Comparison of the Scope of Practice of the Army Combat Medic Specialist and Civilian National EMS Certification Levels

Figures & data

Figure 1. National guidelines and training documents that define the floor of practice for civilian and military EMS and their associated certification levels. Abbreviations: EMT, emergency medical technician; AEMT, advanced emergency medical technician; EMS, emergency medical services; 68W, army combat medic specialists; ATR, army training requirements.

Figure 2. Percent of Tasks satisfied by 68W (army combat medic specialists) at the emergency medical technician (EMT) level plus any military specific task performed above the EMT level.

Table 1. Identified task by 68W (army combat medic specialists) above the civilian emergency medical technician (EMT) level.

Category	Tasks Above civilian EMT Scope of Practice
Airway	Needle chest decompression Cricothyrotomy Supraglottic airway
Cardiology	None
Splints/Stabilization	None
Medication Administration	Intradermal Intramuscular Intranasal Intravenous Subcutaneous Topical Transdermal
Director Approved Medications	Immunizations Intravenous Over-the-counter meds (oral and topical) Parental analgesia for pain Sublingual nitroglycerin for chest pain
Fluids	Intraosseous – initiation Intravenous access Intravenous initiation - peripheral Intravenous – maintenance of nonmedicated fluids
Miscellaneous	Venous blood sampling

Figure 3. Percent of Tasks satisfied by 68W (army combat medic specialists) at the advanced emergency medical technician (AEMT) level plus any military specific task performed above the AEMT level.

Table 2. Identified task by 68W (army combat medic specialists) above the civilian advanced emergency medical technician level.

Category	Tasks Below AEMT Scope of Practice	Tasks Above AEMT Scope of Practice
Airway	Tracheobronchial suctioning of an intubated patient End-tidal CO2 monitoring/waveform capnography	Needle chest decompression Cricothyrotomy
Cardiology	None	None
Splints/Stabilization	None	None
Medication Administration	None	Intradermal Topical Transdermal
Director Approved Medications	Administrating inhaled nitrous oxide	Over-the-counter medications (oral and topical)
Fluids	None	None
Miscellaneous	None	None

