Standing protocol for this simulator until an agency protocol is loaded. It follows the National EMS Scope of Practice Model 2019 (NASEMSO, published by NHTSA, DOT HS 812-666), including Change Notices 1.0 and 2.0 from August 2021. The level on each line is the minimum. A paramedic carries every level below. This is not your state license, and it is not an order.
You may perform a skill only when you are educated to do it, certified as competent, licensed by the state, and credentialed by the medical director. The national model has four levels: emergency medical responder, emergency medical technician, advanced EMT, and paramedic. It does not create a critical-care license. Specialized interfacility care is allowed for a paramedic. Practice past this page still needs a state endorsement and local credentialing.
Airway, ventilation, oxygenation
Head-tilt chin-lift, jaw thrust, oral airway, bag-valve-mask, upper-airway suction, manual relief of an airway obstruction, nasal cannula, non-rebreatherEMR
Nasal airway, CPAP, pulse oximetry, humidified oxygen, simple face mask, partial rebreather, Venturi maskEMT
Supraglottic airway, waveform capnography, tracheobronchial suction of an intubated patientAEMT
Endotracheal intubation, cricothyrotomy, needle chest decompression, high-flow nasal cannula, nasogastric and orogastric decompression, chest-tube monitoring, assist with chest-tube placementParamedic
The model does not list ventilator modes. Intubation is paramedic. On a transfer, the ventilator is part of that airway. Mode, rate, tidal volume, pressure, PEEP, and FiO2 come from the sending team and your medical direction.
Circulation
CPR, automated external defibrillation, direct pressure, tourniquet, wound packingEMR
12-lead acquisition and transmission, mechanical CPREMT
12-lead interpretation, manual defibrillation, synchronized cardioversion, transcutaneous pacing, monitoring of transvenous pacingParamedic
Energy, pacing rate, and milliamps are medical direction. This page authorizes the skill. It does not pick the joules.
Medication routes
A paramedic may give a medical-director-approved medication by nebulizer, inhalation, mouth, sublingual mucosa, intramuscular injection, intranasal route, intravenous route, intraosseous route, subcutaneous injection, rectum, endotracheal tube, or nasogastric tube. Intramuscular injection was added to the EMT column in the 2021 change notices. Intravenous and intraosseous routes start at advanced EMT. Unit-dosed intranasal naloxone and an opioid-antagonist auto-injector start at emergency medical responder.
Medications the model names
Inhaled beta agonist and anticholinergic for dyspnea and wheezingEMT
Oral aspirin for suspected ischemic chest pain. Oral glucose for suspected hypoglycemia. Patient’s own sublingual nitroglycerin for suspected ischemic chest pain.EMT
Parenteral analgesia. Agency sublingual nitroglycerin for suspected ischemic chest pain. Intravenous medications limited to analgesia, antinausea medication, dextrose, epinephrine, glucagon, naloxone, and others a state or local protocol names.AEMT
Intravenous medications the medical director approves. Maintain an infusion of blood or blood products. Thrombolytics.Paramedic
Thrombolytics are paramedic. None are stocked in this index. The model does not name norepinephrine, propofol, heparin, or the rest of the drips. Those sit in the paramedic intravenous column only when your medical director has approved them. Open the drug reference for what this truck actually carries.
IV access and fluids
Peripheral IV, intraosseous access, maintenance of non-medicated IV fluidsAEMT
Maintenance of medicated IV fluids. Access an indwelling catheter or implanted port. Monitor a central line. Maintain a blood or blood-product infusion.Paramedic
What this page will not do
It will not give you a dose. Push buttons and pump units in the simulator are shortcuts, not orders. On a real truck, follow your agency protocol, your medical direction, and your instructor. Spinal motion restriction, childbirth, and the public-health skills in the 2021 notices are in the national model and are outside this truck.
