North Carolina Scope of Practice Changes

There have been a few recent changes with scope of practice in North Carolina which will directly affect EMS, along with changes in Washington, D.C. which may have an indirect effect on EMS. The North Carolina medical board has made changes to the scope of practice for noninvasive positive pressure ventilation, intraosseous catheters, Kalbitor and continuous capnography. The North Carolina Medical Board declined to make changes to the scope of practice for ketamine. There will also be changes to North Carolina rule which will affect EMS. image

With the election there may be changes with the laws overseeing the provisions governing health insurance and how Medicaid and Medicare are administered. It’s difficult to say how these changes will affect the healthcare system or EMS, but it’s always important for EMS agencies to keep a view towards any possible changes in their reimbursement.

In regards to scope of practice, the North Carolina Medical Board has expanded the scope of practice for intraosseous catheters so that advanced intermediates (EMT-Is) can utilize intraosseous catheters. The scope of practice for continuous capnography has expanded to include Basic EMTs. Basic EMTs will also now be able to use noninvasive positive pressure ventilation. The capnography, noninvasive positive pressure ventilation, and intraosseous catheter changes will align North Carolina scope of practice with national scope of practice. The North Carolina Medical Board will also now allow paramedics to administer the drug Kalbitor to patients who have the medication with them and have had that medicine prescribed to them by a physician. Kalbitor is a medication used to treat hereditary angioedema. The North Carolina Medical Board did not agree to expand the scope of practice for ketamine. Currently ketamine can only be used within the RSI protocol or for sedating patients after RSI.

There will also be new rules taking effect for EMS in North Carolina. The target date for the rules to take effect is January 1, 2017. Some of the rules will affect how trauma centers are designated. The rules will also change the names of the EMS skill levels in North Carolina. EMT-Basic will simply become EMT. EMT-Intermediate will become Advanced EMT. EMT-Paramedic will become Paramedic. These rule changes will also reflect national guidelines.

With the election there may be changes with the laws overseeing the provisions governing health insurance and how Medicaid and Medicare are administered. It’s difficult to say how these changes will affect the healthcare system or EMS, but it’s always important for EMS agencies to keep a view towards any possible changes in their reimbursement. The changes may increase the efficiency and lower the costs of healthcare. The changes could also potentially have unforeseen effects on EMS.

Some of the early estimates say that changes to the healthcare laws could cause 20 million people to lose coverage or have their coverage changed which could impact peoples’ ability to pay for EMS services and could cause further strain on some small rural hospitals. Many of the provisions of the affordable care act also encouraged Accountable Care Organizations to invest more in population health which has been a significant driver of community paramedicine. Regardless of what happens there will be changes, so it’s important for EMS agencies to stay current.

Dr. Winslow graduated from Emergency Medicine residency from UNC-Chapel Hill in 2002 and completed his EMS Fellowship in 2003. He has worked at Baptist Hospital in Winston-Salem for the past 11 years. He was appointed as the Medical Director of the NC Office of EMS in 2011. This document contains all protocol, procedures, and policies for all EMS agencies in North Carolina.
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