Title 202 | Chapter 007 | Regulation 701
SUPERSEDED
This document is no longer current.
PREVIOUS VERSION
The previous document that this document is based upon is available.
KENTUCKY COMMUNITY AND TECHNICAL COLLEGE SYSTEM
Kentucky Board of Emergency Medical Services
(Amendment)
202 KAR 7:701.Scope of practice matters.
Section 1.
Emergency Medical Responder.(1)
In addition to the skills and procedures established in the current National Highway Traffic Safety Administration National EMS Scope of Practice Model, emergency medical responders certified by the board shall be eligible to perform the supplemental procedures:(a)
Cervical spine and spinal immobilization; and(b)
Administration of Naloxone via Nasal Atomization Devices.(2)
To be eligible to perform a supplemental procedure established in subsection (1) of this section, an emergency medical responder shall have been trained and educated utilizing:(a)
Kentucky Required Mandatory Supplemental Curriculum: EMR Spinal Immobilization (KBEMS-E-34); and(b)
Kentucky Required Mandatory Supplemental Curriculum for the EMR in the Administration of Naloxone using a Nasal Atomization Device (KBEMS-E-33).(3)
An out-of-state emergency medical responder may perform any skill or procedure that the emergency medical responder may use in the state in which the emergency medical responder is certified subject to the emergency medical responder being called upon to assist in providing medical and related care during a disaster or emergency pursuant to KRS 39A.050, the Emergency Management Assistance Compact, or an agreement made pursuant to KRS Chapter 39A.(4)
(a)
An emergency medical responder shall adhere to the protocols established by KRS Chapter 311A and 202 KAR Chapter 7. Deviation from these protocols shall only occur if:1.
The emergency medical responder's medical director or designated on-line medical direction orders otherwise;2.
Compliance with approved protocols is not in the patient's medical best interest; or3.
The emergency medical responder does not have the equipment or medication to adhere to the protocol.(b)
Any deviation from an approved protocol shall be documented in the Patient Care Report (PCR) established in 202 KAR 7:540.Section 2.
Emergency Medical Technician (EMT).(1)
In addition to the skills and procedures established in the current National Highway Traffic Safety Administration National EMS Scope of Practice Model, an EMT certified by the board shall be eligible to perform the supplemental procedures:(a)
Identification of correct placement of an endotracheal tube (ETT) placed by a licensed paramedic, including the use of end tidal CO2 monitoring (EtCO2);(b)
Securing of an endotracheal tube that has been inserted by appropriately licensed personnel;(c)
The use of Blind Insertion Airway Devices (BIADs);(d)
Utilizing a cardiac monitor and troubleshooting potential problems;(e)
Selecting and applying cardiac electrodes;(f)
Non-interpretive acquisition and transmission of a 12-Lead Electrocardiogram (ECG);(g)
Appropriate utilization of equipment and sampling of blood glucose using a glucometer;(h)
Care for a saline lock site where a catheter has been dislodged;(i)
Administration of Epinephrine for anaphylaxis;(j)
Administration of Naloxone using a Nasal Atomization Device; and(k)
Administration of Albuterol using a Nebulizer.(2)
To be eligible to perform each of the supplemental procedures, an EMT shall have been trained and educated utilizing:(a)
Kentucky Required Mandatory Supplemental Curriculum for the EMT in Advanced Airway Management: Monitoring & Securing an ETT (KBEMS-E-38);(b)
Kentucky Required Mandatory Supplemental Curriculum for the Emergency Medical Technician (EMT) Using a Noninvasive Monitoring Device - Application of Electrocardiogram Electrodes, Use of a Cardiac Monitor, and Acquisition and Transmission of a 12-Lead ECG (KBEMS-E-35);(c)
Kentucky Required Mandatory Supplemental Curriculum for the Emergency Medical Technician (EMT): Training in the Monitoring, Maintaining, and Discontinuing of Pre-established Patient Intravenous Infusions in Prehospital, Interfacility, and Facility-to-Home Encounters (KBEMS-E-40);(d)
Kentucky Required Mandatory Supplemental Curriculum for the Emergency Medical Technician (EMT) Using a Noninvasive Monitoring Device - Application of End-tidal Carbon Dioxide Monitoring (KBEMS-E-39);(e)
Kentucky Required Mandatory Supplemental Curriculum for the EMT in the Administration of Naloxone Using a Nasal Atomization Device (KBEMS-E-36);(f)
Kentucky Required Mandatory Supplemental Curriculum for the EMT in Advanced Airway Management: Blindly Inserted Airway Devices (BIADs) (KBEMS-E-37);(g)
Kentucky Required Mandatory Supplemental Curriculum for the EMT: Sampling of Blood Glucose Using a Glucometer (KBEMS-E-41);(h)
Kentucky Required Mandatory Supplemental Curriculum: Administration of Epinephrine (KBEMS-E-42); and(i)
Kentucky Required Mandatory Supplemental Curriculum: Administration of Albuterol using a Nebulizer (KBEMS-E-43).(3)
An EMT shall adhere to the protocols established by KRS Chapter 311A and 202 KAR Chapter 7. Deviation from these protocols shall only occur if:(a)
The medical director or designated on-line medical direction orders otherwise;(b)
Compliance is not in the medical best interest of the patient; or(c)
The EMT does not have the equipment or medication to adhere to the protocol.(4)
Any deviation from an approved protocol shall be documented in the Patient Care Report (PCR) established in 202 KAR 7:540.(5)
An out-of-state EMT may perform any skill or procedure that the EMT may use in the state in which the EMT is certified subject to the EMT being called upon to assist in providing medical and related care during a disaster or emergency pursuant to KRS 39A.050, the Emergency Management Assistance Compact, or an agreement made pursuant to KRS Chapter 39A.Section 3.
EMT Students.(1)
During the didactic, laboratory, and clinical portions of an EMT course, an EMT student may perform any skill or procedure, or administer any medication within the scope of practice for an EMT as established by this administrative regulation, if the student:(a)
Has been trained and educated to perform the skill or procedure, or to administer the medication; and(b)
Is permitted to perform the skill or procedure in writing or by direct order of the medical director of the EMT course.(2)
During a field internship, an EMT student may perform any skill or procedure, or administer any medication within the scope of practice for an EMT as established by this administrative regulation, if:(a)
The student has written authorization by the medical director of the EMT course to perform the skill or procedure;(b)
Authorization to perform the skill or procedure is filed with the coordinator of the EMT course; and(c)
The medical director of the EMT course and the director of the agency for whom the skill or procedure is performed each give written permission to the EMT student to participate in a field internship with the agency.(3)
This administrative regulation shall not be construed to allow an emergency medical responder student orSection 4.
