OCEMS BLS scope of practice

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.