Copyright 2014 by Northern Arizona Community Integrated Paramedicine (NA-CIP) Page 1

ARIZONA PARAMEDIC
SCOPE OF PRACTICE SUMMARY

Purpose:
This document is intended to give a brief overview of the scope of practice for Arizona certified
paramedics. The complete Arizona Department of Health Services, Bureau of Emergency Medical
Services and Trauma System Statutes and Rules, which outlines paramedic certification requirements
and scope of practice, can be found at:
http://azdhs.gov/bems/documents/statutes-rule-book.pdf
The complete National Registry of Emergency Medical Technicians (NREMT) standards for certification
can be found at:
https://www.nremt.org/nremt/downloads/Scope%20of%20Practice.pdf
Overview:
A paramedic certified by the State of Arizona, must meet the standards of The National Registry of
Emergency Medical Technicians (NREMT) prior to obtaining state certification. Paramedics in Arizona
are not required to maintain their NREMT certification once state certification has been obtained.
Paramedics are trained and equipped to perform pre-hospital emergency care, patient transport and
scene management including mass casualty triage and hazardous material awareness. Their scope of
practice includes invasive and pharmacological interventions to reduce the morbidity and mortality
associated with acute out-of-hospital medical and traumatic emergencies. (nremt.org)
Training:
The State of Arizona requires that all paramedic training programs have a physician medical director
with training and experience in emergency medicine (A.R.S. 36-2202). Paramedic training itself must
include a minimum of 500 contact hours of didactic and practical skills training and a minimum of 500
hours of clinical training and field training (AZDHS). These clinical and field hours are under the direct
supervision of preceptors.
Additionally, Paramedics are required to obtain American Heart Association (AHA) certification in Basic
Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS).
Scope of Practice:
The State of Arizona provides an all-inclusive list of the skills and procedures a paramedic may perform,
however, local and region physician oversight may further restrict a paramedics actual capabilities.
Paramedics perform under the direction of a physician Medical Director, who, in cooperation with
hospitals, EMS and Fire agencies, establish complaint centered Protocols, which provide paramedics
clear operating guidelines in most patient encounters.


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SCOPE OF PRACTICE SUMMARY

Scope of Practice continued:
Paramedics are trained and qualified to perform numerous skills and patient care intervention. These
skills are broken down below into Assessment, Advanced Level Interventions, and Pharmacological
Interventions and Others.
1. Assessment:
Medical and Trauma Assessments:
Advanced assessment of all body systems; neurological, respiratory, cardiac, immune,
integumentary, musculoskeletal, gastrointestinal, endocrine, renal and urogenital.

Objective and Subjective Assessments: injury, pain, mental status, deficits.

Diagnostic Assessments:
Blood Pressure, Pulse, Respiratory Rate, Pupils, Temperature
Electrocardiogram (EKG) monitoring
Lung Sounds, Pulse Oximetry (SPO2), End tidal CO2 (ETCO2)
Ophthalmoscopy, Otoscope
Electrolyte and Hematology
Blood Glucose

2. Advanced Level Interventions:

Intravenous Intra-Osseous Access:
Adults and children.
IV /IO, Intra-nasal, intra-muscular, sub-cutaneous drug administrations
Access indwelling catheters and implanted central IV ports for fluid and medication
administration
Fluid administration to support blood pressure
Infusions of D5W and numerous medications listed under medications below.
Maintain an infusion of blood or blood products

Advanced Airway Management:
Oxygen Administration
Bag Valve Mask (BVM) Ventilations.
Ventilator Operations.
Basic Airway Adjuncts
Airway Suctioning
Decompression of the Pleural Space
Gastric Decompression
Endotracheal Intubation by Direct Laryngoscopy.

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ARIZONA PARAMEDIC
SCOPE OF PRACTICE SUMMARY


Advanced Airway Management: Continued

Supra-glottic Airway Devices.
Emergency Percutaneous Cricothyrotomy
Rapid Sequence Induction. (RSI) (Additional training required)
Chest Tube Monitoring

Electrical Therapies
4 lead and 12 Lead analysis
Synchronized and Unsynchronized Cardioversion
Defibrillation
External Transcutaneous Pacing (TCP)

3. Pharmacological Interventions
(See complete list and drug profiles at http://www.azdhs.gov/bems/drugs/index.htm)

Cardiovascular Support Drugs:
ACLS and PALS Related Drugs
Atropine, Aspirin, Adenosine, Amiodarone, Calcium, Diltiazem, Epinephrine,
Lidocaine, Magnesium, Morphine Sulfate, Nitroglycerin, Sodium Bicarbonate

Respiratory Support Drugs
Oxygen, Albuterol (small volume nebulizer), Ipratropium Bromide (SVN),
Epinephrine (1:1000), Magnesium, Sedatives and Neuro-muscular Blocking
Agents for Intubation and RSI.

Pain Management and Sedation
Morphine Sulfate, Ativan, Fentanyl, Diazepam, Midazolam.

Blood Sugar Support
Dextrose (IV), Glucagon (IM), Glucose (oral)

Hemodynamic Support
Dopamine, Epinephrine, Pitocin, Normal Saline, Lactated Ringers, Blood/Blood
Products

Immune System Support / Suppression
Benadryl


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SCOPE OF PRACTICE SUMMARY



4. Others:
Paramedics may be authorized to monitor numerous infusions during critical care transports
including, anticoagulant therapies, fibrinolytics, antiarrhythmic therapies, antibiotic
infusions, seizure control, chemical restraint, pain management, and blood pressure
regulation.