Advanced Emergency Medical Technician (AEMT).(1)
An AEMT shall provide emergency medical services consistent with the current National Highway Traffic Safety Administration National EMS Scope of Practice Model.(2)
In addition to the skills and procedures in the National EMS Scope of Practice Model, the scope of practice of a Kentucky AEMT shall include the supplemental procedures:(a)
Quantitative and qualitative capnography and capnometry;(b)
Bi-level Positive Airway Pressure and Continuous Positive Airway Pressure (BiPAP/CPAP) devices; and(c)
Establishing and maintaining an adult intraosseous infusion.(3)
To be eligible to perform each of the supplemental procedures, an AEMT shall have been trained and educated utilizing:(a)
Kentucky Required Mandatory Supplemental Curriculum for the AEMT Using a Noninvasive Monitoring Device - Application and Interpretation of Quantitative Capnography and End Tidal Carbon Dioxide Monitoring (KBEMS-E30);(b)
Kentucky Required Mandatory Supplemental Curriculum for the AEMT - Intraosseous Infusion in the Adult (KBEMS-E-31); and(c)
Kentucky Required Mandatory Supplemental Curriculum for the AEMT Using Bi-level Positive Airway Pressure and Continuous Positive Airway Pressure Devices (KBEMS-E-32).(4)
(a)
An AEMT shall adhere to the protocols established by KRS Chapter 311A and 202 KAR Chapter 7. Deviation from these protocols shall only occur if:1.
The AEMT's medical director or designated on-line medical direction orders otherwise;2.
Compliance with approved protocols is not in the patient's medical best interest; or3.
The AEMT does not have the equipment or medication to adhere to the protocol.(b)
Any deviation from an approved protocol shall be documented in the Patient Care Report (PCR) established in 202 KAR 7:540.(5)
If providing emergency medical services during a disaster or emergency that qualifies as part of the Emergency Management Assistance Compact pursuant to KRS 39A.050, or if acting pursuant to another agreement made pursuant to KRS Chapter 39, an AEMT certified in another state may perform the skills and procedures approved by the certifying state.Section 5.
AEMT Students.(1)
During the didactic, laboratory, and clinical portions of an AEMT course, an AEMT student may perform any skill or procedure, or administer any medication within the scope of practice for an AEMT, as defined by this administrative regulation, if the student:(a)
Has been trained and educated to perform the skill or procedure, or to administer the medication; and(b)
Is permitted to perform the skill or procedure in writing or by direct order of the medical director of the AEMT course.(2)
During a field internship, an AEMT student may perform any skill or procedure, or administer any medication within the scope of practice for an AEMT, as established by this administrative regulation, if:(a)
The student has written authorization by the medical director of the AEMT course to perform the skill or procedure;(b)
Authorization to perform the skill or procedure is filed with the coordinator of the AEMT course; and(c)
The medical director of the AEMT course and the director of the agency for whom the skill or procedure is performed each give written permission to the AEMT student to participate in a field internship with the agency.(3)
This administrative regulation shall not be construed to allow anSection 6.
Paramedic.(1)
A paramedic may perform any of the skills and procedures consistent with the current National Highway Traffic Safety Administration National EMS Scope of Practice Model.(2)
A paramedic shall adhere to the protocols established by KRS Chapter 311A and 202 KAR Chapter 7. Deviation from these protocols shall only occur if:(a)
The medical director or designated on-line medical direction orders otherwise;(b)
Compliance is not in the medical best interest of the patient; or(c)
The paramedic does not have the equipment or medication to adhere to the protocol.(3)
Any deviation from an approved protocol shall be documented in the Patient Care Report (PCR) established in 202 KAR 7:540.(4)
(a)
A paramedic functioning in a position of employment may perform any procedure or administer medications authorized by KRS 311A.170 or this administrative regulation, at any location within the Commonwealth subject to the written approval of, and limitations established by the paramedic's medical director and the paramedic's employer.(b)
A paramedic performing skills or procedures outside of the normal response area for the paramedic shall accompany and assist with or continue treatment for the patient until the patient is accepted by a receiving hospital, an ALS ground or licensed ALS air ambulance provider, or care is transferred to another licensed paramedic, receiving facility RN, advanced practice registered nurse (APRN), licensed physician's assistant, or physician.(5)
(a)
1.
An off-duty paramedic may perform any procedure or administer medications authorized by KRS 311A.170 or this administrative regulation, at any location within the Commonwealth subject to the written approval of, and limitations established by the paramedic's medical director and, if appropriate, the paramedic's employer; or2.
The paramedic may render care subject to the limitations of the paramedic's scope of practice at any location, if ordered to do so by a duly licensed physician.(b)
A paramedic performing skills or procedures outside of the normal response area for the paramedic shall accompany and assist with or continue treatment for the patient until the patient is accepted by a receiving hospital, an ALS ground or licensed ALS air ambulance provider, or care is transferred to another licensed paramedic, hospital emergency department, RN, advanced practice registered nurse (APRN), licensed physician's assistant, or physician.(6)
An out-of-state paramedic may perform any skill, procedure, or administer any medications that the paramedic may use in the state in which the paramedic is certified or licensed, subject to the control of the out-of-state paramedic's medical director or protocols and only in the following circumstances:(a)
An out-of-state paramedic is transporting a patient from out-of-state to a Kentucky medical facility or other location in Kentucky;(b)
An out-of-state paramedic is transporting a patient from out of state through Kentucky to another location out of state; or(c)
An out-of-state paramedic is called upon to assist in providing medical and related care during a disaster or emergency pursuant to KRS 39A.050, the Emergency Management Assistance Compact, or an agreement made pursuant to KRS Chapter 39A.(7)
A paramedic with a critical care endorsement shall be authorized to perform the skills and procedures included in the paramedic's education and training subject to authorization by the medical director through established protocols in accordance with KRS Chapter 311A and 202 KAR Chapter 7.Section 7.
Paramedic Hospital Scope of Practice.(1)
Paramedics functioning in the hospital environment shall perform within the scope of practice, as established in this administrative regulation.(2)
Employment of paramedics in hospital emergency department settings, exclusive of employment by air or ground transport components, or both, owned or operated by the hospital, shall be subject to demonstrating knowledge based and clinical competencies at a level satisfactory to the employing hospital and subject to KRS Chapter 311A and 202 KAR Chapter 7.(3)
An employer shall not require practice for a paramedic that exceeds the defined scope of practice established by KRS Chapter 311A and 202 KAR Chapter 7. The paramedic shall inform the employing institution or supervising staff of any inability or limitation to perform an ordered skill or procedure based upon:(a)
A lack of knowledge of or training or education in the procedure or skill; or(b)
The order or directive exceeding the paramedic's scope of practice.(4)
An employer may provide education or educational opportunities to expand the documented clinical practice of the paramedic but shall not do so with the intent of requiring the paramedic to perform skills or procedures exceeding the scope of practice established by KRS Chapter 311A and 202 KAR Chapter 7 while in the hospital's employ.(5)
A paramedic shall:(a)
Maintain strict patient confidentiality;(b)
Provide and assure continuity of care to patients;(c)
Be a patient advocate;(d)
Follow the hospital's chain of command;(e)
Be knowledgeable and function within the scope of practice of a paramedic;(f)
Be clearly identified as a licensed paramedic while functioning in the hospital's employ;(g)
Document on patient care records all interventions, treatments, and assessments performed by the paramedic;(h)
Perform patient assessment, which may include triage; and(i)
Institute appropriate therapy in the care of patients subject to the limitation of existing protocols.Section 8.
