What can paramedics do in each state?

RSI drugs are listed at the Critical Care level, not for standard paramedics.

In the statewide protocols for pain and chemical restraint.

Paramedics and critical care providers may give blood under the statewide trauma and shock protocols (11th edition).

In the statewide protocols for trauma and severe bleeding.

Needle cric is a paramedic skill; surgical cric is for critical care and tactical medics.

Your medical director's standing orders set the advanced airway techniques you may perform (7 AAC 26.640); medications beyond the state scope need department approval under 7 AAC 26.670.

Alaska's state scope lists ketamine at the advanced levels with medical director approval (marked *).

Your medical director can add blood by written standing order; the department-approval step in 7 AAC 26.670 covers EMT and AEMT levels, not paramedics (Anchorage Fire runs a program).

Your medical director adds medications by written standing order; the department-approval step in 7 AAC 26.670 covers EMT and AEMT levels, not paramedics.

Your medical director's standing orders set the advanced airway techniques you may perform.

A paramedic 'STR' skill: it requires the state's specified training under A.A.C. R9-25-505 before use.

An optional drug-box agent your administrative medical director may authorize.

Authorized only for paramedics with the Critical Care Endorsement.

On the state drug box list as an optional paramedic agent (approved January 2026).

A paramedic skill in the state scope (Table 5.1).

The service applies to the Department of Health and must be approved before any paramedic uses the RSI protocol.

Paramedics may give medications in the National Scope of Practice once trained and credentialed by the service's medical director.

Not in the paramedic scope; a 2026 state pilot lets approved agencies start blood with Department permission.

Paramedics give the medications in their service's protocols once its medical director credentials them.

Arkansas paramedics work within the National EMS Scope of Practice, which includes cricothyrotomy; the service medical director credentials you.

RSI isn't in the California paramedic scope; it's taught in critical care paramedic training, and a local EMS agency can add it only as a trial study approved by the state EMS Authority.

In the basic paramedic scope; your local EMS agency's protocols set the uses.

Critical care and flight paramedics on interfacility transports; anything else needs a state-approved local optional scope.

Part of the basic paramedic scope since January 2025; your local EMS agency decides whether it's carried.

The paramedic scope covers needle cricothyroidotomy; surgical cric is taught in critical care paramedic training.

Paralytics and etomidate aren't on the paramedic formulary, so an agency needs a CDPHE waiver (typically three years) to do RSI.

Ketamine is marked not allowed on the paramedic formulary, so an agency needs a CDPHE waiver.

Blood isn't on the paramedic formulary, so an agency needs a CDPHE waiver; several Front Range agencies have one.

Not on the paramedic formulary, so an agency needs a CDPHE waiver.

Allowed for paramedics on the state list of medical acts.

RSI is in the statewide protocols; your sponsor hospital trains and credentials you.

Paramedic standing order for moderate to severe pain in the statewide protocols.

A paramedic standing order in the statewide protocols for agencies that carry blood.

In the statewide protocols for trauma and postpartum hemorrhage.

Percutaneous cric for paramedics; bougie-assisted surgical cric only for paramedics credentialed for RSI by their sponsor hospital.

Paralytics are limited to agencies the Office of EMS has approved for RSI (statewide ALS protocols, 2022 edition).

Statewide ALS protocols: severe pain, and induction in approved RSI agencies.

A state pilot for approved agencies; Delaware paramedics passed 250 units by late 2024.

In the statewide paramedic protocols for hemorrhagic shock.

In the statewide paramedic protocols.

DC Fire and EMS uses medication-facilitated intubation; its protocols list no paralytic agents.

In DC Fire and EMS protocols for pain and procedural dissociation.

DC Fire and EMS gives low-titer O whole blood for hemorrhagic shock.

In the FEMS protocols as part of the trauma resuscitation bundle.

FEMS protocols use needle cricothyroidotomy (QuickTrach), not surgical cric.

No state RSI rule: each provider's medical director decides in its standing orders.

No state medication list for paramedics: your medical director's protocols decide whether you carry ketamine and for what.

