Protocols

BLS protocols: The Commonwealth of Pennsylvania utilizes common Basic Life Support protocols for all regions of Pennsylvania. This ensures consistency and limits confusion for personnel who may work in multiple EMS regions. BLS protocols are applicable to ALL levels of EMS personnel. All First Responders, EMTs, Paramedics and PHRNs as well as medical command physicians and service medical directors should be well versed in the BLS protocols. Personnel should also be familiar with the scope of practice of EMS personnel at not just their level but all levels.

The Commonwealth of Pa ALS protocols may be adopted by regional councils or may serve as a template for regional protocols. The EMMCO West Regional Medical Advisory Committee and Board of Directors has chosen to elaborate on the Commonwealth template to better guide the ALS practitioner with medications and procedures which may be optional at the state level but may have been or not been adopted at the regional level. The EMMCO West ALS protocols include some additional protocols and procedural guidelines.

The EMMCO West ALS Interfacility treatment protocols provide direction on the administration of approved infusions which may not be covered in the general ALS protocols.

The EMMCO West Regional ALS medication list includes those medications from the Commonwealth ALS medication list which are included in the Regional ALS protocols.

The Commonwealth ALS medication list includes all of the medications which may be administered by ALS personnel if those medications are included in regional protocol or if the medication is used in an interfacility transfer and the ALS service medical director has approved the use of the medication for an interfacility transfer and has trained the ALS personnel in the use of the medication.

Out of hospital DNR orders allow EMS personnel to honor the wishes of terminally ill patients.

Click here for the 2020 BLS Protocols

March 16, 2020

Dear EMS Provider:

NOTE: These 2020 Statewide BLS Protocols are an update to the 2019 protocols for the sole purpose of updating the Statewide Influenza-like Illness Protocol #931 to provide additional guidance during the COVID-19 coronavirus pandemic. All EMS providers must immediately review the updated protocol #931.

The Bureau of EMS, Department of Health, is pleased to provide these updated “Statewide BLS Protocols” to the EMS providers of Pennsylvania.

This 2019 update contain many important changes, but some of the highlights include: a. the DMIST program to standardize the verbal report from EMS to receiving hospital personnel. b. an optional module for delivery of bronchodilator medication by nebulizer by EMT’s. c. optional use of an 12-lead ECG device to obtain an electrocardiogram and transmit it for interpretation, when a system has the required capabilities. d. changes to encourage improved high-performance CPR and more care before transport of patients with cardiac arrest to improve outcomes. e. updates to align our protocols with the recently released National Scope of Practice Model.

Fortunately, Pennsylvania has already adopted the majority of the enhancements within this new national scope of practice.

Pennsylvania has used Statewide BLS Protocols since Sept. 1, 2004, and this edition is an update to the version that was posted since June 10, 2017. To assist EMS providers when reviewing the changes, new sections of the protocols that correspond to this 2019 version are identified with yellow highlighting and sections that have been removed are struck through and highlighted. EMS providers may use this 2019 version of the statewide BLS protocols as soon as they are familiar with the changes, but all providers must be using these updated protocols by the effective date of Sept. 1, 2019.

EMS providers are permitted to perform patient care, within their Pa. defined scope of practice, when following the appropriate protocol(s) or when following the order of a medical command physician. Each EMS provider is responsible for being knowledgeable regarding current state-approved protocols so that he/she may provide the safest, highest quality and most effective care to patients.

To assist providers in becoming familiar with the changes to the protocols, a continuing education presentation is available to regions and agencies. This update is available for in-person presentations or the course can be completed on TRAIN PA, the on-line Learning Management System (LMS). The 2019 BLS Protocol Update (BEMS course #1000022407 will be considered a core requirement for all levels of EMS providers that register their certification during the current time period. Furthermore, the completion of this course should be used by EMS agencies when ensuring that the agency’s providers have been educated to the current protocols.

When providing patient care under the EMS Act, EMS providers of all levels must follow applicable protocols. Although the Statewide BLS Protocols are written for BLS-level care, they also apply to the BLS-level care that is performed by all providers at or above the level of AEMT. Since written protocols cannot feasibly address all patient care situations that may develop, the Department expects EMS providers to use their training and judgment regarding any protocol-driven care that would be harmful to a patient. When the practitioner believes that following a protocol is not in the best interest of the patient, the EMS practitioner should contact a medical command physician if possible. Cases where deviation from the protocol is justified are rare. The reason for any deviation should be documented. All deviations are subject to investigation to determine whether or not they were appropriate. In all cases, EMS providers are expected to deliver care within the scope of practice for their level of certification.

