Expanded Roles of EMS Personnel

Revised and approved by the ACEP Board of Directors April 2008
Reaffirmed by the ACEP Board of Directors October 2001
Originally approved by the ACEP Board of Directors June 1997 

The American College of Emergency Physicians (ACEP) acknowledges expanded scope of practice programs are being developed in response to community needs. ACEP recognizes that EMS providers are likely to be used in the workforce for these programs. With proper design and medical oversight, potential benefits may include improved access to health care in underserved areas, improved patient care, and reduced costs.

The evidence must be clear and compelling that significant patient benefit will result from any such expansion of roles for EMS providers. To expand the scope of practice for EMS personnel, the following principles must be met:

• Close medical oversight by physicians with experience and an understanding of the roles and capabilities of EMS personnel is mandatory.
• Education programs with quality assurance mechanisms to ensure maintenance of standards must be in place before implementing an expanded scope for EMS providers.
• Quality assurance mechanisms for the care provided by EMS personnel operating under expanded roles must be in place at the time of implementation of such programs to ensure appropriate and safe patient care. 
• Expanded roles for out-of-hospital providers must adhere to legal requirements. Physician oversight of any such expanded roles for out-of-hospital providers is a necessity.
• The existing emergency response system must not suffer for the sake of an expanded scope program.
• Access to emergency care must not be compromised by efforts to alter the basic emergency response system as a part of medical care integration.
• A community plan and needs assessment with physician input must guide the development of any expanded scope program.
• Attempts to expand the scope of paramedic practice without the support of all involved parties and adequate medical oversight are not in the best interest of good patient care.
• Any current pilot programs for expanded roles of EMS personnel are strongly encouraged to share the results of their programs with ACEP and other EMS organizations.