Scope of Practice

Scope of Practice Documents

Standardizing the Scope of Practice for Providers

Scope of Practice Documents

IAES Scope of Practice (SOP) guidelines outline the core clinical activities, interventions, and decision-making responsibilities appropriate to each certification level within the IAES training framework. These guidelines ensure consistency across training providers and clarify the expected competencies of certified responders in remote, resource-limited, and delayed-care environments. While SOPs define what is medically indicated and educationally endorsed by IAES, it remains the responsibility of each provider organisation and individual responder to ensure alignment with relevant legal, regulatory, and organisational authorisations in their operating context.

Austere BLS (Basic Life Support)

Audience: General public, workplace responders, new recruits in field teams

General Scope:

  • Recognise and respond to the most time-critical, life-threatening emergencies using foundational life support interventions

  • Provide immediate support until a higher-level responder or evacuation becomes available

Permitted Skills:

  • Recognition and management of cardiac arrest (adult/child)

  • HCP-CPR with AED use

  • Choking response (adult/child)

  • Recognition and basic response for heart attack and stroke

  • Recognition and management of anaphylaxis (including assisting with epinephrine auto-injector)

  • Termination of resuscitation according to authorized protocols

Limitations:

  • Does not include general patient assessment or trauma care

  • No medication administration beyond Aspiring for ACS and EpiPen use

  • No wound care, splinting, or environmental injury management

Austere First Aid (AFA)

Audience: Individual enthusiasts and accidental responders (e.g., hikers, adventure travellers, volunteer trip leaders)

General Scope:

  • Recognise and manage life-threatening conditions using basic interventions

  • Provide initial stabilisation and initiate communication for evacuation

  • Deliver care for common injuries and environmental illnesses with minimal equipment

Permitted Skills:

  • Basic patient assessment (primary and secondary survey)

  • Vital signs and trend monitoring

  • Use of airway adjuncts (OPAs/NPAs)

  • Control of external bleeding using direct pressure, dressings, basic tourniquets

  • Management of choking

  • HCP-CPR (adult/child, with AED)

  • Recognition of signs and symptoms of common medical and environmental emergencies

  • Basic splinting and wound care

  • Medication assistance 

  • Fluid support (oral)

  • Termination of resuscitation efforts according to authorized protocols

  • Evacuation support (assisting in patient packaging, calling for help)

  • Use of checklists, field guides, and documentation tools

  • Traction for reduced distal CSM in long bone injuries

Pharmacology:

  • Administration of Aspirin for ACS in adult patients
  • Administration of an EPIPEN for anaphylaxis
  • Advice on appropriate OTC medication

Limitations:

  • No independent medication administration without protocols authorized by a licensed medical professional
  • No invasive procedures

Austere Advanced First Aid (AAFA)

Audience: Occasional or assistant responders (e.g., outdoor instructors, field team members, camp staff)

General Scope:

  • Provide advanced first aid care and assist with extended care tasks under guidance

  • Recognise trends and initiate care planning in delayed-access scenarios

  • Support primary caregivers and assist with field-based interventions

Permitted Skills:

  • All AFA-level skills, plus:

  • Limited independent medication administration (e.g., oral analgesics, antihistamines)

  • Spinal motion restriction (SMR)

  • Field pharmacology (within non-invasive scope)

  • Epinephrine for asthma refractory to salbutamol

  • Communication with remote medical direction

  • Contribute to care planning and evacuation decisions with supervision

Pharmacology:

  • Administration of Aspirin for ACS in adult patients
  • Administration of an EPIPEN for anaphylaxis
  • Advice on appropriate OTC medication

Limitations:

  • No independent medication administration without protocols authorized by a licensed medical professional
  • No invasive procedures

Limitations:

  • Autonomy limited to protocols and training

  • No IV/IM administration

  • Advanced interventions require higher-level support

Austere First Responder (AFR)

Audience: Primary designated responders (e.g., field medics, NGO field staff, security teams, expedition leaders)

General Scope:

  • Independently assess, treat, and manage patients during prolonged care scenarios

  • Serve as the lead responder in field settings without immediate access to higher care

  • Deliver care within defined protocols and guidelines

Permitted Skills:

  • All AAFA-level skills, plus:

  • Broader medication administration under standing orders (including additional oral and inhaled medications)