Paramedic Students.(1)
During the didactic, laboratory, and clinical portions of a paramedic course, a paramedic student may perform any skill or procedure, or administer any medication within the scope of practice for a paramedic as established by this administrative regulation, if the student:(a)
Has been trained and educated to perform the skill or procedure or administer the medication; and(b)
Is permitted to perform the skill or procedure in writing or by direct order of the medical director of the paramedic course.(2)
During the field internship, a paramedic student may perform any skill or procedure, or administer any medication within the scope of practice for a paramedic as established by this administrative regulation, if:(a)
The student has written authorization by the medical director of the paramedic course to perform the skill or procedure;(b)
The permission is filed with the paramedic course coordinator of the paramedic course; and(c)
The medical director and director of the ambulance service each give written permission to the paramedic student to participate in a field internship with the ambulance service.(3)
This administrative regulation shall not be construed to allow aSection 9.
Restriction of Practice. This administrative regulation shall not prohibit a medical director from restricting the scope of practice of any emergency medical responder, EMT, AEMT, or paramedic under the medical director's authority through established protocols.Section 10.
Exemptions. This administrative regulation shall not prohibit an emergency medical responder, emergency medical technician, advanced emergency medical technician, or paramedic certified or licensed in another state or registered with the NREMT from functioning in accordance with the scope of practice established in KRS Chapter 311A and 202 KAR Chapter 7 while assisting with mass casualties, weapons of mass destruction, or disaster incidents.Section 11.
Incorporation by Reference.(1)
The following documents are incorporated by reference.(a)
"Kentucky Required Mandatory Supplemental Curriculum for the AEMT Using a Noninvasive Monitoring Device - Application and Interpretation of Quantitative Capnography and End Tidal Carbon Dioxide Monitoring", KBEMS-E-30, February 2007;(b)
"Kentucky Required Mandatory Supplemental Curriculum for the AEMT Intraosseous Infusion in the Adult", KBEMS-E-31, February 2007;(c)
"Kentucky Required Mandatory Supplemental Curriculum for the AEMT using Bi-level Positive Airway Pressure and Continuous Positive Airway Pressure Devices", KBEMS-E-32, February 2007;(d)
"Kentucky Required Mandatory Supplemental Curriculum for the EMR in the Administration of Naloxone Using a Nasal Atomization Device", KBEMS-E-33, February 2007;(e)
"Kentucky Required Mandatory Supplemental Curriculum: EMR Spinal Immobilization", KBEMS-E-34, February 2007;(f)
"Kentucky Required Mandatory Supplemental Curriculum for the Emergency Medical Technician (EMT) Using a Noninvasive Monitoring Device - Application of Electrocardiogram Electrodes, Use of a Cardiac Monitor, and Acquisition and Transmission of a 12-Lead ECG", KBEMS-E-35, February 2007;(g)
"Kentucky Required Mandatory Supplemental Curriculum for the EMT in the Administration of Naloxone Using a Nasal Atomization Device", KBEMS-E-36, February 2007;(h)
"Kentucky Required Mandatory Supplemental Curriculum for the EMT in Advanced Airway Management: Blindly Inserted Airway Devices (BIADs)", KBEMS-E-37, February 2007;(i)
"Kentucky Required Mandatory Supplemental Curriculum for the EMT in Advanced Airway Management: Monitoring & Securing an ETT", KBEMS-E-38, February 2007;(j)
"Kentucky Required Mandatory Supplemental Curriculum for the Emergency Medical Technician (EMT) Using a Noninvasive Monitoring Device - Application of End-Tidal Carbon Dioxide Monitoring", KBEMS-E-39, February 2007;(k)
"Kentucky Required Mandatory Supplemental Curriculum for Emergency Medical Technician (EMT): Training in the Monitoring, Maintaining, and Discontinuing of Pre-established Patient Intravenous Infusions in Prehospital, Interfacility, and Facility-to-Home Encounters", KBEMS-E-40, February 2007;(l)
"Kentucky Required Mandatory Supplemental Curriculum for the EMT: Sampling of Blood Glucose Using a Glucometer", KBEMS-E-41, February 2007;(m)
"Kentucky Required Mandatory Supplemental Curriculum: Administration of Epinephrine", KBEMS-E-42, February 2007;(n)
"Kentucky Required Mandatory Supplemental Curriculum: Administration of Albuterol Using a Nebulizer", KBEMS-E-43, February 2007; and(o)
"National Highway Traffic Safety Administration National EMS Scope of Practice Model", February 2007.(2)
This material may be inspected, obtained, or copied, subject to applicable copyright law, at the Office of the Kentucky Board of Emergency Medical Services, 2464 Fortune Drive, Suite 195, Lexington, Kentucky 40509PHILIP DIETZ, Chair
APPROVED BY AGENCY: June 30, 2022
FILED WITH LRC: July 12, 2922 at 12:25 p.m.
PUBLIC HEARING AND COMMENT PERIOD: A public hearing on this administrative regulation shall be held on September 28, 2022 at 1:00 p.m. ET at the Kentucky Board of Emergency Medical Services, 2464 Fortune Drive, Suite 195, Lexington, Kentucky 40509. Individuals interested in being heard at this hearing shall notify this agency in writing by five (5) workdays prior to the hearing of their intent to attend. If no notification of intent to attend the hearing is received by that date, the hearing may be canceled. This hearing is open to the public. Any person who wishes to be heard will be given an opportunity to comment on the proposed administrative regulation. A transcript of the public hearing will not be made unless a written request for a transcript is made. If you do not wish to be heard at the public hearing, you may submit written comments on the proposed administrative regulation. Written comments shall be accepted through September 30, 2022. Send written notification of intent to be heard at the public hearing or written comments on the proposed administrative regulation to the contact person.
CONTACT PERSON: John K. Wood, counsel for the Kentucky Board of Emergency Medical Services, 163 East Main Street, Suite 200, Lexington, Kentucky 40507, phone (859) 225-4714, email administrativeregulations@wgmfirm.com.
REGULATORY IMPACT ANALYSIS AND TIERING STATEMENT
Contact Person:
John K. Wood
(1) Provide a brief summary of:
(a) What this administrative regulation does:
202 KAR 7:701 establishes the scope of practice for individuals certified or licensed by the Board.
(b) The necessity of this administrative regulation:
KRS 311A.025, 311A.030, 311A.135, 311A.140, 311A.160, 311A.165, and 311A.170 require the Board to promulgate administrative regulations relating to the scope of practice for individuals certified or licensed by the board. This administrative regulation establishes the scope of practice.
(c) How this administrative regulation conforms to the content of the authorizing statutes:
This administrative regulation conforms to the content of KRS 311A.025, 311A.030, 311A.135, 311A.140, 311A.160, 311A.165, and 311A.170 by establishing the scope of practice for individuals licensed or certified by the Board.
