Advanced Practice Paramedic (APP)

What is an Advanced Practice Paramedic (APP)?

The Advanced Practice Paramedic is physician extender, capable of extensive, advanced patient care interventions in critical and emergent patients. This individual possesses the complex knowledge and advanced interventional skills necessary to provide physician extension to the patient’s side, allowing their physician medical program director (MPD) the ability to have physician level care extended to the scene of any emergency, through the hand, eyes, and ears of the APP. Advanced Practice Paramedics are the pinnacle of a comprehensive EMS response, under medical oversight. Advanced Practice Paramedics perform interventions and patient care management with the advanced and diagnostic equipment typically found in an advanced response vehicle, on an advanced practice ALS ambulance, or in an emergency department. The Advanced Practice Paramedic is a tertiary link from the scene into the tertiary health care system, serving as advanced responders, critical care transport providers, aeromedical providers, and in atypical care provision.

What is the Scope of Practice of an APP?

An Advanced Practice Paramedic (APP) may, under the direction of a Committee approved Medical Director:

1. Perform all procedures that a Paramedic may perform;
2. Initiate, manage, and utilize an orogastric or nasogastric tube;
3. Initiate, manage, and utilize a mechanical ventilator;
4. Initiate, manage, and utilize the following airway management techniques:
   1. Endotracheal intubation, via oral or nasal route, with the use of sedative and paralytic agents;
   2. Video laryngoscopy or bronchoscopy;
   3. Surgical Cricothyrotomy; and
   4. Other airway management techniques as identified by the Medical Program Director
5. Initiate, manage, and utilize simple (open) technique thoracostomy for tension pneumothorax, tension hemothorax, or pneumohemothorax;
6. Initiate, manage, and utilize chest tube thoracostomy;
7. Initiate, manage, and utilize chest drains;
8. Initiate, manage, or utilize all forms of vascular access;
9. With ultrasound guidance, place central vascular access or deep vein cannulation;
10. With ultrasound guidance, perform needle pericardiocentesis;
11. Perform normal and high-risk childbirth;
12. Perform bimanual massage in life threatening postpartum hemorrhage;
13. Perform ultrasound guided nerve block;
14. Perform needle or surgical incision and drainage of fluid filled oral or subcutaneous masses;
15. Initiate placement of, and maintain, a urinary catheter;
16. Prepare, initiate, and/or administer any medications or blood products by any means, under specific written protocols authorized by the Medical Director, or direct orders from a licensed transferring physician.
17. Prepare, initiate, perform, and/or interpret any diagnostic test or utilize any diagnostic device under specific written authorized by the Medical Director, or direct orders from a licensed transferring physician;
18. May carry out other tasks and procedures as authorized by the Medical Director or direct orders from a licensed transferring physician; and
19. Be unrestricted as to the environment of practice or function, may serve as a physician extender for an authorized Medical Director in EMS, aeromedical, rescue, underserved or under staffed hospital emergency departments, and critical care areas.