No state rule limits it: your medical director's protocols decide, and the agency needs a blood supplier agreement.

No state medication list for paramedics: your medical director's protocols decide whether you carry TXA.

No state skills list limits it: your medical director's protocols decide whether you do surgical cric and how.

The agency needs written approval from the Office of EMS and Trauma; without it, paramedics may only maintain paralysis in already-intubated patients on interfacility transports.

Georgia's scope lets paramedics give any physician-approved medication, ketamine included.

The agency needs state Post-Licensure Skill approval (two-year term).

Georgia's scope lets paramedics give any physician-approved medication, TXA included.

Paramedics may do percutaneous cric; surgical cric is limited to critical care.

RSI is in the statewide standing orders for Hawaii paramedics (MICTs).

Ketamine isn't on the statewide standing orders' medication list (2025).

Paramedics may continue a transfusion on interfacility transfers; the standing orders have no protocol to start blood.

Not on the 2025 statewide standing orders' medication list.

Not in the 2025 statewide standing orders.

RSI is an optional module for paramedics who hold FP-C or CCP-C certification, approved by their medical director, following the EMSPC protocol.

In the statewide protocols for pain and sedation.

In the statewide shock and trauma protocols; an optional module your agency medical director must approve.

In the statewide trauma protocol at the paramedic level.

At the paramedic level in the statewide airway protocol.

Paralytics aren't in the national education standards, so an EMS System must get IDPH approval before adding them.

Medications beyond the national education standards need IDPH approval for your EMS System before use; your System's standing medical orders say whether ketamine is included.

Pilot programs need IDPH approval; Eureka-Goodfield EMS started Illinois's first ground program in 2026.

Medications beyond the national education standards need IDPH approval for your EMS System; your System's standing medical orders say whether TXA is carried.

Illinois paramedics work within the national scope, which includes cricothyrotomy; your EMS System's standing medical orders set the technique.

Indiana's scope gives paramedics medical-director-approved medications rather than a fixed list; RSI depends on your provider organization's protocol and credentialing.

Indiana's scope lets the medical director approve paramedic medications; ketamine depends on your provider organization's protocols.

The state scope lists maintaining blood, not initiating it.

Indiana's scope lets the medical director approve paramedic medications.

In the state paramedic scope; your medical director picks the technique.

Iowa's paramedic scope allows medications in the service's approved protocols, and endotracheal intubation; the service medical director credentials you.

No state medication list for paramedics: your medical director's protocols decide whether you carry ketamine and for what.

In the Iowa paramedic scope; the service medical director credentials you.

No state medication list for paramedics: your medical director's protocols decide whether you carry TXA.

Percutaneous cric is in the paramedic scope; surgical cric is in the critical care paramedic scope.

Services decide; the state Medical Advisory Council's position asks for a demonstrated need, a medical-director-led program and ongoing review.

Kansas law lets paramedics give medications authorized by medical protocols.

Kansas law lets paramedics perform procedures authorized by medical protocols; your service medical director decides.

Kansas law lets paramedics give medications authorized by medical protocols.

Kansas law lets paramedics perform procedures authorized by medical protocols.

Both the service and the paramedic need KBEMS authorization; pediatric RSI is limited to critical care transport and air medical providers.

Paramedic scope; state protocols use it for agitation and pain.

Blood isn't in the state protocol set; an agency adds it as a protocol amendment approved by KBEMS (Lexington, Louisville and others have).

A statewide protocol for severe hemorrhage.

In the statewide protocols; your service medical director decides who is credentialed.

Medication-assisted intubation is an optional paramedic module: your agency trains you and its medical director authorizes it (2017 scope matrix; the 2024 revision kept the optional-module approach).

Louisiana paramedics give medications in agency protocols approved by the medical director.

The paramedic scope lists maintaining a transfusion, not starting one (2017 matrix).

Louisiana paramedics give medications in agency protocols approved by the medical director.

In the paramedic column of the state scope matrix (2017).

The 2025 statewide protocols, which govern all Maine EMS licensees, include no RSI protocol and no paralytic medications.