(d) How this administrative regulation currently assists or will assist in the effective administration of the statutes:
KRS 311A.025, 311A.030, 311A.135, 311A.140, 311A.160, 311A.165, and 311A.170 require the Board to promulgate administrative regulations relating to the scope of practice for individuals certified or licensed by the board. This administrative regulation assists in the effective administration of the statutes by establishing the scope of practice.
(2) If this is an amendment to an existing administrative regulation, provide a brief summary of:
(a) How the amendment will change this existing administrative regulation:
This amendment will allow students seeking certification as an EMT to be supervised by a certified AEMT or EMT when performing a skill or procedure, in addition to a physician, registered nurse, or paramedic who are currently the only personnel authorized to supervise EMT students. Additionally, this amendment will allow students seeking certification as an AEMT to be supervised by a certified AEMT when performing a skill or procedure, in addition to a physician, registered nurse, or paramedic who are currently the only personnel authorized to supervise AEMT students. Finally, while this amendment does amend the substantive requirements for paramedic student supervision, changes are made to Section 8(3) to clarify that the provision applies only to paramedics and that, in general, supervising personnel must be licensed or certified in the Commonwealth.
(b) The necessity of the amendment to this administrative regulation:
This amendment is necessary to mitigate staffing concerns. Specifically, due in part to staffing issues, there are not enough available paramedics to supervise students seeking EMT and AEMT certification from the Board. This has resulted in delays in students’ ability to become certified, which has further aggravated staffing concerns.
(c) How the amendment conforms to the content of the authorizing statutes:
KRS 311A.025, 311A.030, 311A.135, 311A.140, 311A.160, 311A.165, and 311A.170 require the Board to promulgate administrative regulations relating to the scope of practice for individuals certified or licensed by the board. This amendment conforms to the content of these statutes by establishing the scope of practice.
(d) How the amendment will assist in the effective administration of the statutes:
This amendment will assist in the effective administration of KRS 311A.025, 311A.030, 311A.135, 311A.140, 311A.160, 311A.165, and 311A.170 by establishing the scope of practice.
(3) List the type and number of individuals, businesses, organizations, or state and local governments affected by this administrative regulation:
All Kentucky EMS agencies and students seeking EMT or AEMT certification.
(4) Provide an analysis of how the entities identified in question (3) will be impacted by either the implementation of this administrative regulation, if new, or by the change, if it is an amendment, including:
(a) List the actions that each of the regulated entities identified in question (3) will have to take to comply with this administrative regulation or amendment:
No action is required on the part of EMS agencies. Students seeking EMT certification will be permitted to perform skills and procedures under the supervision of a licensed or certified physician, registered nurse, paramedic, AEMT, or EMT. Students seeking AEMT certification will be permitted to perform skills and procedures under the supervision of a physician, registered nurse, paramedic, or AEMT.
(b) In complying with this administrative regulation or amendment, how much will it cost each of the entities identified in question (3):
There will be no cost to any entity identified in question (3), other than administrative costs that may be incurred in recruiting and maintaining qualified personnel.
(c) As a result of compliance, what benefits will accrue to the entities identified in question (3):
All EMS agencies will benefit from students being able to be supervised by additional certified or licensed personnel, which will likely result in more available certified EMS personnel in a shorter amount of time than the current regulation would allow. All students seeking certification as an EMT or AEMT will benefit from being able to be supervised by additional personnel, which will likely result in students becoming certified in a shorter amount of time than the current regulation would allow.
(5) Provide an estimate of how much it will cost the administrative body to implement this administrative regulation:
(a) Initially:
There will be no cost to any entity identified in question (3), other than administrative costs that may be incurred in recruiting and maintaining qualified personnel.
(b) On a continuing basis:
There will be no cost to any entity identified in question (3), other than administrative costs that may be incurred in recruiting and maintaining qualified personnel.
(6) What is the source of the funding to be used for the implementation and enforcement of this administrative regulation:
The Kentucky Board of Emergency Medical Services is a state agency that receives its annual budget from the state government.
(7) Provide an assessment of whether an increase in fees or funding will be necessary to implement this administrative regulation, if new, or by the change if it is an amendment:
No increase in fees or funding will be necessary.
(8) State whether or not this administrative regulation establishes any fees or directly or indirectly increases any fees:
This regulation did not establish any fees.
(9) TIERING: Is tiering applied?
Tiering is not applied to this administrative regulation because the amendment establishes scope of practice requirements for all affected personnel.
FISCAL NOTE
(1) What units, parts, or divisions of state or local government (including cities, counties, fire departments, or school districts) will be impacted by this administrative regulation?
The administrative regulation will impact all Kentucky EMS agencies and students seeking EMT or AEMT certification.
(2) Identify each state or federal statute or federal regulation that requires or authorizes the action taken by the administrative regulation.
KRS 311A.030. No federal statutes necessitate this administrative regulation.
(3) Estimate the effect of this administrative regulation on the expenditures and revenues of a state or local government agency (including cities, counties, fire departments, or school districts) for the first full year the administrative regulation is to be in effect.
(a) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for the first year?
This administrative regulation will generate no revenue for the first year.
(b) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for subsequent years?
This administrative regulation will generate no revenue for subsequent years.
(c) How much will it cost to administer this program for the first year?
This administrative regulation will not impose any costs on state or local government.
(d) How much will it cost to administer this program for subsequent years?
This administrative regulation will not impose any costs on state or local government.
Note: If specific dollar estimates cannot be determined, provide a brief narrative to explain the fiscal impact of the administrative regulation.
Revenues (+/-):
This administrative regulation will not generate revenue.
Expenditures (+/-):
This administrative regulation will not impose any costs.
Other Explanation:
(4) Estimate the effect of this administrative regulation on the expenditures and cost savings of regulated entities for the first full year the administrative regulation is to be in effect.
(a) How much cost savings will this administrative regulation generate for the regulated entities for the first year?
This administrative regulation will not generate any cost savings.
(b) How much cost savings will this administrative regulation generate for the regulated entities for subsequent years?
This administrative regulation will not generate any cost savings.
(c) How much will it cost the regulated entities for the first year?
This administrative regulation will not impose any costs.
(d) How much will it cost the regulated entities for subsequent years?
This administrative regulation will not impose any costs.
Note: If specific dollar estimates cannot be determined, provide a brief narrative to explain the fiscal impact of the administrative regulation.
Cost Savings (+/-):
The administrative regulation will impact all Kentucky EMS agencies and students seeking EMT or AEMT certification.
Expenditures (+/-):
This administrative regulation will not impose any costs.
Other Explanation:
(5) Explain whether this administrative regulation will have a major economic impact, as defined below.
"Major economic impact" means an overall negative or adverse economic impact from an administrative regulation of five hundred thousand dollars ($500,000) or more on state or local government or regulated entities, in aggregate, as determined by the promulgating administrative bodies. This administrative regulation will not have a major economic impact.
KENTUCKY COMMUNITY AND TECHNICAL COLLEGE SYSTEM
Kentucky Board of Emergency Medical Services
(Amendment)
202 KAR 7:701.Scope of practice matters.
Section 1.