The Department of Health’s Bureau of EMS website will always contain the most current version of the EMS protocols, the scope of practice for each level of provider, important EMS Information Bulletins, and many other helpful resources. This information can be accessed online at www.health.pa.gov The Statewide BLS Protocols may be directly printed or downloaded into a mobile device for easy reference.

The Department is committed to providing Pennsylvania’s EMS providers with the most up-to-date protocols, and to do this requires periodic updates. The protocols will be reviewed regularly, and EMS providers are encouraged to provide recommendations for improvement at any time. Comments should be directed to the Commonwealth EMS Medical Director, Pennsylvania Department of Health, Bureau of EMS, 1310 Elmerton Avenue, Harrisburg, PA 17110.

Dylan Ferguson
BEMS Director
Pennsylvania Department of Health
Bureau of Emergency Medical Services

Douglas F. Kupas, MD, EMT-P, FAEMS
Commonwealth EMS Medical Director
Pennsylvania Department of Health
Bureau of Emergency Medical Services

Previous BLS Protocols:
2017 Statewide BLS Protocols
ED Bulletin for Protocol 261
PA BLS Protocol 190 – Appendix A
PA BLS Protocol 190 – Appendix B
PA BLS Protocol 190 – Appendix C

Statewide ALS Protocol Update Including Interim COVID-19 Treatment Changes

Click here for the 2019 ALS Protocols

November 1, 2019

NOTE: This version is an update to the 2019 Statewide ALS Protocols released on 7/1/19. There have been some additional edits to protocols #4091, #7003, and #8002.

Dear EMS Provider:

The Bureau of EMS, Department of Health, is pleased to provide these updated “Statewide ALS Protocols” to the ALS providers of Pennsylvania.

This 2019 update contains many important changes, but some of the highlights include:

  • New Adult and Pediatric Crashing Patient Protocols aimed at stabilizing certain patients before moving them to the ambulance to prevent cardiac arrest during this critical time.
  • an option for the use of subdissociative doses of ketamine for pain, provided that specific requirements are followed.
  • changes to encourage improved high-performance CPR and more care before transport of patients with cardiac arrest to improve outcomes.
  • updates to align our protocols with the recently released National Scope of Practice Model.

Pennsylvania has used Statewide ALS Protocols since July 1, 2007, and this edition is an update to the version that was posted on March 16, 2018. To assist ALS providers when reviewing the changes, new sections of the protocols that correspond to this 2019 version are identified with yellow highlighting, and sections that have been removed are struck through and highlighted. ALS providers may use this 2019 version of the statewide ALS protocols as soon as they are familiar with the changes, but all ALS providers must use these protocols by the effective date of Sept. 1, 2019.

EMS providers are permitted to perform patient care, within their PA defined scope of practice, when following the appropriate protocol(s) or when following the order of a medical command physician. Each EMS provider is responsible for being knowledgeable regarding current state-approved protocols so that he/she may provide the safest, highest quality and most effective care to patients.

To assist providers in becoming familiar with the changes to the protocols, a continuing education presentation is available to regions and agencies. This update is available for inperson presentations or the course can be completed on TRAIN PA, the on-line Learning Management System (LMS). The 2019 ALS Protocol Update (BEMS course #1000022408) is considered a core requirement for all EMS providers above the level of AEMT that register their certification during the current time period. Furthermore, the completion of this course should be used by EMS agencies when ensuring that the agency’s providers have been educated to the current protocols.

When providing patient care under the EMS Act, EMS providers of all levels must follow applicable protocols. Since written protocols cannot feasibly address all patient care situations that may develop, the Department expects EMS providers to use their training and judgment regarding any protocol-driven care that would be harmful to a patient. When the practitioner believes that following a protocol is not in the best interest of the patient, the EMS practitioner should contact a medical command physician if possible. Cases where deviation from the protocol is justified are rare. The reason for any deviation should be documented. All deviations are subject to investigation to determine whether or not they were appropriate. In all cases, EMS providers are expected to deliver care within the scope of practice for their level of certification.

The Department of Health’s Bureau of EMS website will always contain the most current version of the EMS protocols, the scope of practice for each level of provider, important EMS Information Bulletins, and many other helpful resources. This information can be accessed online at www.health.pa.gov. The Statewide ALS Protocols may be directly printed or downloaded into a mobile device for easy reference.

The Department is committed to providing Pennsylvania’s EMS providers with the most upto-date protocols, and to do this requires periodic updates. The protocols will be reviewed regularly, and EMS providers are encouraged to provide recommendations for improvement at any time. Comments should be directed to the Commonwealth EMS Medical Director, Pennsylvania Department of Health, Bureau of EMS, 1310 Elmerton Avenue, Harrisburg, PA 17110.