Statewide protocols include ketamine for adult pain (IV infusion or IM) and post-intubation sedation.

The 2025 statewide protocols have no blood product protocol.

In the statewide hemorrhagic shock protocol at the paramedic level.

In the statewide protocols.

RSI is an Optional Supplemental Program: a jurisdiction must apply and be approved before its paramedics can use it.

Statewide protocols for pain and agitation.

Low-titer O+ whole blood runs as a state pilot protocol for approved jurisdictions.

In the Maryland Medical Protocols for trauma and angioedema.

An Optional Supplemental Protocol: the jurisdiction needs MIEMSS approval.

Statewide Treatment Protocols v2026.2 (Sep 1, 2026) have no RSI; paralytics appear only as drugs a paramedic may continue on an interfacility transfer. Services have run medication-assisted intubation under OEMS special-project waivers (105 CMR 170.405).

Paramedic standing order for adult pain in Statewide Treatment Protocols v2026.2 (Sep 1, 2026).

Statewide Treatment Protocols v2026.2 (Sep 1, 2026), protocol 6.13: whole blood or PRBCs for trauma is a paramedic standing order, but each service needs a letter of approval from OEMS (blood bank, storage and training reviewed).

In the statewide trauma protocols on a medical control order, where the service carries it (v2026.2).

A Medical Director Option: the service and its affiliate hospital medical director run a surgical cric program (v2026.2).

The state protocol suite limits intubation to patients without a gag reflex and has no drug-assisted intubation protocol; a Medical Control Authority would need state approval for its own.

The state pain protocol lets each Medical Control Authority choose: not permitted, medical control contact first, or standing order.

Not in the state protocol suite; a Medical Control Authority adds it with MDHHS approval (Genesee County started in 2026).

Not in the state protocol suite; a Medical Control Authority adds it with MDHHS approval.

Your Medical Control Authority selects surgical, needle or a commercial kit.

No state RSI rule: each ambulance service's medical director sets the standing orders.

No state medication list for paramedics: your medical director's protocols decide whether you carry ketamine and for what.

No state rule limits it: your medical director's protocols decide, and the agency needs a blood supplier agreement.

No state medication list for paramedics: your medical director's protocols decide whether you carry TXA.

No state skills list limits it: your medical director's protocols decide whether you do surgical cric and how.

Paralytics are in the Critical Care Paramedic column only of the state scope (August 2024).

In the paramedic scope for behavioral emergencies and pain control only (August 2024).

Paramedics may initiate and maintain blood products under the state scope (August 2024).

In the paramedic column of the state scope of practice.

Percutaneous cric for paramedics; surgical cric only for critical care paramedics (August 2024 scope).

No state RSI rule: each service's medical director writes the treatment protocols.

No state medication list for paramedics: your medical director's protocols decide whether you carry ketamine and for what.

No state rule limits it: your medical director's protocols decide, and the agency needs a blood supplier agreement.

No state medication list for paramedics: your medical director's protocols decide whether you carry TXA.

No state skills list limits it: your medical director's protocols decide whether you do surgical cric and how.

Drug-assisted intubation needs the Paramedic Critical Care Endorsement.

In the Board-approved state protocols.

IV blood products are in the paramedic scope.

In the state protocols for hemorrhagic shock, per local protocol.

In the state paramedic protocols.

RSA is in the state model protocols; your service's physician medical director decides whether to adopt it.

State model protocols: severe pain, agitation and induction.

In the state model protocols for services that carry blood.

In the state model protocols for hemorrhagic shock.

In the state model protocols for failed airways.

The state manual includes an RSI procedure; whether you use it depends on your agency's medical director. Las Vegas and Reno run their own regional protocols.

State manual for pain, severe agitation and sedation; agencies adopt it, and Las Vegas and Reno run their own protocols.

The state manual has no blood protocol; Clark County Fire's program runs as a Southern Nevada Health District–approved protocol trial.

In the state protocols for severe hemorrhage.

In the state protocols.

Patient Care Protocols v9.3 (Nov 7, 2025), protocol 7.8: RSI is a prerequisite protocol; the EMS unit must be authorized by the state (FSTEMS) before its paramedics use it.

