positive end-expiratory
			 pressure;
(8) Bilevel positive air
			 pressure;
(9)  Ventilator management of patients
			 sixteen years of age or older;
(10) Chest tube monitoring and
			 management;
(11) Central line monitoring;
(12) Transcutaneous cardiac
			 pacing;
(13) Administration of cardiac
			 medication;
(14) Cardioversion;
(15) Carotid massage;
(16)  Twelve-lead electrocardiogram
			 performance and interpretation;
(17) Administration of
			 nitroglycerin;
(18) Administration of aerosolized or
			 nebulized medication;
(19) Epinephrine
			 administration via intravenous or intraosseous route;
(20) Placement of nasogastric or
			 orogastric tubes;
(21) Administration of other medications
			 pursuant to written protocols;
(22) Intravenous infusion
			 pump;
(23) Blood chemistry
			 analysis;
(24) Thrombolytic therapy initiation and
			 monitoring;
(25) Immunizations for influenza to
			 firefighters, EMTs, AEMTs, or paramedics in accordance with section 4765.391 of
			 the Revised Code;
(26) Maintenance of medicated intravenous
			 fluids;
(27) Maintenance of blood
			 administration;
(28) Eye irrigation morgan
			 lens;
(29) Withdraw blood for the purpose of
			 determining the alcohol, drug, controlled substance, metabolite of a controlled
			 substance, or combination content of the whole blood, blood serum, or blood
			 plasma as provided in division (D) of section 4765.39 of the Revised Code when
			 performed in accordance with the criteria established in rule 4765-6-06 of the
			 Administrative Code and the protocols established by the medical director of
			 the emergency medical service organization with which the paramedic is
			 affiliated;
(30) Any other services pursuant to a
			 research study approved by the board under rule 4765-6-04 of the Administrative
			 Code and within the parameters established by the board for such
			 study;
(31) Any other services approved by the
			 board pursuant to rule 4765-6-01 of the Administrative Code.
(B) A paramedic may perform non-emergent
		  ambulance transport of a stable patient less than sixteen years of age who has
		  a chronic condition requiring a tracheostomy tube and a ventilator provided the
		  patient's caregiver accompanies the patient during transport and the
		  patient's caregiver has received appropriate training in use of the
		  patient's ventilator.
A caregiver is not required to accompany the
		  patient if the patient is accompanied by an Ohio licensed registered nurse or
		  respiratory therapist, or other appropriately trained and licensed Ohio
		  healthcare provider.
(C) The utilization of waveform capnography is mandatory
		  for all patients requiring invasive airway devices with the exception of stable
		  patients with no cardiac or pulmonary complaints or symptoms unless ordered by
		  the transferring physician.
As used in this rule, an invasive airway device
		  is any airway device inserted or pre-positioned into a patient's airway by
		  means of the mouth, directly into the trachea, or into the trachea by means of
		  a tracheostomy tube, cricothyrotomy or nasotracheal intubation. Dual lumen and
		  extraglottic airways, even though they are blindly inserted into the
		  hypopharynx or the esophagus, are considered invasive airway devices.
(D)  A physician or cooperating physician advisory board
		  that serves as the medical director for any EMS organization may limit, but not
		  exceed, the scope of practice for those paramedics who provide emergency
		  medical services under the auspices of the physician's certificate to
		  practice medicine and surgery, or osteopathic medicine and surgery, issued
		  under Chapter 4731. of the Revised Code to include the withdrawing of blood for
		  evidence collection.
(E)  A paramedic shall not perform emergency medical
		  services within this rule unless the paramedic has received training as part of
		  an initial certification course or through subsequent training approved by the
		  board. If certain emergency medical services, within the paramedic scope of
		  practice, were not included in the training specified in this paragraph, the
		  paramedic must have received training regarding such services approved by the
		  local medical director before performing those services.