Emergency Medical Responder.(1)
In addition to the skills and procedures established in the current National Highway Traffic Safety Administration National EMS Scope of Practice Model, emergency medical responders certified by the board shall be eligible to perform the supplemental procedures:(a)
Cervical spine and spinal immobilization; and(b)
Administration of Naloxone via Nasal Atomization Devices.(2)
To be eligible to perform a supplemental procedure established in subsection (1) of this section, an emergency medical responder shall have been trained and educated utilizing:(a)
Kentucky Required Mandatory Supplemental Curriculum: EMR Spinal Immobilization (KBEMS-E-34); and(b)
Kentucky Required Mandatory Supplemental Curriculum for the EMR in the Administration of Naloxone using a Nasal Atomization Device (KBEMS-E-33).(3)
An out-of-state emergency medical responder may perform any skill or procedure that the emergency medical responder may use in the state in which the emergency medical responder is certified subject to the emergency medical responder being called upon to assist in providing medical and related care during a disaster or emergency pursuant to KRS 39A.050, the Emergency Management Assistance Compact, or an agreement made pursuant to KRS Chapter 39A.(4)
(a)
An emergency medical responder shall adhere to the protocols established by KRS Chapter 311A and 202 KAR Chapter 7. Deviation from these protocols shall only occur if:1.
The emergency medical responder's medical director or designated on-line medical direction orders otherwise;2.
Compliance with approved protocols is not in the patient's medical best interest; or3.
The emergency medical responder does not have the equipment or medication to adhere to the protocol.(b)
Any deviation from an approved protocol shall be documented in the Patient Care Report (PCR) established in 202 KAR 7:540.Section 2.
Emergency Medical Technician (EMT).(1)
In addition to the skills and procedures established in the current National Highway Traffic Safety Administration National EMS Scope of Practice Model, an EMT certified by the board shall be eligible to perform the supplemental procedures:(a)
Identification of correct placement of an endotracheal tube (ETT) placed by a licensed paramedic, including the use of end tidal CO2 monitoring (EtCO2);(b)
Securing of an endotracheal tube that has been inserted by appropriately licensed personnel;(c)
The use of Blind Insertion Airway Devices (BIADs);(d)
Utilizing a cardiac monitor and troubleshooting potential problems;(e)
Selecting and applying cardiac electrodes;(f)
Non-interpretive acquisition and transmission of a 12-Lead Electrocardiogram (ECG);(g)
Appropriate utilization of equipment and sampling of blood glucose using a glucometer;(h)
Care for a saline lock site where a catheter has been dislodged;(i)
Administration of Epinephrine for anaphylaxis;(j)
Administration of Naloxone using a Nasal Atomization Device; and(k)
Administration of Albuterol using a Nebulizer.(2)
To be eligible to perform each of the supplemental procedures, an EMT shall have been trained and educated utilizing:(a)
Kentucky Required Mandatory Supplemental Curriculum for the EMT in Advanced Airway Management: Monitoring & Securing an ETT (KBEMS-E-38);(b)
Kentucky Required Mandatory Supplemental Curriculum for the Emergency Medical Technician (EMT) Using a Noninvasive Monitoring Device - Application of Electrocardiogram Electrodes, Use of a Cardiac Monitor, and Acquisition and Transmission of a 12-Lead ECG (KBEMS-E-35);(c)
Kentucky Required Mandatory Supplemental Curriculum for the Emergency Medical Technician (EMT): Training in the Monitoring, Maintaining, and Discontinuing of Pre-established Patient Intravenous Infusions in Prehospital, Interfacility, and Facility-to-Home Encounters (KBEMS-E-40);(d)
Kentucky Required Mandatory Supplemental Curriculum for the Emergency Medical Technician (EMT) Using a Noninvasive Monitoring Device - Application of End-tidal Carbon Dioxide Monitoring (KBEMS-E-39);(e)
Kentucky Required Mandatory Supplemental Curriculum for the EMT in the Administration of Naloxone Using a Nasal Atomization Device (KBEMS-E-36);(f)
Kentucky Required Mandatory Supplemental Curriculum for the EMT in Advanced Airway Management: Blindly Inserted Airway Devices (BIADs) (KBEMS-E-37);(g)
Kentucky Required Mandatory Supplemental Curriculum for the EMT: Sampling of Blood Glucose Using a Glucometer (KBEMS-E-41);(h)
Kentucky Required Mandatory Supplemental Curriculum: Administration of Epinephrine (KBEMS-E-42); and(i)
Kentucky Required Mandatory Supplemental Curriculum: Administration of Albuterol using a Nebulizer (KBEMS-E-43).(3)
An EMT shall adhere to the protocols established by KRS Chapter 311A and 202 KAR Chapter 7. Deviation from these protocols shall only occur if:(a)
The medical director or designated on-line medical direction orders otherwise;(b)
Compliance is not in the medical best interest of the patient; or(c)
The EMT does not have the equipment or medication to adhere to the protocol.(4)
Any deviation from an approved protocol shall be documented in the Patient Care Report (PCR) established in 202 KAR 7:540.(5)
An out-of-state EMT may perform any skill or procedure that the EMT may use in the state in which the EMT is certified subject to the EMT being called upon to assist in providing medical and related care during a disaster or emergency pursuant to KRS 39A.050, the Emergency Management Assistance Compact, or an agreement made pursuant to KRS Chapter 39A.Section 3.
EMT Students.(1)
During the didactic, laboratory, and clinical portions of an EMT course, an EMT student may perform any skill or procedure, or administer any medication within the scope of practice for an EMT as established by this administrative regulation, if the student:(a)
Has been trained and educated to perform the skill or procedure, or to administer the medication; and(b)
Is permitted to perform the skill or procedure in writing or by direct order of the medical director of the EMT course.(2)
During a field internship, an EMT student may perform any skill or procedure, or administer any medication within the scope of practice for an EMT as established by this administrative regulation, if:(a)
The student has written authorization by the medical director of the EMT course to perform the skill or procedure;(b)
Authorization to perform the skill or procedure is filed with the coordinator of the EMT course; and(c)
The medical director of the EMT course and the director of the agency for whom the skill or procedure is performed each give written permission to the EMT student to participate in a field internship with the agency.(3)
This administrative regulation shall not be construed to allow an emergency medical responder student or EMT student to perform any skill or procedure without direct supervision by a physician, registered nurse, paramedic, AEMT, or EMT, any of whom shall be licensed or certified in the Commonwealth of Kentucky, except for out-of-state clinical or field rotations specifically approved by the board.Section 4.
