Approved Drugs for ALS Ambulance Services

[43 Pa.B. 3060]
[Saturday, June 1, 2013]

 Under 28 Pa. Code § 1005.11 (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 EMT-paramedics (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

 2. Acetaminophen

 3. Adenosine

 4. Albuterol

 5. Amiodarone

 6. Antimicrobials—for interfacility transports only

 7. Aspirin

 8. Atropine sulfate

 9. Benzocaine—for topical use only

 10. Bivalirudin—for interfacility transports only

 11. Calcium chloride

 12. Calcium gluconate

 13. Captopril

 14 Dexamethasone sodium phosphate

 15. Diazepam

 16. Dilaudid—for interfacility transports only

 17. Diltiazem

 18. Diphenhydramine HCL

 19. Dobutamine

 20. Dopamine

 21. Enalapril

 22. Epinephrine HCL

 23. Epinephrine, Racemic

 24. Etomidate (only permitted for services approved by a regional EMS council and participating in the required QI program)

 25. Fentanyl

 26. Furosemide

 27. Glucagon

 28. Heparin by intravenous drip—for interfacility transports only

 29. Hydrocortisone sodium succinate

 30. Glycoprotein IIb/IIIa Inhibitors—for interfacility transports only

 a. Abciximab

 b. Eptifibatide

 c. Tirofiban

 31. Intravenous electrolyte solutions

 a. Dextrose

 b. Lactated Ringer's

 c. Sodium chloride

 d. Normosol

 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

 35. Lorazepam

 36. Magnesium sulfate

 37. Methylprednisolone

 38. Midazolam

 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

 43. Ondansetron

 44. Oxytocin

 45. Pralidoxime CL

 46. Procainamide

 47. Sodium bicarbonate

 48. Sodium thiosulfate

 49. Sterile water for injection

 50. Terbutaline

 51. Tetracaine—for topical use only

 52. Total parenteral nutrition—for interfacility transport only

 53. Verapamil

 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 corrected 42 Pa.B. 4229 (July 7, 2012).

 The following addition is the only change from the previous list:

 1. The addition of racemic epinephrine.

 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 to exceed, under specified circumstances, the drugs (taken from the master list) that a region's medical treatment protocols authorize for 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 which 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 after 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 D. Cooney, EMS Program Manager, Bureau of Emergency Medical Services, Department of Health, 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).


[Pa.B. Doc. No. 13-1003. Filed for public inspection May 31, 2013, 9:00 a.m.]

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