being common terms. By 2015, most states recognized the level of Emergency Medical Responder. Scope of practice Emergency Medical Responders (EMR) in the United States provide initial emergency care first on the scene (police/fire department/search and rescue) and support Emergency Medical Technicians and Paramedics when they arrive. The skills allowed at this level include taking vital signs, bleeding control, positive pressure ventilation with a bag valve mask, oropharyngeal airway, supplemental oxygen administration, oral suctioning, cardio-pulmonary resuscitation (CPR), use of an automated external defibrillator (AED), splinting, and assisting in the administration of basic medications such as epinephrine auto-injectors and oral glucose. They are also trained in packaging, moving and transporting patients. Due to the opioid epidemic, EMRs in certain states or regions are also trained and allowed to give Naloxone and utilize supraglottic airways. Procedures by certification level These are the minimum skills recommendations put forth by the National Highway Traffic Safety Administration and endorsed by the National Registry of Emergency Medical Technicians. Each State, region, and agencies may add to or deduct from this list as they see medically fit. First responder skills and limitations First responders can serve as secondary providers with some volunteer EMS services. An Emergency Medical Responder can be seen either as an advanced first aid provider, or as a limited provider of emergency medical care when more advanced providers have not yet arrived or are not available. Skills that Emergency Medical Responders are commonly not allowed to perform (that EMTs are) include insertion of traction splinting, administration of nebulized albuterol, administration of ASA, pulse oximetry, glucometry, or insertion of supraglottic airways. However, certain regions and states (such as Wisconsin) or medical directors may allow them to assist in or actually perform these skills. Rescue The National Fire Protection Association standards 1006 and 1670 state that all "rescuers" must have medical training to perform any technical rescue operation, including cutting the vehicle itself during an extrication. Therefore, in most all rescue environments, whether it is an EMS or fire department that runs the rescue, the actual rescuers who cut the vehicle and run the extrication scene or perform any rescue such as rope rescues or swift water rescue, etc., are Emergency Medical Responders, Emergency Medical Technicians, or Paramedics, as most every rescue has a patient involved. Traditional Emergency Medical Responders Emergency Medical Responder training is considered a bare minimum for emergency service workers who may be