Advanced Emergency Medical Technician (AEMT).(1)
An AEMT shall provide emergency medical services consistent with the current National Highway Traffic Safety Administration National EMS Scope of Practice Model.(2)
In addition to the skills and procedures in the National EMS Scope of Practice Model, the scope of practice of a Kentucky AEMT shall include the supplemental procedures:(a)
Quantitative and qualitative capnography and capnometry;(b)
Bi-level Positive Airway Pressure and Continuous Positive Airway Pressure (BiPAP/CPAP) devices; and(c)
Establishing and maintaining an adult intraosseous infusion.(3)
To be eligible to perform each of the supplemental procedures, an AEMT shall have been trained and educated utilizing:(a)
Kentucky Required Mandatory Supplemental Curriculum for the AEMT Using a Noninvasive Monitoring Device - Application and Interpretation of Quantitative Capnography and End Tidal Carbon Dioxide Monitoring (KBEMS-E30);(b)
Kentucky Required Mandatory Supplemental Curriculum for the AEMT - Intraosseous Infusion in the Adult (KBEMS-E-31); and(c)
Kentucky Required Mandatory Supplemental Curriculum for the AEMT Using Bi-level Positive Airway Pressure and Continuous Positive Airway Pressure Devices (KBEMS-E-32).(4)
(a)
An AEMT shall adhere to the protocols established by KRS Chapter 311A and 202 KAR Chapter 7. Deviation from these protocols shall only occur if:1.
The AEMT's medical director or designated on-line medical direction orders otherwise;2.
Compliance with approved protocols is not in the patient's medical best interest; or3.
The AEMT does not have the equipment or medication to adhere to the protocol.(b)
Any deviation from an approved protocol shall be documented in the Patient Care Report (PCR) established in 202 KAR 7:540.(5)
If providing emergency medical services during a disaster or emergency that qualifies as part of the Emergency Management Assistance Compact pursuant to KRS 39A.050, or if acting pursuant to another agreement made pursuant to KRS Chapter 39, an AEMT certified in another state may perform the skills and procedures approved by the certifying state.Section 5.
AEMT Students.(1)
During the didactic, laboratory, and clinical portions of an AEMT course, an AEMT student may perform any skill or procedure, or administer any medication within the scope of practice for an AEMT, as defined by this administrative regulation, if the student:(a)
Has been trained and educated to perform the skill or procedure, or to administer the medication; and(b)
Is permitted to perform the skill or procedure in writing or by direct order of the medical director of the AEMT course.(2)
During a field internship, an AEMT student may perform any skill or procedure, or administer any medication within the scope of practice for an AEMT, as established by this administrative regulation, if:(a)
The student has written authorization by the medical director of the AEMT course to perform the skill or procedure;(b)
Authorization to perform the skill or procedure is filed with the coordinator of the AEMT course; and(c)
The medical director of the AEMT course and the director of the agency for whom the skill or procedure is performed each give written permission to the AEMT student to participate in a field internship with the agency.(3)
This administrative regulation shall not be construed to allow an AEMT student to perform any skill or procedure without direct supervision by a physician, registered nurse, paramedic, or AEMT, any of whom shall be licensed or certified in the Commonwealth of Kentucky, except for out-of-state clinical or field rotations specifically approved by the board.Section 6.
Paramedic.(1)
A paramedic may perform any of the skills and procedures consistent with the current National Highway Traffic Safety Administration National EMS Scope of Practice Model.(2)
A paramedic shall adhere to the protocols established by KRS Chapter 311A and 202 KAR Chapter 7. Deviation from these protocols shall only occur if:(a)
The medical director or designated on-line medical direction orders otherwise;(b)
Compliance is not in the medical best interest of the patient; or(c)
The paramedic does not have the equipment or medication to adhere to the protocol.(3)
Any deviation from an approved protocol shall be documented in the Patient Care Report (PCR) established in 202 KAR 7:540.(4)
(a)
A paramedic functioning in a position of employment may perform any procedure or administer medications authorized by KRS 311A.170 or this administrative regulation, at any location within the Commonwealth subject to the written approval of, and limitations established by the paramedic's medical director and the paramedic's employer.(b)
A paramedic performing skills or procedures outside of the normal response area for the paramedic shall accompany and assist with or continue treatment for the patient until the patient is accepted by a receiving hospital, an ALS ground or licensed ALS air ambulance provider, or care is transferred to another licensed paramedic, receiving facility RN, advanced practice registered nurse (APRN), licensed physician's assistant, or physician.(5)
(a)
1.
An off-duty paramedic may perform any procedure or administer medications authorized by KRS 311A.170 or this administrative regulation, at any location within the Commonwealth subject to the written approval of, and limitations established by the paramedic's medical director and, if appropriate, the paramedic's employer; or2.
The paramedic may render care subject to the limitations of the paramedic's scope of practice at any location, if ordered to do so by a duly licensed physician.(b)
A paramedic performing skills or procedures outside of the normal response area for the paramedic shall accompany and assist with or continue treatment for the patient until the patient is accepted by a receiving hospital, an ALS ground or licensed ALS air ambulance provider, or care is transferred to another licensed paramedic, hospital emergency department, RN, advanced practice registered nurse (APRN), licensed physician's assistant, or physician.(6)
An out-of-state paramedic may perform any skill, procedure, or administer any medications that the paramedic may use in the state in which the paramedic is certified or licensed, subject to the control of the out-of-state paramedic's medical director or protocols and only in the following circumstances:(a)
An out-of-state paramedic is transporting a patient from out-of-state to a Kentucky medical facility or other location in Kentucky;(b)
An out-of-state paramedic is transporting a patient from out of state through Kentucky to another location out of state; or(c)
An out-of-state paramedic is called upon to assist in providing medical and related care during a disaster or emergency pursuant to KRS 39A.050, the Emergency Management Assistance Compact, or an agreement made pursuant to KRS Chapter 39A.(7)
A paramedic with a critical care endorsement shall be authorized to perform the skills and procedures included in the paramedic's education and training subject to authorization by the medical director through established protocols in accordance with KRS Chapter 311A and 202 KAR Chapter 7.Section 7.
Paramedic Hospital Scope of Practice.(1)
Paramedics functioning in the hospital environment shall perform within the scope of practice, as established in this administrative regulation.(2)
Employment of paramedics in hospital emergency department settings, exclusive of employment by air or ground transport components, or both, owned or operated by the hospital, shall be subject to demonstrating knowledge based and clinical competencies at a level satisfactory to the employing hospital and subject to KRS Chapter 311A and 202 KAR Chapter 7.(3)
An employer shall not require practice for a paramedic that exceeds the defined scope of practice established by KRS Chapter 311A and 202 KAR Chapter 7. The paramedic shall inform the employing institution or supervising staff of any inability or limitation to perform an ordered skill or procedure based upon:(a)
A lack of knowledge of or training or education in the procedure or skill; or(b)
The order or directive exceeding the paramedic's scope of practice.(4)
An employer may provide education or educational opportunities to expand the documented clinical practice of the paramedic but shall not do so with the intent of requiring the paramedic to perform skills or procedures exceeding the scope of practice established by KRS Chapter 311A and 202 KAR Chapter 7 while in the hospital's employ.(5)
A paramedic shall:(a)
Maintain strict patient confidentiality;(b)
Provide and assure continuity of care to patients;(c)
Be a patient advocate;(d)
Follow the hospital's chain of command;(e)
Be knowledgeable and function within the scope of practice of a paramedic;(f)
Be clearly identified as a licensed paramedic while functioning in the hospital's employ;(g)
Document on patient care records all interventions, treatments, and assessments performed by the paramedic;(h)
Perform patient assessment, which may include triage; and(i)
Institute appropriate therapy in the care of patients subject to the limitation of existing protocols.Section 8.
