Prehospital Provider Scope of Practice and Implications for Pediatric Prehospital Care

Prior to the publication of "Accidental Death and Disability, The Neglected Disease of Modern Society" in 1966, the field of emergency medical services (EMS) was an endeavor undertaken at the local level with minimal requirements, clinical sophistication, or oversight. Since then, there has been a substantial evolution of the definition of EMS provider scope of practice, certification requirements, and educational standards for training with a more recent focus on maintenance of competency and skill levels. This article will focus on describing the different levels of EMS providers, their scope of practice, and training requirements. We will also describe the issues and challenges with regard to maintaining competency in the care of children, given the infrequent contact many prehospital providers may have with this patient population. Finally, we will describe new advances and controversies in prehospital provider scope of practice including paramedic specialization and community paramedicine.