In the statewide Adult Medication Reference of Patient Care Protocols v9.3 (Nov 7, 2025), including analgesia and post-intubation sedation.

Patient Care Protocols v9.3 (Nov 7, 2025): starting blood is under the Critical Care protocol, which only units authorized by the state can use. Paramedics on credentialed interfacility transfers may continue blood started before departure.

A paramedic standing order in Patient Care Protocols v9.3 (Nov 7, 2025).

In the paramedic scope of Patient Care Protocols v9.3.

The agency needs an OEMS-approved RSI program, and the protocol requires an online medical command order.

Statewide protocols for pain and RSI; not allowed under communication-failure procedures.

Statewide protocol; agencies submit their blood program to OEMS before starting.

A statewide paramedic protocol (2025).

In the statewide protocols (2025).

RSI is a critical care transport special skill: it needs a bureau-approved critical care course and exam, and an agency with an approved critical care special skill.

Ketamine isn't on New Mexico's paramedic scope; an agency adds it through the state special-skill process, or as a critical care transport skill.

In the paramedic scope, with online medical control.

On the paramedic medication list in state rules, for patients over 15.

On the paramedic skills list in state rules.

RSI is a regional program in New York: your region's REMAC credentials agencies and paramedics (this example is the Susquehanna region's policy).

ALS medications come from your region's REMAC protocols; New York City's include ketamine.

Signed into law September 17, 2024 (Chapter 316); your region's REMAC protocols set how it's done.

ALS medications come from your region's REMAC; the Hudson-Mohawk region requires TXA in every agency's formulary (2025).

Set by your region's REMAC protocols; New York City's no longer include cricothyroidotomy.

The county EMS System submits the NCCEP DAI policy, unaltered protocols, training records and peer review to state OEMS for approval.

The EMS System needs an OEMS-approved ketamine or drug-assisted intubation program.

On the North Carolina Medical Board's approved paramedic list; your EMS System's protocols must include it.

Each EMS System needs OEMS State Medical Director approval, with a letter from the receiving trauma centers.

An approved paramedic skill; systems that do drug-assisted intubation must be able to perform it.

Medication-assisted intubation is an optional paramedic module; your agency trains you and its medical director authorizes it.

Paramedic medications are those your agency medical director approves.

An optional paramedic module: your agency trains you and its medical director authorizes it.

Paramedic medications are those your agency medical director approves.

In the state paramedic scope.

Ohio's scope doesn't list RSI separately: paramedics may intubate and give protocol-approved medications, so it's your medical director's call.

Ohio approves ketamine even at the AEMT level; paramedics give it under their medical director's protocols.

An added competency for paramedics: your medical director provides the training, protocol and quality review.

Ohio's rules let AEMTs give TXA; paramedics give it under their medical director's protocols.

A paramedic skill on the state scope (April 2026).

The state protocol set uses medication-assisted intubation without paralytics; an agency that wants RSI submits its own protocol to OSDH for approval.

The state protocol set has no ketamine; an agency adds it through its own protocol submitted to OSDH for approval.

Agencies add blood through an OSDH-approved protocol change (EMSA, Pafford and AMR Edmond run programs).

Not in the state protocol set; an agency adds it through its own protocol submitted to OSDH for approval.

On the state paramedic skills list, with a statewide procedure.

Paramedics may intubate and give any medication their supervising physician's protocols authorize, so RSI is the medical director's call.

No state medication list for paramedics: your medical director's protocols decide whether you carry ketamine and for what.

Oregon's paramedic scope includes initiating blood products under the supervising physician's written protocols.

No state medication list for paramedics: your medical director's protocols decide whether you carry TXA.

In the paramedic scope under the supervising physician’s protocols.

Statewide ALS protocols give paramedics sedation-assisted intubation only; RSI appears only for prehospital RNs under approved air ambulance protocols.

Optional for ALS agencies with extra requirements, and your regional council decides.

An optional statewide protocol; your regional Medical Advisory Committee approves each agency.

