FIELD REFERENCE
Full criteria & treatment guidance
Start with your authorized role
- This is an orientation to OCEMS-accredited EMT practice, not a complete treatment protocol. A listed skill still requires the applicable training, equipment, indications, and OCEMS/agency authorization.
- Assisting a paramedic does not authorize independent ALS procedures. Use the specific BLS instructions for a medication or device; an ALS medication page does not expand EMT scope.
Orange County BLS: where to start
- Basic Life Support (BLS) is the EMT-level assessment and care described in Orange County Emergency Medical Services (OCEMS) policies. Policy 315.00 defines the local scope; SO-B-001 provides the BLS standing orders. This independent OC Medic guide helps you navigate both.
1. Start with assessment and BLS care
- Assess the patient, obtain vital signs, and recognize immediate threats. SO-B-001 includes primary and secondary assessment, mental status, blood pressure, pulse, breathing, pain, skin signs, and pupils as indicated.
- Provide oxygen and BVM ventilation when indicated. Perform CPR and use an AED as appropriate; approved mechanical CPR devices are included.
- Control bleeding with approved tourniquets and hemostatic dressings. Apply indicated splints and spinal motion restriction; assist with extrication and field triage.
- Policy 315.00 includes oral/nasal airway adjuncts and suction. Equipped, trained BLS providers can also apply and monitor CPAP as described below.
BLS can use CPAP when equipped
- OCEMS-accredited EMTs can apply and monitor CPAP when their unit has the equipment and they are trained and authorized to use it. SO-B-001 specifically includes CPAP in BLS standing orders.
- Use particular caution: ALS should be en route or already on scene. Patients needing CPAP can deteriorate and may need care beyond BLS scope.
- Check the patient’s eligibility and all contraindications before starting. Continuously monitor breathing, mental status, oxygen saturation, blood pressure, and mask tolerance. Be ready to remove CPAP and provide appropriate BLS airway support if the patient deteriorates; follow the stop criteria in the CPAP guide.
Open the CPAP guide: criteria, pressures, and stop instructions →
2. Keep medication pathways separate
- Suspected opioid overdose: SO-B-002 requires ALS to be responding and an equipped unit. Support breathing and follow the instructions for the exact naloxone product; the nasal spray and syringe/atomizer use different doses.
- Suspected hypoglycemia: SO-B-003 requires a responsive patient who can swallow and protect their airway, with an intact gag reflex. Ensure ALS is present or responding. Do not give oral glucose to an unresponsive patient or one unable to swallow.
- Epinephrine auto-injector: Policy 315.00 permits use for suspected anaphylaxis or severe asthma. Follow the applicable OCEMS procedure and device criteria; this does not authorize drawing up injectable epinephrine.
- The patient’s prescribed medication: Attachment I requires ALS response for assistance with prescribed nitroglycerin, albuterol, epinephrine auto-injectors, or aspirin for cardiac chest pain. Assistance is distinct from independently choosing an ALS medication.
- Nerve-agent antidote auto-injectors: Policy 315.00 includes DuoDote/Mark-1 use for yourself or others under ALS direction. Follow the specific exposure and device instructions.
3. Assist ALS within the stated limits
- Attachment I requires an OCEMS-accredited paramedic on scene or responding for ECG lead placement, IV-fluid preparation, and preparation for ALS airway procedures.
- Preparing IV equipment is not starting an IV. Placing ECG leads is not interpreting the ECG. Helping prepare an advanced airway is not independently placing it.
4. Check transport suitability and existing devices
- The transferring physician must determine that BLS transport is appropriate. Device presence alone does not establish that the patient’s care needs fit BLS.
- Attachment I lists preset infusions of normal saline, lactated Ringer’s, TPN, folic acid, thiamine, and multivitamins. Sending-facility staff set the prescribed rate.
- Policy 315.00 permits maintaining a preset rate for specified glucose/isotonic IV fluids and stopping flow. This does not authorize starting a new infusion or independently titrating a medication.
- Patient-operated pumps have a limited transport role; the policy lists preset insulin, morphine, and TPN. This is not general authorization to manage critical care infusion pumps.
- Existing feeding tubes, ostomies, urinary catheters, tracheostomies, and other listed devices require the policy’s conditions. Chest tubes must be clamped or connected to a closed drainage system.
- Arterial lines are excluded. Central vascular lines used for monitoring or infusing fluids/medications are also excluded, even though long-established central lines appear elsewhere in the device list. Resolve device or infusion uncertainty before accepting BLS transport.
5. Build a reliable learning routine
- Before your shift, review the BLS protocols for equipment your unit actually carries. Locate the full policy and identify what requires ALS response or assistance.
- For naloxone, reassess breathing and consciousness and continue necessary airway support while awaiting ALS. Medication response does not remove the need for reassessment.
- For oral glucose, reassess mental status and vital signs after 5 minutes and every 5 minutes until ALS arrives. Record the indication, product/amount, time, route, and response.
- When a scope question comes up, pause the proposed intervention, continue appropriate BLS care, and seek clarification through your agency’s clinical chain. Discuss unfamiliar cases with your preceptor or educator.