  • Epinephrine for asthma refractory to salbutamol

  • Traction splinting for long bone injuries

  • Evacuation planning and leadership

  • Communication with medical oversight and documentation to a professional standard

Pharmacology:

  • Administration of Aspirin for ACS in adult patients
  • Administration of an EPIPEN for anaphylaxis
  • Advice on appropriate OTC medication
  • Use of standing orders or medical protocols for common medications (antipyretics, anti-inflammatories, analgesia, antibiotics, antihistamines, antiemetics, antibiotics, bronchodilators, sympathomimetics (epinephrine only)

Limitations:

  • No independent medication administration without protocols authorized by a licensed medical professional
  • No invasive procedures

Limitations:

  • Medication use limited to protocols and organisational authorisation

  • No IV/IM medication administration (unless within jurisdictional scope)

  • Field diagnostics limited to non-invasive tools (e.g., SpO2, BGL, temperature)

Austere Medic (AM)

Audience: Lead caregivers in remote, prolonged, or resource-depleted settings (e.g., wilderness EMTs, NGO medics, rural clinicians, expedition medical officers)

General Scope:

  • Function as the clinical lead in austere environments

  • Deliver advanced field care, manage critically ill patients, and coordinate evacuation or prolonged care

  • Operate under standing orders or delegated protocols

Permitted Skills:

  • All AFR-level skills, plus:

  • Advanced patient assessment and differential diagnosis

  • Field pharmacology: oral, buccal, inhaled, rectal, and IM (where authorised)

  • Use of standing orders or medical protocols (unless otherwise licensed/authorized) for common medications (antipyresis, anti-inflammatories, analgesia, antibiotics, antihistamines, antiemetics, antibiotics, bronchodilators, sympathomimetics (epinephrine only) 

  • Combivent followed by epinephrine for asthma refractory to salbutamol

  • Decompression of tension pneumothorax (if authorised)

  • Dislocation reduction and field reduction protocols

  • Long-term wound, burn, and pressure care

  • Fluid resuscitation via oral and rectal routes (rectal IV equivalent)

  • Trauma arrest protocols

  • Prolonged monitoring, documentation, and leadership during multi-day care

  • Ethical decision-making and medical consultation with off-site physicians or medical directors

  • Termination of resuscitation efforts (with supporting documentation and guidelines)

Limitations:

  • Invasive procedures must be within scope of training and jurisdiction

  • Requires written protocols and/or real-time oversight for ALS-level interventions

  • Expected to practise within the limits of licensure, standing orders, and environment

 

Comparative Scope of Practice Table

Competency/SkillABLSAFAAAFAAFRAM
Primary & secondary assessment ✔️✔️✔️✔️
Vital signs & trend monitoring ✔️✔️✔️✔️
Bleeding control (basic & advanced)✔️✔️✔️✔️✔️
Airway adjuncts (OPA/NPA) ✔️✔️✔️✔️
CPR with AED✔️✔️✔️✔️✔️
Choking response✔️✔️✔️✔️✔️
Recognition of stroke, MI, anaphylaxis✔️✔️✔️✔️✔️
Pain & symptom assessment ✔️✔️✔️✔️
Medication assistance (self-administered)✔️✔️✔️✔️✔️
Independent medication administration  Limited*✔️✔️
Spinal motion restriction  ✔️✔️✔️
Joint dislocation reduction   ✔️†✔️
Prolonged field care  ✔️✔️✔️
Evacuation coordination  Assist✔️✔️
Triage & scene leadership   ✔️✔️
Fluid support (oral, rectal) ✔️✔️ ✔️
Field pharmacology (standing orders)  ✔️✔️‡✔️
Remote medical consultation  ✔️✔️✔️
Formal documentation (SOAP, PCR) ✔️✔️✔️✔️
Traction for reduced distal CSM ✔️✔️✔️✔️
Traction splinting   ✔️✔️
Epinephrine for asthma (refractory cases)  ✔️✔️✔️
Combivent before epinephrine    ✔️
Impaled object removal ✔️✔️✔️✔️
Termination of resuscitation efforts✔️✔️✔️✔️✔️
Trauma arrest protocols    ✔️

*Under organisational protocols (e.g. epinephrine, oral analgesia)
†Within defined scope and mechanism; training required
‡Only where permitted and authorised