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Scope of Practice
In the United States there are no federal guidelines for the scope of practice for any level of EMS provider. In the field, paramedics follow a set of pre-approved procedures and interventions for particular scenarios. For example, all fifty states allow for the administration of some form of anti-convulsive. In the state of Massachusetts a paramedic may administer the anti-convulsant, midazolam, up to a maximum of 6mg. While in Maine paramedics are allowed to administer midazolam in upwards of 10mg boluses. These pre-approved procedures are known as standing orders. Standing orders cannot surpass a provider's scope of practice. Scopes of practice represent the degree to which providers are trained.

The following is derived NHTSA's "National EMS Scope of Practice model". Without federal mandate, each state's office of emergency medical services may alter their respective standing orders. The purpose of the model is to provide a guide toward standardization in patient care that both improves patient outcomes but allows for reciprocity between states. Prior to certification as a paramedic, candidates must be a certified EMT. Traditionally, a paramedic is allowed to perform all skills and EMT may perform.

Below are some of the key skills and procedures expected of a paramedic in the United States.

Paramedic's Key Skills and Procedures. [edit]

 * Assessment and evaluation of general incident scene safety.
 * Triage of patients in a mass casualty incident.
 * Patient primary and secondary assessments.
 * Effective verbal and written reporting skills (Documentation).
 * Carrying/Lifting/Extrication of patients.
 * Peripheral intravenous cannulation.
 * Cardiac monitoring and manual defibrillation.
 * ECG acquisition and interpretation.
 * Orotracheal intubation.

Medications [edit]
One of the primary differences between emergency medical technicians and paramedics includes the breadth and number of medications paramedic ambulances typically carry. Due to the variation is amongst each state EMS office it would be cumbersome and unrealistic to list each and every single medication paramedics carry across the United States. Instead, different medications are carried to serve similar patient-care scenarios. Most services carry medications like albuterol or ipratropium to alleviate broncospasm during an acute asthma attack. They carry cardiac medications to reverse deadly heart rhythms like amiodarone and lidocaine. They can also use medications like atropine, adenosine and different types of beta-blockers as heart rate controls. Paramedics may also utilize a number of other medications for analgesia, as antiemetics and as anti-convulsants. In the setting of inter-facility transfers providers may continue the administration other medications that are not typically carried in the field (Heparin, Blood products, Potassium).

Variations in Scope
The aforementioned skills and medications are often standing orders in state protocols. The expectations and responsibilities of providers varies across state lines. There are instances where special waivers granted by states allowing paramedic services to go beyond their protocols. For example, some paramedics in New Hampshire may be allowed to perform a surgical cricothyrotomy, medics in Virginia are allowed to use ultrasound as a diagnostic technique and paramedics in Arizona are allowed to perform rapid-sequence intubation utilizing paralytic and sedating medication to completely control a patient's airway.

Paramedics in many jurisdictions administer a variety of emergency medications; the individual medications vary widely, based on physician (medical director) direction and local law. These drugs may include Adenocard (Adenosine), which stops and resets a heart that is beating too rapidly, and Atropine, which speeds a heartbeat that is too slow. The list may include sympathomimetics like norepinephrine or dopamine for severe hypotension (low blood pressure) and cardiogenic shock. Diabetics often benefit from the fact that paramedics are able to give D50W (Dextrose 50%) to treat hypoglycemia (low blood sugar). Paramedics may also be permitted to perform rapid sequence induction; a rapid way of obtaining an advanced airway with the use of paralytics and sedatives, using such medications as Ketamine or Etomidate, and paralytics such as succinylcholine, rocuronium, or vecuronium. Paramedics in some jurisdictions may also be permitted to sedate combative patients using antipsychotics like Haldol or Geodon. The use of medications for treating respiratory conditions such as, albuterol, atrovent, and methylprednisolone is common. Paramedics may also be permitted to administer medications such as those that relieve pain or decrease nausea and vomiting. Nitroglycerin, baby aspirin, and morphine sulfate may be administered for chest pain. Paramedics may also use other medications and antiarrhythmics like amiodarone to treat cardiac arrhythmias such as ventricular tachycardia and ventricular fibrillation not responding to defibrillation. Paramedics also treat for severe pain, i.e. burns or fractures, with narcotics like morphine sulfate, pethidine, fentanyl and in some jurisdictions, ketorolac. This list is not representative of all jurisdictions, and EMS jurisdictions may vary greatly in what is permitted. Some jurisdictions may not permit administration of certain classes of drugs, or may use drugs other than the ones listed for the same purposes. For an accurate description of permitted drugs or procedures in a given location, it is necessary to contact that jurisdiction directly.