Dylan Ferguson
BEMS Director
Pennsylvania Department of Health
Bureau of Emergency Medical Services


Douglas F. Kupas, MD, EMT-P, FAEMS
Commonwealth EMS Medical Director
Pennsylvania Department of Health
Bureau of Emergency Medical Services

 

Previous ALS Protocols Guidelines – (Regional)
2025 CPAP/BiPAP Use
2032 Confirmation of Airway Placement
2033 Orotracheal Intubation
2034 Nasotracheal Intubation
2035 Combitube Insertion
2036 King Airway Insertion
2038 Endotracheal Tube Medication Administration
2041 Needle Cricothyrotomy
2052 ECG Monitoring
2055 Electrical Countershock
2056 Transcutaneous Pacing
2065 External Jugular IV Access
2067 Intraosseous IO Access
2070 Central Venous Lines-Access of Existing
2071 Sublingual/Oral Medication Administration
2072 Pulmonary Medication Administration
2074 Peripheral IV Access/Heparin or Saline Lock
2075 Intravenous/Intraosseaous Medication Admin.

2020 AEMT Protocol

February 20, 2020

Dear EMS Provider:

The Bureau of EMS, Department of Health, is pleased to provide these updated “Statewide AEMT Protocols” to the EMS providers of Pennsylvania. This 2020 update contains many important changes, but some of the highlights include: •  Changes that include vascular access and intravenous fluids in more protocols. Previously, PEHSC and stakeholders in Pennsylvania established a principle of restricting intravenous access by AEMTs to certain conditions and when in the presence of a provider with certification above the AEMT level. These protocols no longer reflect this previous principle. Providers are reminded that the use of vascular access and intravenous fluids are medically warranted in some conditions, but like all treatments, are detrimental in some situations also. These treatments should be used when they are likely to improve patient outcome. •  Updates to align our protocols with the recently released National Scope of Practice Model, including the addition of intravenous EPINEPHrine (restricted to use only in cardiac arrest) and ondansetron. Pennsylvania has used Statewide AEMT Protocols since July 1, 2015, and this edition is an update to the Pennsylvania has used Statewide Pennsylvania has used Statewide version that has been in effect since September 1, 2017. To assist AEMT providers when reviewing the changes, new sections of the protocols that correspond to this 2020 version are identified with yellow highlighting, and sections that have been removed are struck through and highlighted. AEMT providers may use this 2020 version of the statewide AEMT protocols as soon as they are educated to the changes, but all providers functioning as an AEMT must use these protocols by the effective date of September 1, 2020.

EMS providers are permitted to perform patient care, within their PA defined scope of practice, when following the appropriate protocol(s) or when following the order of a medical command physician. Each EMS provider is responsible for being knowledgeable regarding current state-approved protocols so that he/she may provide the safest, highest quality and most effective care to patients.

Because these changes are significant and the current AEMT courses do not include the new Pennsylvania or national expanded scope curriculum, AEMTs MUST complete the Pennsylvania Department of Health AEMT Protocol Update/Bridge Course before using these protocols. It is the responsibility of each EMS agency medical director and agency that credentials providers to function at the AEMT level on an IALS service to ensure that each AEMT is educated and competent to provide care using these updated protocols.

It is essential that EMS agencies and regions that utilize IALS ambulances work with their county PSAPs and dispatch centers to ensure that the expansion of this level of care does not keep ALS services from being dispatched to appropriate calls. For example, an IALS service with a provider functioning at the AEMT level may be appropriate for a diabetic patient with altered mental status, but the additional interventions of an ALS service should be dispatched to other patients with altered level of consciousness. EMS agencies providing IALS should work in conjunction with their PSAP and local ALS services to ensure the best care for their patients.

When providing patient care under the EMS Act, EMS providers of all levels must follow applicable protocols. Since written protocols cannot feasibly address all patient care situations that may develop, the Department expects EMS providers to use their training and judgment regarding any protocol-driven care that would be harmful to a patient. When the provider believes that following a protocol is not in the best interest of the patient, the EMS provider should contact a medical command physician if possible. Cases where deviation from the protocol is justified are rare. The reason for any deviation should be documented. All deviations are subject to investigation to determine whether or not they were appropriate. In all cases, EMS providers are expected to deliver care within the scope of practice for their level of certification.

The Department of Health’s Bureau of EMS website will always contain the most current version of the EMS protocols, the scope of practice for each level of provider, important EMS Information Bulletins, and many other helpful resources. This information can be accessed online at www.health.pa.gov. The Statewide AEMT Protocols may be directly printed or downloaded into a mobile device for easy reference. The Department is committed to providing Pennsylvania’s EMS providers with the most upto-date protocols, and to do this requires periodic updates. The protocols will be reviewed regularly, and EMS providers are encouraged to provide recommendations for improvement at any time. Comments should be directed to the Commonwealth EMS Medical Director, Pennsylvania Department of Health, Bureau of EMS, 1310 Elmerton Avenue, Harrisburg, PA 17110.