An optional statewide ALS protocol; your agency medical director decides whether to use it.

In the statewide ALS airway protocol as a surgical airway option, if the agency carries it.

A restricted protocol: you need the state (CEMS) prerequisite plus your agency medical director's sign-off.

In the statewide protocols.

Transport of a running transfusion after an approved competency program.

In the statewide protocols.

In the statewide protocols.

A state protocol the service may adopt; if it does, it must be followed as written with 100% case review.

On the state formulary; your local medical control physician approves its use.

Paramedics may continue a transfusion started at the sending hospital but not start new units.

A state TXA procedure for paramedics; the agency agrees its protocol with the regional trauma center.

In the state protocols for paramedics trained and permitted by medical control.

RSI is in the paramedic scope of practice; your service medical director decides whether to authorize it.

On the paramedic medication list in the state scope.

Paramedic scope covers monitoring and maintaining blood started elsewhere.

On the state paramedic medication list.

In the state paramedic scope.

Your service medical director confirms competency in writing.

In the state protocol guidelines (2022–23), with a ketamine reference.

A Board-approved clinical practice; training happens at the service level.

Not in the 2022–23 state model protocols; services adopt those, and your service's medical director decides whether to add TXA.

In the state protocol guidelines as a rescue airway for patients over 12.

Texas has no state RSI rule: each provider's medical director writes and signs the protocols, RSI included.

No state medication list for paramedics: your medical director's protocols decide whether you carry ketamine and for what.

No state rule limits it: your medical director's protocols decide, and the agency needs a blood supplier agreement.

No state medication list for paramedics: your medical director's protocols decide whether you carry TXA.

No state skills list limits it: your medical director's protocols decide whether you do surgical cric and how.

RSI isn't in Utah's protocol guidelines; an agency adds it through a state variance or state-approved optional procedure, and only a handful of Utah agencies do.

In the state protocol guidelines for pain.

A guideline in the state protocol guidelines that agencies may adopt.

In the 2025 state protocol guidelines for severe hemorrhage.

In the 2025 state protocol guidelines.

Paramedics must be credentialed locally and enrolled in an approved Vermont EMS RSI program.

Paramedic standing order for pain in the statewide protocols.

Paramedics continue blood on transfers; starting additional units is a critical care paramedic skill.

In the statewide protocols; your District Medical Advisor must approve it.

A statewide procedure (5.13).

RSI is in the Virginia paramedic scope with an additional-training requirement; your agency's operational medical director decides whether to use it.

Paramedics may give up to 0.5 mg/kg; higher doses for violent or aggressive patients need additional training.

Paramedics may initiate blood with additional training (marked red in the state formulary).

On the state formulary from the AEMT level up.

Surgical cric is a paramedic skill on the state scope.

Your county medical program director decides; several counties use RSI and others don't.

No state medication list for paramedics: your medical director's protocols decide whether you carry ketamine and for what.

No state rule limits it: your medical director's protocols decide, and the agency needs a blood supplier agreement.

Your county medical program director's protocols decide whether you carry TXA.

Your county medical program director's protocols decide.

An optional statewide protocol that needs approval from WVOEMS and your squad's medical director.

Statewide protocols: pain, sedation, and RSI induction.

An optional statewide protocol for approved agencies and providers who pass the state blood course.

In the statewide protocols for hemorrhage.

In the statewide protocols (July 2024).

Paralytics are optional paramedic medications; the service must get them approved in its DHS operational plan.

Ketamine is an optional paramedic medication: the service needs it approved in its DHS operational plan.

Blood initiation is an optional paramedic skill the service must get approved in its DHS operational plan.

An optional paramedic medication on the state scope; your service medical director chooses.

A required paramedic skill on the 2026 state scope.

The agency needs prior written approval of its RSI protocol from the Office of EMS.

Any medication you are educated, certified, licensed and credentialed for — your medical director decides.

The agency needs prior written approval of a blood protocol from the Office of EMS (2024 rule revision).

Any medication you are educated, certified, licensed and credentialed for — your medical director decides.

A paramedic skill in the state scope guidance.