Objective: The scope of practice (SOP) for flight paramedics (FPs) remains a controversial issue for air medical directors. This study's objective was to determine the current level and breadth of FPs'SOP.

Methods: A 6-item survey of lead FPs in all 158 air medical programs throughout the U.S. The survey addressed five issues: 1)Certifications required of FPs above state certification; 2) Procedures included in SOP; 3) Medications FPs are allowed to administer; and 4) Requirements needed to expand FPs’ SOP. Views on establishing a National FP certification (NFPC) to alter their current SOP.

Results: Survey response was 57% (90/158). Ten responding programs (11%) did not utilize FPs. Of the 80 programs (89%) that utilize FPs, 76 programs (95%) required certification in ACLS, 65 (81%) in PALS, and 50 (63%) in BCLS. Paramedics were allowed to perform cricothyroidotomy in 68 programs (85%), pericardiocentesis in 24 programs (30%), and tube thoracostomy in 23 programs (29%). A wide spectrum of medications were approved for administration by FPs, including streptokinase in 37 programs (46%), r-TPA in 51 (64%), and succinylcholine in 50 (63%). In 61 programs (76%), the SOP was determined solely by the air medical director. Eighteen respondents (23%) believed that the development of a NFPC program would alter their SOP.