(a) Except as otherwise provided in these rules, the authorized acts or scope of practice for an EMR or EMT in this state shall be those described in the United States Department of Transportation, National Highway Traffic and Safety Administration (NHTSA) National EMS Scope of Practice Model, DOT HS 810 657, February, 2007. Copies are available from the Division upon request, and may be obtained through the NHTSA at: http://www.ems.gov/education/EMSScope.pdf. This adoption does not include later amendments or editions of the incorporated matter.
(b) EMRs may: - (i) Administer up to 324 milligrams of aspirin orally to patients complaining of chest pain.
- (ii) Utilize nasopharyngeal airways.
- (iii) Utilize mechanical devices approved by the Division for the provision of CPR.
- (iv) Utilize electronic devices for the measurement of vital signs.
- (v) Provide immobilization of the spinal column through manual means and the use of appropriate equipment.
- (vi) Provide splinting of extremities to include the use of traction splints for the femur.
- (vii) Utilize a tourniquet in the management of hemorrhage.
(c) EMTs shall not utilize automatic transport ventilators.
(d) EMTs may: - (i) Administer up to 324 milligrams of aspirin orally to patients complaining of chest pain.
- (ii) Utilize auto-injection devices for the administration of epinephrine in the treatment of anaphylaxis.
- (iii) Perform capillary blood glucose testing.
- (iv) Utilize twelve (12) lead electrocardiograph (ECG) machines to capture and transmit a patient's ECG to a receiving facility;
(e) In addition to the authorizations for the EMT, AEMTs may: - (i) Provide nebulized ipratropium (Atrovent) or combinations of albuterol and ipratropium.
- (ii) Utilize continuous positive airway pressure (CPAP) devices.
(f) The scope of practice for the IEMT shall be that of the AEMT and the following additional authorizations: - (i) Administer medications as authorized for the IEMT by the Division;
- (ii) Perform manual defibrillation;
- (iii) Apply non-invasive patient monitoring devices, to include the application of cardiac monitoring devices;
- (iv) Perform needle thoracotomy;
- (v) Perform endotracheal intubation if specifically authorized by the Division.
(g) Individuals that were certified or licensed at an Intermediate level that exceeds the scope of practice for that of the EMT level in this section prior to the adoption of this Chapter, shall be considered to be "grandfathered" and shall retain the authorization to perform those specific skills unless one of the following occurs: - (i) The license is revoked subsequent to a disciplinary action.
- (ii) The license is upgraded as specified in Section 8 of this Chapter.
- (iii) The licensee completes a Transition Course approved by the Division. Transition Courses shall not be considered to meet the entirety of the Continuing Education Requirements for license renewal under Chapter 8.
- (iv) The licensee is granted a voluntary downgrade under Section 8 of this Chapter.
- (v) The license has been expired more than one (1) year. In these circumstances, the applicant may only recover an EMT level license as specified in Section 10(b).
(h) Irrespective of the employment or service setting, EMTs shall not practice beyond the scope of practice outlined in this Chapter unless licensed or certified to do so by another board or agency under Title 33 of the Wyoming Statutes.
(i) EMS personnel may only perform within their scope of practice based on the written or verbal order of a physician. Written orders shall be through one of the following means: - (i) Standing orders authorizing an EMT at any level to perform a skill or administer a medication; or
- (ii) Protocols that address unforeseen or unusual circumstances and authorize an EMT to perform a skill or administer a medication when not previously addressed in a set of standing orders.
- (iii) A written order on the appropriate patient care forms utilized by a medical facility.
(j) Physician medical directors of EMS Agencies, as defined by Chapter 4, Section 1 of these rules or supervising physicians in a place of employment shall promulgate written protocols and standing orders as defined by this Section.
(k) Physician medical directors and supervising physicians shall: - (i) Indicate by signature, that written protocols and standing orders have been reviewed and approved at least every two years.
- (ii) Indicate by signature, approval of amendments to written protocols and standing orders at the time that amendments are adopted.
- (iii) Indicate by signature approval of written protocols and standing orders upon the assumption of duties as a physician medical director or as a supervising physician.
048-5 Wyo. Code R. § 5-12