DEPARTMENT OF HEALTH
Approved Drugs for ALS Ambulance Services
[42 Pa.B. 4229]
[Saturday, July 7, 2012]
Under 28 Pa. Code § 1005.11(b) (relating to drug use, control and security), the following drugs are approved for use by ground advanced life support (ALS) ambulance services and may be administered by emergency medical technicians—paramedics, prehospital registered nurses and health professional physicians when use of the drugs is permitted by the applicable Department of Health (Department) approved regional medical treatment protocols:
1. Activated charcoal
6. Antimicrobials—for interfacility transports only
8. Atropine sulfate
9. Benzocaine—for topical use only
10. Bivalirudin—for interfacility transports only
11. Calcium chloride
12. Calcium gluconate
14. Dexamethasone sodium phosphate
16. Dilaudid—for interfacility transports only
18. Diphenhydramine HCL
22. Epinephrine HCL
23. Etomidate (only permitted for services approved by a regional EMS council and participating in the required QI program)
27. Heparin by intravenous drip—for interfacility transports only
28. Hydrocortisone sodium succinate
29. Glycoprotein IIb/IIIa Inhibitors—for interfacility transports only
30. Intravenous electrolyte solutions
b. Lactated Ringer's
c. Sodium chloride
e. Potassium—for interfacility transports only
31. Ipratropium Bromide
32. Isoproterenol HCL—for interfacility transports only
33. Levalbuterol—for interfacility transports only
34. Lidocaine HCL
36. Magnesium sulfate
39. Morphine sulfate
40. Naloxone HCL
41. Nitroglycerin (all forms/routes, but continuous intravenous infusion must be regulated by an infusion pump)
42. Nitrous oxide
45. Pralidoxime CL
47. Sodium bicarbonate
48. Sodium thiosulfate
49. Sterile water for injection
51. Tetracaine—for topical use only
52. Total parenteral nutrition—for interfacility transport only
During interfacility transport, all medications given by continuous infusion (except intravenous electrolyte solutions with potassium concentrations of no more than 20 mEq/L) must be regulated by an electronic infusion pump. For prehospital transport, continuous infusions of crystalloid solutions containing medication (except intravenous electrolyte solutions with potassium concentrations of no more than 20 mEq/L) must be rate controlled by electronic IV pump or a manual flow control device capable of setting specific numeric flow rates.
This list supersedes the list of approved drugs published at 41 Pa.B. 2286 (April 30, 2011). The changes from the previous notice are:
1. The removal of heparin flush.
2. The addition of prehospital transport continuous infusions of crystalloid solutions containing medication (except intravenous electrolyte solutions with potassium concentrations of no more than 20 mEq/L) must be rate controlled by an electronic IV pump or a manual flow control device capable of setting specific numeric flow rates.
Ambulance services are not authorized to stock drugs designated ''for interfacility transports only.'' However, paramedics and health professionals may administer a drug so designated if the facility transferring a patient provides the drug, directs that it be administered to the patient during the transfer, and the regional transfer and medical treatment protocols permit the administration of the drug by those personnel. See 28 Pa. Code § 1005.11(a)(3) and (d).
Section 1005.11 of 28 Pa. Code permits a ground ALS ambulance service, with Department approval, to stock drugs, under specified circumstances, in addition to those drugs on the approved list if a region's medical treatment protocols authorize their use within the region.
The list of drugs in this notice does not apply to air ambulance services. Under 28 Pa. Code § 1007.7(i)(2) (relating to licensure and general operating requirements), each air ambulance service is to develop its own medical treatment protocols that identify drugs that may be used by the air ambulance service. The air ambulance service is to then submit the protocols to the medical advisory committee of the appropriate regional emergency medical services council for the medical advisory committee's review and recommendations. Following its consideration of the recommendations and making further revisions if needed, the air ambulance service is to file the protocols with the Department for approval.
Persons with a disability who require an alternate format of this notice (for example, large print, audiotape, Braille) should contact Robert Cooney, Department of Health, Bureau of Emergency Medical Services, Room 606, Health and Welfare Building, 625 Forster Street, Harrisburg, PA 17120-0701, (717) 787-8740. Speech or hearing impaired persons may use V/TT (717) 783-6154 or the Pennsylvania AT&T Relay Service at (800) 654-5984 (TT).
ELI N. AVILA, MD, JD, MPH, FCLM,
[Pa.B. Doc. No. 12-1270. Filed for public inspection July 6, 2012, 9:00 a.m.]
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