What is an Advanced Practice Paramedic (APP)?
The Advanced Practice Paramedic is physician extender, capable of extensive, advanced patient care interventions in critical and emergent patients. This individual possesses the complex knowledge and advanced interventional skills necessary to provide physician extension to the patient’s side, allowing their physician medical program director (MPD) the ability to have physician level care extended to the scene of any emergency, through the hand, eyes, and ears of the APP. Advanced Practice Paramedics are the pinnacle of a comprehensive EMS response, under medical oversight. Advanced Practice Paramedics perform interventions and patient care management with the advanced and diagnostic equipment typically found in an advanced response vehicle, on an advanced practice ALS ambulance, or in an emergency department. The Advanced Practice Paramedic is a tertiary link from the scene into the tertiary health care system, serving as advanced responders, critical care transport providers, aeromedical providers, and in atypical care provision.
What is the Scope of Practice of an APP?
An Advanced Practice Paramedic (APP) may, under the direction of a Committee approved Medical Director:
- Perform all procedures that a Paramedic may perform;
- Initiate, manage, and utilize an orogastric or nasogastric tube;
- Initiate, manage, and utilize a mechanical ventilator;
- Initiate, manage, and utilize the following airway management techniques:
- Endotracheal intubation, via oral or nasal route, with the use of sedative and paralytic agents;
- Video laryngoscopy or bronchoscopy;
- Surgical Cricothyrotomy; and
- Other airway management techniques as identified by the Medical Program Director
- Initiate, manage, and utilize simple (open) technique thoracostomy for tension pneumothorax, tension hemothorax, or pneumohemothorax;
- Initiate, manage, and utilize chest tube thoracostomy;
- Initiate, manage, and utilize chest drains;
- Initiate, manage, or utilize all forms of vascular access;
- With ultrasound guidance, place central vascular access or deep vein cannulation;
- With ultrasound guidance, perform needle pericardiocentesis;
- Perform normal and high-risk childbirth;
- Perform bimanual massage in life threatening postpartum hemorrhage;
- Perform ultrasound guided nerve block;
- Perform needle or surgical incision and drainage of fluid filled oral or subcutaneous masses;
- Initiate placement of, and maintain, a urinary catheter;
- Prepare, initiate, and/or administer any medications or blood products by any means, under specific written protocols authorized by the Medical Director, or direct orders from a licensed transferring physician.
- Prepare, initiate, perform, and/or interpret any diagnostic test or utilize any diagnostic device under specific written authorized by the Medical Director, or direct orders from a licensed transferring physician;
- May carry out other tasks and procedures as authorized by the Medical Director or direct orders from a licensed transferring physician; and
- Be unrestricted as to the environment of practice or function, may serve as a physician extender for an authorized Medical Director in EMS, aeromedical, rescue, underserved or under staffed hospital emergency departments, and critical care areas.
Responsibilities of Registry Certified Personnel:
Certified personnel must notify the Registry within 30 days regarding the following matters:
- Change in mailing address (the best way to update a mailing address is by editing your account profile)
- Any criminal conviction.
- Disciplinary action taken by any agency having jurisdiction (or government body) that has resulted in suspension, revocation, or expiration of registration/licensure; termination of right to practice; voluntary surrender of registration/licensure while under investigation.
The Registry considers the individual to be solely responsible for their certification and reporting, any failure to follow process or report as required is solely the failure of the certified person and may result in immediate dismissal of their certification, as well as, immediate notification to any pertinent regulatory agency of their dismissal.
Disciplinary Policy and Rights of Appeal for The Registry can be found on The Registry website.
Requirements for Initial Registration (Certification):
Individuals applying for Advanced Practice Paramedic (APP) certification must meet the following requirements:
- Candidate must be 21 years of age or older
- Successful completion of a registry accredited Advanced Practice Paramedic (APP) course that meets or exceeds the Registry Education Standards for APP.
- Candidate must have completed the course within the past two years and the course Program Director must verify successful course completion on the Registry website.
- Candidate must have a current American Heart Association Advanced Cardiac Life Support (ACLS) or equivalent credential.
- Candidate must have a current American Heart Association Pediatric Advanced Life Support (PALS) or equivalent credential.
- Candidate must have a current American Heart Association BLS for "Healthcare Provider" or equivalent credential.
- Candidate must successfully complete the Registry cognitive (knowledge) and approved psychomotor (skills) exams. Passed portions of each examination (cognitive and psychomotor) remain valid for 12 months.
- Create an account on the Registry website.
- Submit a Registry application and answer all questions truthfully.
- The Registry may deny certification or take other appropriate actions in regards to applicants for certification or recertification when a criminal conviction has occurred.
- Pay the application fee of $150 usd.
- The application fee is non-transferable and non-refundable.
- This fee is charged for each attempt at the cognitive examination.
- Candidates will receive an electronic Authorization to Test (ATT) once you are eligible for the exam.
- The electronic ATT contains scheduling instructions and important details concerning proper identification required at testing centers.
- You can find the ATT in the “Alerts” section of your account page.
- The ATT is your test key and you will need to carry it with you to a testing center to be provided access to your examination.
- The candidate who holds a current certification with the National Registry of Emergency Medical Technicians (NREMT), at this level or higher, may apply for reciprocity at this level, if their initial or CME training meets the scope of practice listed above.
- The candidate who holds a current license with a State in the United States, at this level or higher, may apply for reciprocity at this level, if their initial or CME training meets the scope of practice listed above.
- The candidate who holds a current registration with the Paramedicine Board of Australia (PBA), at this level or higher, may apply for reciprocity at this level, if their initial or CME training meets the scope of practice listed above.
- The candidate who holds a current certification with the Pre-Hospital Emergency Care Council (PHECC), at this level or higher, may apply for reciprocity at this level, if their documented training meets the scope of practice listed above.
- The candidate who holds a current certification with the Health & Care Professionals Council (HCPC), at this level or higher, may apply for reciprocity at this level, if their documented training meets the scope of practice listed above.