California certification and the OC local scope
- California EMT certification and OCEMS local practice authorization are separate. OCEMS says EMTs working in Orange County need a current state EMT certificate and local Ambulance Driver/Attendant License. Local accreditation/expanded-scope training does not make an EMT a paramedic.
- State scope sets a framework, while OCEMS Policy 315.00 and its applicable standing orders/procedures define the local activities and conditions summarized here. A skill learned in school, listed in another county, or described on an ALS page is not independent OC authorization.
- Policy 315.00 still cites older Title 22 numbering. Use the current state rules and current OCEMS instructions rather than treating those old section numbers as a current legal crosswalk. This guide does not attempt to reproduce every California EMT rule.
A practical scope check before an intervention
- Confirm the patient fits the indication and has no listed exclusion. Confirm your certification/local authorization, documented training, agency equipment and the applicable BLS order.
- Check whether ALS must be present/responding, whether you are assisting a patient with their own prescribed product, or whether ALS direction is required. These are different conditions, not interchangeable approvals.
- When uncertain, continue appropriate BLS assessment/support, request ALS or clinical direction through the agency process, and resolve the specific proposed intervention before performing it.
Common Orange County EMT scope questions
| Question | OC scope distinction |
|---|---|
| Can an EMT use CPAP? | 315.00 and SO-B-001 include CPAP. Equipment, training, authorization and PR-120 eligibility/stop criteria still apply. |
| Can an EMT start an IV or give any ALS drug? | IV setup/monitoring and assistance do not authorize starting IV access, independent IV medication administration or titration. |
| Does a PICC make every patient unsuitable for BLS? | 315.00 lists long-established central lines among devices, but excludes central lines used for monitoring or IV fluids/medications; resolve the actual use and transfer suitability. |
| Does Narcan response remove the need for ALS? | SO-B-002 requires ALS response and ongoing respiratory/mental-status reassessment. Follow the exact product pathway. |
| Can I use another county’s skills list in OC? | A different county’s listing does not expand OC practice. Mutual-aid situations have specific policy conditions; check medical/agency direction. |
Certification, skills and training planning
- Use these education guides to prepare paperwork and compare programs; they do not expand treatment authority or replace hands-on training.
VISUAL FIELD REFERENCE
BLS care and ALS assistance have different limits
Adult / pediatric — follow each procedure’s criteria · BLS
Selected scope distinctions. Review the medication, transport, and device-specific sections below.
BLS airway support
Provide oxygen and BVM ventilation when indicated. Perform CPR and use an AED as appropriate; approved mechanical CPR devices are included.
Policy 315.00 includes oral/nasal airway adjuncts and suction. Equipped, trained BLS providers can also apply and monitor CPAP as described below.
Equipped, trained, authorized CPAP use
OCEMS-accredited EMTs can apply and monitor CPAP when their unit has the equipment and they are trained and authorized to use it. SO-B-001 specifically includes CPAP in BLS standing orders.
Use particular caution: ALS should be en route or already on scene. Patients needing CPAP can deteriorate and may need care beyond BLS scope.
Assisting ALS
Attachment I requires an OCEMS-accredited paramedic on scene or responding for ECG lead placement, IV-fluid preparation, and preparation for ALS airway procedures.
Preparing IV equipment is not starting an IV. Placing ECG leads is not interpreting the ECG. Helping prepare an advanced airway is not independently placing it.
- This is an orientation to OCEMS-accredited EMT practice, not a complete treatment protocol. A listed skill still requires the applicable training, equipment, indications, and OCEMS/agency authorization.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. 315.00 · SO-B-001 · SO-B-002 · SO-B-003 · PR-120
UNDERSTAND THE CARE
How to apply a scope boundary at the bedside
An intervention fits BLS practice only when the provider, patient, equipment and order all fit. A familiar device or a skill learned during training does not independently establish local authorization. Read the condition attached to the activity: ALS responding, ALS direction and assisting with a patient’s prescribed medicine are different requirements.
Applying the guidance
Transport suitability needs the same reasoning. Identify what an existing line, pump or device is doing during the trip and what care the patient may need. A device appearing on one list does not override an explicit exclusion in the governing policy. Resolve uncertainty before accepting a transport that needs monitoring, titration or intervention beyond the permitted scope.
Putting it together
Teaching example: a sending unit describes a patient as “just a pump transfer.” Clarify the medication, line, rate, monitoring needs and anticipated interventions before deciding whether the transport fits the local BLS criteria.
Diagram text & teaching checkpoints
- Provider
- Certification and local authorization.
- Patient
- Indication and exclusions.
- Equipment
- Training and the actual device.
- Conditions
- ALS involvement and transport limits.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
- 315.00 — OCEMS EMT Scope of Practice: EMS-OCEMS Accredited
- 315.00 — OCEMS EMT Scope of Practice: Field Reference Guide - Attachment I
- SO-B-001 — Basic Life Support Standing Orders
- SO-B-002 — Naloxone Administration
- SO-B-003 — Glucose Oral Administration
- PR-120 — Continuous Positive Airway Pressure (CPAP)
- OCEMS licensing — OCEMS: California certificate and local license