Paramedic Students.(1)
During the didactic, laboratory, and clinical portions of a paramedic course, a paramedic student may perform any skill or procedure, or administer any medication within the scope of practice for a paramedic as established by this administrative regulation, if the student:(a)
Has been trained and educated to perform the skill or procedure or administer the medication; and(b)
Is permitted to perform the skill or procedure in writing or by direct order of the medical director of the paramedic course.(2)
During the field internship, a paramedic student may perform any skill or procedure, or administer any medication within the scope of practice for a paramedic as established by this administrative regulation, if:(a)
The student has written authorization by the medical director of the paramedic course to perform the skill or procedure;(b)
The permission is filed with the paramedic course coordinator of the paramedic course; and(c)
The medical director and director of the ambulance service each give written permission to the paramedic student to participate in a field internship with the ambulance service.(3)
This administrative regulation shall not be construed to allow a paramedic student to perform any skill or procedure without direct supervision by a physician, registered nurse, or paramedic, any of whom shall be licensed or certified in the Commonwealth of Kentucky, except for out-of-state clinical or field rotations specifically approved by the board.Section 9.
Restriction of Practice. This administrative regulation shall not prohibit a medical director from restricting the scope of practice of any emergency medical responder, EMT, AEMT, or paramedic under the medical director's authority through established protocols.Section 10.
Exemptions. This administrative regulation shall not prohibit an emergency medical responder, emergency medical technician, advanced emergency medical technician, or paramedic certified or licensed in another state or registered with the NREMT from functioning in accordance with the scope of practice established in KRS Chapter 311A and 202 KAR Chapter 7 while assisting with mass casualties, weapons of mass destruction, or disaster incidents.Section 11.
Incorporation by Reference.(1)
The following documents are incorporated by reference.(a)
"Kentucky Required Mandatory Supplemental Curriculum for the AEMT Using a Noninvasive Monitoring Device - Application and Interpretation of Quantitative Capnography and End Tidal Carbon Dioxide Monitoring", KBEMS-E-30, February 2007;(b)
"Kentucky Required Mandatory Supplemental Curriculum for the AEMT Intraosseous Infusion in the Adult", KBEMS-E-31, February 2007;(c)
"Kentucky Required Mandatory Supplemental Curriculum for the AEMT using Bi-level Positive Airway Pressure and Continuous Positive Airway Pressure Devices", KBEMS-E-32, February 2007;(d)
"Kentucky Required Mandatory Supplemental Curriculum for the EMR in the Administration of Naloxone Using a Nasal Atomization Device", KBEMS-E-33, February 2007;(e)
"Kentucky Required Mandatory Supplemental Curriculum: EMR Spinal Immobilization", KBEMS-E-34, February 2007;(f)
"Kentucky Required Mandatory Supplemental Curriculum for the Emergency Medical Technician (EMT) Using a Noninvasive Monitoring Device - Application of Electrocardiogram Electrodes, Use of a Cardiac Monitor, and Acquisition and Transmission of a 12-Lead ECG", KBEMS-E-35, February 2007;(g)
"Kentucky Required Mandatory Supplemental Curriculum for the EMT in the Administration of Naloxone Using a Nasal Atomization Device", KBEMS-E-36, February 2007;(h)
"Kentucky Required Mandatory Supplemental Curriculum for the EMT in Advanced Airway Management: Blindly Inserted Airway Devices (BIADs)", KBEMS-E-37, February 2007;(i)
"Kentucky Required Mandatory Supplemental Curriculum for the EMT in Advanced Airway Management: Monitoring & Securing an ETT", KBEMS-E-38, February 2007;(j)
"Kentucky Required Mandatory Supplemental Curriculum for the Emergency Medical Technician (EMT) Using a Noninvasive Monitoring Device - Application of End-Tidal Carbon Dioxide Monitoring", KBEMS-E-39, February 2007;(k)
"Kentucky Required Mandatory Supplemental Curriculum for Emergency Medical Technician (EMT): Training in the Monitoring, Maintaining, and Discontinuing of Pre-established Patient Intravenous Infusions in Prehospital, Interfacility, and Facility-to-Home Encounters", KBEMS-E-40, February 2007;(l)
"Kentucky Required Mandatory Supplemental Curriculum for the EMT: Sampling of Blood Glucose Using a Glucometer", KBEMS-E-41, February 2007;(m)
"Kentucky Required Mandatory Supplemental Curriculum: Administration of Epinephrine", KBEMS-E-42, February 2007;(n)
"Kentucky Required Mandatory Supplemental Curriculum: Administration of Albuterol Using a Nebulizer", KBEMS-E-43, February 2007; and(o)
"National Highway Traffic Safety Administration National EMS Scope of Practice Model", February 2007.(2)
This material may be inspected, obtained, or copied, subject to applicable copyright law, at the Office of the Kentucky Board of Emergency Medical Services, 2464 Fortune Drive, Suite 195, Lexington, Kentucky 40509, Monday through Friday, 8 a.m. to 4:30 p.m.PHILIP DIETZ, Chair
APPROVED BY AGENCY: June 30, 2022
FILED WITH LRC: July 12, 2922 at 12:25 p.m.
PUBLIC HEARING AND COMMENT PERIOD: A public hearing on this administrative regulation shall be held on September 28, 2022 at 1:00 p.m. ET at the Kentucky Board of Emergency Medical Services, 2464 Fortune Drive, Suite 195, Lexington, Kentucky 40509. Individuals interested in being heard at this hearing shall notify this agency in writing by five (5) workdays prior to the hearing of their intent to attend. If no notification of intent to attend the hearing is received by that date, the hearing may be canceled. This hearing is open to the public. Any person who wishes to be heard will be given an opportunity to comment on the proposed administrative regulation. A transcript of the public hearing will not be made unless a written request for a transcript is made. If you do not wish to be heard at the public hearing, you may submit written comments on the proposed administrative regulation. Written comments shall be accepted through September 30, 2022. Send written notification of intent to be heard at the public hearing or written comments on the proposed administrative regulation to the contact person.
CONTACT PERSON: John K. Wood, counsel for the Kentucky Board of Emergency Medical Services, 163 East Main Street, Suite 200, Lexington, Kentucky 40507, phone (859) 225-4714, email administrativeregulations@wgmfirm.com.
REGULATORY IMPACT ANALYSIS AND TIERING STATEMENT
Contact Person:
John K. Wood
(1) Provide a brief summary of:
(a) What this administrative regulation does:
202 KAR 7:701 establishes the scope of practice for individuals certified or licensed by the Board.
(b) The necessity of this administrative regulation:
KRS 311A.025, 311A.030, 311A.135, 311A.140, 311A.160, 311A.165, and 311A.170 require the Board to promulgate administrative regulations relating to the scope of practice for individuals certified or licensed by the board. This administrative regulation establishes the scope of practice.