Table

I. Skill – Airway/Ventilation/Oxygenation
Skill	EMT	AEMT	68W
Airway – nasal	X	X	X
Airway – oral	X	X	X
Airway – supraglottic	X	X	X
Bag-valve-mask	X	X	X
CPAP	X	X	X
Chest decompression – needle			X
Chest tube placement – assist only			X
Chest tube – monitoring and management
Cricothyrotomy			X
End-tidal CO2 monitoring and interpretation of waveform capnography		X	X
Gastric decompression – NG tube
Gastric decompression – OG tube
Head tilt – chin lift	X	X	X
Endotracheal intubation
Jaw thrust	X	X	X
Mouth-to-barrier	X	X	X
Mouth-to-mask	X	X	X
Mouth-to-mouth	X	X	X
Mouth-to-nose	X	X	X
Skill	EMT	AEMT	68W
Mouth-to-stoma	X	X	X
Airway obstruction – dislodgement by direct laryngoscopy
Airway obstruction – manual dislodgement techniques	X	X	X
Oxygen therapy – high flow nasal cannula
Oxygen therapy – humidifiers	X	X	X
Oxygen therapy – nasal cannula	X	X	X
Oxygen therapy – non-rebreather mask	X	X	X
Oxygen therapy – partial rebreather mask	X	X	X
Oxygen therapy – simple face mask	X	X	X
Oxygen therapy – Venturi mask	X	X	X
Pulse oximetry	X	X	X
Suctioning – upper airway	X	X	X
Suctioning – tracheobronchial of an intubated patient		X
II. Skill – Cardiovascular/Circulation
Skill	EMT	AEMT	68W
Cardiopulmonary resuscitation	X	X	X
Cardiac monitoring − 12 lead ECG acquisition and transmission	X	X	X
Cardiac monitoring − 12 lead electrocardiogram (interpretive)
Cardioversion – electrical
Defibrillation – automated / semiautomated	X	X	X
Defibrillation – manual
Skill	EMT	AEMT	68W
Hemorrhage control – direct pressure	X	X	X
Hemorrhage control – tourniquet	X	X	X
Hemorrhage control – wound packing	X	X	X
Transvenous cardiac pacing – monitoring and maintenance
Mechanical CPR device	X	X	X
Telemetric monitoring devices and transmission of clinical data, including video data	X	X	X
Transcutaneous pacing
III. Skill – Splinting, Spinal Motion Restriction, and Patient Restraint
Skill	EMT	AEMT	68W
Cervical collar	X	X	X
Long spine board	X	X	X
Manual cervical stabilization	X	X	X
Seated SMR	X	X	X
Extremity stabilization – manual	X	X	X
Extremity splinting	X	X	X
Splint – traction	X	X	X
Mechanical patient restraint	X	X	X
Emergency moves for endangered patients	X	X	X
IV. Skill – Medication Administration – Routes
Skill	EMT	AEMT	68W
Aerosolized/nebulized	X	X	X
Endotracheal tube
Inhaled	X	X	X
Intradermal			X
Intramuscular		X	X
Intramuscular – auto-injector	X	X	X
Intranasal		X	X
Intranasal – unit-dosed, premeasured	X	X	X
Intraosseous – initiation, pediatrics or adult		X
Intravenous		X	X
Mucosal/sublingual	X	X	X
Nasogastric
Oral	X	X	X
Rectal
Subcutaneous		X	X
Topical			X
Transdermal
V. Medical Director Approved Medications
Medications	EMT	AEMT	68W
Use of epinephrine (auto-injector) for anaphylaxis (supplied and carried by the EMS agency)	X	X	X
Use of auto-injector antidotes for chemical/hazardous material exposures	X	X	X
Use of opioid antagonist auto-injector for suspected opioid overdose	X	X	X
Medications	EMT	AEMT	68W
Immunizations		X	X
Inhaled – beta-agonist/bronchodilator and anticholinergic for dyspnea and wheezing	X	X	X
Inhaled – monitor patient administered (i.e., nitrous oxide)		X
Intranasal – opioid antagonist for suspected opioid overdose	X	X	X
Intravenous		X*	X
Maintain an infusion of blood or blood products
Oral aspirin for chest pain of suspected ischemic origin	X	X	X
Oral glucose for suspected hypoglycemia	X	X	X
OTC analgesics for pain or fever	X	X	X
OTC medications, oral and topical			X
Parenteral analgesia for pain		X	X
Sublingual nitroglycerin for chest pain of suspected ischemic origin – limited to patient’s prescribed medication	X		X
Sublingual nitroglycerin for chest pain of suspected ischemic origin		X
Thrombolytics
VI. Skill – IV Initiation/Maintenance Fluids
Skill	EMT	AEMT	68W
Access indwelling catheters and implanted central IV ports
Central line – monitoring
Intraosseous – initiation, peds or adult	X^†	X
Intravenous access		X
Intravenous initiation – peripheral		X
Skill	EMT	AEMT	68W
Intravenous – maintenance of nonmedicated IV fluids	X	X
Intravenous – maintenance of medicated IV fluids
VII. Skill – Miscellaneous
Skill	EMT	AEMT	68W
Assisted delivery (childbirth)	X	X	X
Assisted complicated delivery (childbirth)	X	X	X
Blood chemistry analysis
Blood pressure automated	X	X	X
Blood pressure – manual	X	X	X
Blood glucose monitoring	X	X	X
Eye irrigation	X	X	X
Eye irrigation –hands-free irrigation using a sterile eye irrigation device
Patient transport	X	X	X
Venous blood sampling		X	X

* Limited to analgesia, antinausea/antiemetic, dextrose, epinephrine, glucagon, naloxone, and others defined by local/state policy.

^† Adults only.

Abbreviations: EMT, emergency medical technician; AEMT, advanced emergency medical technician; 68W, army combat medic specialists; CPAP, continuous positive airway pressure; CO₂, carbon dioxide; NG, nasogastric; OG, orogastric; CPR, cardiopulmonary resuscitation; SMR, spinal motion restriction; EMS, emergency medical services; OTC, over the counter; IV, intravenous.