Exploring Rural vs. Urban Variations in EMT Scope of Practice: Advanced Airway and IV Access Policies

This thesis investigates how states across the United States (US) modify the Emergency Medical Technician (EMT) Scope of Practice (SoP) to permit advanced skills, with a focus on advanced airway management via supraglottic airways (SGAs) and intravenous (IV) access procedures, and whether rurality plays a role in these decisions. While the National EMS SoP Model establishes minimum competencies for each emergency medical services (EMS) provider level, individual states often alter their standards in response to local demographic, geographic, and resource-based needs. This study reviewed SoP policies from all 50 states, and 44 states were included. Logistic regression analysis was utilized to explore relationships between advanced skill allowances and predictors such as percent rural population, state EMS funding, population density, and geographic size. This analysis aimed to assess whether states with a higher percent rural population were more likely to permit EMTs to perform SGA and IV access skills. Although statistical models did not yield significant results due to sample size limitations, descriptive trends suggested that states allowing SGA placement at the EMT level tended to have higher rural populations and increased EMS funding. Conversely, IV access at the EMT level was permitted more often in less rural, lower-density states with fewer EMS agencies. This research highlights the complexities of SoP modifications along with the critical role of EMTs in resource-limited areas and the ongoing debate over expanding their clinical responsibilities. Findings underscore the need for improved standardization in reporting SoPs, greater transparency in policy rationale, and more localized or regional analyses to capture nuanced EMS operational needs.