EMS Scope of Practice


In 2016, the National Association of State EMS Officials (NASEMSO) under contract with the National Highway Traffic Safety Administration (NHTSA) and the Health Resources & Services Administration (HRSA), launched an initiative to revise the 2007 National EMS Scope of Practice Model.  Utilizing a Subject Matter Expert Panel comprised of organizational representatives from the EMS and fire communities, state EMS directors, EMS medical directors, EMS educators, EMS field providers, and an EMS researcher, the group provided an evidence-based approach intended to identify practice gaps between the 2007 Model and emerging science, current EMS practice, and community needs.

When the scientific literature was inconclusive, expert opinion was used to improve descriptions, roles, and attributes of each level that would support changes in practice by addressing two fundamental questions:

  1. Is there evidence that the procedure or skill is beneficial to public health?
  2. What is the clinical evidence that the new skill or technique as used by EMS personnel will promote access to quality health care or improve patient outcomes?

The work of the Expert Panel concluded in June 2018.  We thank the Expert Panel for their professionalism and diligence in completing the task and we encourage all persons to read the document in its entirety to fully appreciate the complexities involved in scope of practice decisions.


2018 National EMS Scope of Practice Revision This PowerPoint presentation is a comprehensive overview of the revision. The document is password protected to prevent editing, but can be viewed by clicking the “read only” button when the file opens.

2018 Scope of Practice Model – Talking points for State EMS Officials.

2019 National EMS Scope of Practice Model – Final document

Venn Diagrams for Instructors –  This document contains the images contained in the 2018 National EMS Scope of Practice Model as a resource for licensing boards and instructors on the relationship among education, certification, licensure, and credentialing. The center, where all the four elements overlap, represents skills and roles for which an individual has been educated, certified, licensed by a State, and credentialed. This is the only acceptable region of performance, as it entails four overlapping and mutually dependent levels of public protection: education, certification, licensure, and credentialing. Individuals may perform those roles and skills for which they are educated, certified, licensed, AND credentialed.

NASEMSO Scope of Practice Model Decision-Making Framework for EMS – These decision-making framework guidelines are for educational purposes only. The guidelines do not purport to establish a standard of care or advise a course of action for patient care in any particular situation. Content on this page is used under license from the National Council of State Boards of Nursing, Inc. (“NCSBN”). Copyright 2018 NCSBN. All rights reserved.

Persons with specific EMS scope of practice questions are encouraged to contact their agency’s legal advisor and/or state licensing authority for interpretive assistance as needed.

Systematic Reviews – Under contract with the research department of the National Registry of EMTs, the Subject Matter Expert Panel was asked to consider a systematic review of the available literature along with collection of information leading to improvement in clinical outcomes in patients treated and transported by EMS, specific to hemorrhage control, naloxone, therapeutic hypothermia in cardiac arrest, CPAP/BiPAP, and pharmacological pain management. The key general questions which are to be addressed for specific psychomotor skills through this systematic review are as follows:

Change Notices — In 2021, the NHTSA Office of EMS convened an expert panel to consider additional psychomotor skills to enhance an EMS response to a global pandemic. Recommendations from the expert panel regarding specimen collection via nasal swab, intramuscular injections, and immunizations during a public health emergency were adopted in March 2021 as “Change Notices” at It should be noted that prior to the implementation of any program, the assumption of the panel in making the recommendations was that all associated educational activities, knowledge of indications and potential contraindications, knowledge of potential complications and management, other potential skills, supervised assessment of skill competency, and quality improvement activities would be included.

Rapid Process for Emergent Changes to the National EMS Scope of Practice Model – The first National EMS Scope of Practice Model (“Model”) was published in 2007 by the National Highway Traffic Safety Administration. The Model was developed by NASEMSO with funding provided by NHTSA and the Health Resources and Services Administration (HRSA). It has provided guidance for States in developing their EMS scope of practice legislation, rules, and regulations. Thus, the subject matter expert panel proposed a rapid revision process to provide general recommendations and procedures applicable to emergent changes (change notices) that need to occur to the Model between regular revision cycles to sustain and strengthen national preparedness. The process for requesting an emergent change to the Model is now available on NHTSA’s web site at While the Model provides national guidance, each State maintains the authority to regulate EMS within its border, and determine the scope of practice of State-licensed EMS practitioners.


For More Information

Contact:  NASEMSO Deputy Executive Director, Andy Gienapp
Telephone:  703.538.1799