Dylan Ferguson
BEMS Director
Pennsylvania Department of Health
Bureau of Emergency Medical Services

Douglas F. Kupas, MD, EMT-P, FAEMS
Commonwealth EMS Medical Director
Pennsylvania Department of Health
Bureau of Emergency Medical Services

Links

2017 Statewide AEMT Protocol
2020 AEMT Protocol
2017 Scope of Practice

April 2, 2015

Dear EMS Provider:

The Bureau of EMS, Department of Health, is pleased to provide these “Statewide Critical Care Transport Protocols” for the care of patients transported by a licensed critical care transport (CCT) service in Pennsylvania.

The regulations promulgated under the EMS System Act of 2009 includes a critical care transport service within the types of services that an EMS agency can be licensed to provide. The EMS regulations require the crew of a critical care transport ambulance service to be staffed by at least one EMS provider above the AEMT level who has successfully completed a critical transport educational program approved by the Department.

The Statewide Critical Care Transport (CCT) Protocols will guide the patient care that is provided by authorized EMS providers during a critical care interfacility transport. These protocols may only be used by authorized EMS providers who have completed the requirements of a CCT educational program approved by the Department when they are performing skills within the scope of practice of their designated EMS provider-level or the enhanced skills that are permitted for authorized EMS providers who staff a CCT ambulance service. Additionally, authorized EMS providers must only perform skills for which they have been approved and credentialed by the EMS agency medical director.

Since written protocols cannot feasibly address all patient care situations that may develop, the Department expects EMS providers to use their training and judgment regarding any protocol-driven care that would be harmful to a patient. When the provider believes that following a protocol is not in the best interest of the patient, the EMS provider must contact a medical command physician if possible. Cases where deviation from the protocol is justified are rare. The reason for any deviation should be documented. All deviations are subject to investigation to determine whether or not they were appropriate. In all cases, EMS providers are expected to deliver care within the scope of practice for their level of certification.

The Department of Health’s Bureau of EMS website will contain the most current version of the EMS protocols, the scope of practice for each level of provider, important EMS Information Bulletins, and many other helpful resources. This information can be accessed online at www.health.state.pa.us. The Statewide CCT Protocols may be directly printed or downloaded into a hand-held device for easy reference.

The Department is committed to providing Pennsylvania’s EMS providers with the most up-to-date protocols, and to do this requires periodic updates. The protocols will be reviewed regularly, and EMS providers are encouraged to provide recommendations for improvement at any time. Comments should be directed to the Commonwealth EMS Medical Director, Pennsylvania Department of Health, Bureau of EMS, Room 606, 625 Forster Street, Harrisburg, PA 17120.

Richard L. Gibbons
BEMS Director
Pennsylvania Department of Health
Bureau of Emergency Medical Services

Douglas F. Kupas, MD
Commonwealth EMS Medical Director
Pennsylvania Department of Health
Bureau of Emergency Medical Services

Links for CCT Information
Scope of Practice for Critical Care Transport (CCT) Providers
2019 Statewide Treatment CCT Protocols
2015 Statewide CCT Protocols
Approved CCT Medications
Scope of Practice CCT
Additional Scope of Practice CCT
Vehicle-Equipment CCT

Facility Trauma STEMI Stroke 24/7 CT 24/7 Neuro
Grove City Medical Center Level IV X
LECOM – Millcreek Community Primary
Meadville Medical Center PCI Primary X On call coverage
Sharon Regional Health PCI Primary X Cleveland Clinic
St. Vincent Hospital PCI Primary X Cleveland Clinic
UPMC Hamot Level II PCI Comprehensive X In house
UPMC Northwest Primary X UPMC Presby
Adjacent Regional Facility Trauma STEMI Stroke 24/7 CT 24/7 Neuro
Armstrong Memorial Hospital PCI X Telemedicine
Butler Memorial Hospital PCI Primary X
Dubois – Penn Highlands PCI X Telemedicine
Forbes Regional Hospital Level II PCI Primary X In house
St. Elizabeth, Ohio Level II
Interventional Centers Trauma STEMI Stroke 24/7 CT 24/7 Neuro
Allegheny General Hospital Level I PCI Comprehensive X Yes
UPMC Presbyterian Hospital Level I PCI Comprehensive X Yes
UPMC Mercy Hospital Level I PCI Comprehensive X Yes
UPMC Children’s Hospital Level I
St. Elizabeth, Ohio Level II