(c) How this administrative regulation conforms to the content of the authorizing statutes:
This administrative regulation conforms to the content of KRS 311A.025, 311A.030, 311A.135, 311A.140, 311A.160, 311A.165, and 311A.170 by establishing the scope of practice for individuals licensed or certified by the Board.
(d) How this administrative regulation currently assists or will assist in the effective administration of the statutes:
KRS 311A.025, 311A.030, 311A.135, 311A.140, 311A.160, 311A.165, and 311A.170 require the Board to promulgate administrative regulations relating to the scope of practice for individuals certified or licensed by the board. This administrative regulation assists in the effective administration of the statutes by establishing the scope of practice.
(2) If this is an amendment to an existing administrative regulation, provide a brief summary of:
(a) How the amendment will change this existing administrative regulation:
This amendment will allow students seeking certification as an EMT to be supervised by a certified AEMT or EMT when performing a skill or procedure, in addition to a physician, registered nurse, or paramedic who are currently the only personnel authorized to supervise EMT students. Additionally, this amendment will allow students seeking certification as an AEMT to be supervised by a certified AEMT when performing a skill or procedure, in addition to a physician, registered nurse, or paramedic who are currently the only personnel authorized to supervise AEMT students. Finally, while this amendment does amend the substantive requirements for paramedic student supervision, changes are made to Section 8(3) to clarify that the provision applies only to paramedics and that, in general, supervising personnel must be licensed or certified in the Commonwealth.
(b) The necessity of the amendment to this administrative regulation:
This amendment is necessary to mitigate staffing concerns. Specifically, due in part to staffing issues, there are not enough available paramedics to supervise students seeking EMT and AEMT certification from the Board. This has resulted in delays in students’ ability to become certified, which has further aggravated staffing concerns.
(c) How the amendment conforms to the content of the authorizing statutes:
KRS 311A.025, 311A.030, 311A.135, 311A.140, 311A.160, 311A.165, and 311A.170 require the Board to promulgate administrative regulations relating to the scope of practice for individuals certified or licensed by the board. This amendment conforms to the content of these statutes by establishing the scope of practice.
(d) How the amendment will assist in the effective administration of the statutes:
This amendment will assist in the effective administration of KRS 311A.025, 311A.030, 311A.135, 311A.140, 311A.160, 311A.165, and 311A.170 by establishing the scope of practice.
(3) List the type and number of individuals, businesses, organizations, or state and local governments affected by this administrative regulation:
All Kentucky EMS agencies and students seeking EMT or AEMT certification.
(4) Provide an analysis of how the entities identified in question (3) will be impacted by either the implementation of this administrative regulation, if new, or by the change, if it is an amendment, including:
(a) List the actions that each of the regulated entities identified in question (3) will have to take to comply with this administrative regulation or amendment:
No action is required on the part of EMS agencies. Students seeking EMT certification will be permitted to perform skills and procedures under the supervision of a licensed or certified physician, registered nurse, paramedic, AEMT, or EMT. Students seeking AEMT certification will be permitted to perform skills and procedures under the supervision of a physician, registered nurse, paramedic, or AEMT.
(b) In complying with this administrative regulation or amendment, how much will it cost each of the entities identified in question (3):
There will be no cost to any entity identified in question (3), other than administrative costs that may be incurred in recruiting and maintaining qualified personnel.
(c) As a result of compliance, what benefits will accrue to the entities identified in question (3):
All EMS agencies will benefit from students being able to be supervised by additional certified or licensed personnel, which will likely result in more available certified EMS personnel in a shorter amount of time than the current regulation would allow. All students seeking certification as an EMT or AEMT will benefit from being able to be supervised by additional personnel, which will likely result in students becoming certified in a shorter amount of time than the current regulation would allow.
(5) Provide an estimate of how much it will cost the administrative body to implement this administrative regulation:
(a) Initially:
There will be no cost to any entity identified in question (3), other than administrative costs that may be incurred in recruiting and maintaining qualified personnel.
(b) On a continuing basis:
There will be no cost to any entity identified in question (3), other than administrative costs that may be incurred in recruiting and maintaining qualified personnel.
(6) What is the source of the funding to be used for the implementation and enforcement of this administrative regulation:
The Kentucky Board of Emergency Medical Services is a state agency that receives its annual budget from the state government.
(7) Provide an assessment of whether an increase in fees or funding will be necessary to implement this administrative regulation, if new, or by the change if it is an amendment:
No increase in fees or funding will be necessary.
(8) State whether or not this administrative regulation establishes any fees or directly or indirectly increases any fees:
This regulation did not establish any fees.
(9) TIERING: Is tiering applied?
Tiering is not applied to this administrative regulation because the amendment establishes scope of practice requirements for all affected personnel.
FISCAL NOTE
(1) What units, parts, or divisions of state or local government (including cities, counties, fire departments, or school districts) will be impacted by this administrative regulation?
The administrative regulation will impact all Kentucky EMS agencies and students seeking EMT or AEMT certification.
(2) Identify each state or federal statute or federal regulation that requires or authorizes the action taken by the administrative regulation.
KRS 311A.030. No federal statutes necessitate this administrative regulation.
(3) Estimate the effect of this administrative regulation on the expenditures and revenues of a state or local government agency (including cities, counties, fire departments, or school districts) for the first full year the administrative regulation is to be in effect.
(a) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for the first year?
This administrative regulation will generate no revenue for the first year.
(b) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for subsequent years?
This administrative regulation will generate no revenue for subsequent years.
(c) How much will it cost to administer this program for the first year?
This administrative regulation will not impose any costs on state or local government.
(d) How much will it cost to administer this program for subsequent years?
This administrative regulation will not impose any costs on state or local government.
Note: If specific dollar estimates cannot be determined, provide a brief narrative to explain the fiscal impact of the administrative regulation.
Revenues (+/-):
This administrative regulation will not generate revenue.
Expenditures (+/-):
This administrative regulation will not impose any costs.
Other Explanation:
(4) Estimate the effect of this administrative regulation on the expenditures and cost savings of regulated entities for the first full year the administrative regulation is to be in effect.
(a) How much cost savings will this administrative regulation generate for the regulated entities for the first year?
This administrative regulation will not generate any cost savings.
(b) How much cost savings will this administrative regulation generate for the regulated entities for subsequent years?
This administrative regulation will not generate any cost savings.
(c) How much will it cost the regulated entities for the first year?
This administrative regulation will not impose any costs.
(d) How much will it cost the regulated entities for subsequent years?
This administrative regulation will not impose any costs.
Note: If specific dollar estimates cannot be determined, provide a brief narrative to explain the fiscal impact of the administrative regulation.
Cost Savings (+/-):
The administrative regulation will impact all Kentucky EMS agencies and students seeking EMT or AEMT certification.
Expenditures (+/-):
This administrative regulation will not impose any costs.
Other Explanation:
(5) Explain whether this administrative regulation will have a major economic impact, as defined below.
"Major economic impact" means an overall negative or adverse economic impact from an administrative regulation of five hundred thousand dollars ($500,000) or more on state or local government or regulated entities, in aggregate, as determined by the promulgating administrative bodies. This administrative regulation will not have a major economic impact.