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NOTICES

DEPARTMENT OF HEALTH

Approved and Required Medications Lists for Emergency Medical Service Agencies and Emergency Medical Service Providers

[47 Pa.B. 3285]
[Saturday, June 10, 2017]

 Under 28 Pa. Code §§ 1027.3(c) and 1027.5(b) (relating to licensure and general operating standards; and medication use, control and security), the Department of Health (Department) has approved the following medications for administration by emergency medical responders (EMR), emergency medical technicians (EMT), advanced emergency medical technicians (AEMT), paramedics, prehospital registered nurses (PHRN), prehospital physician extenders (PHPE) and prehospital emergency medical services physicians (PHP) when functioning on behalf of an emergency medical service (EMS) agency. The approvals are based upon the type of EMS service an EMS agency is licensed to provide under 35 Pa.C.S. § 8129 (relating to emergency medical services agencies). This notice also specifies the minimum required medications to be stocked on a specified EMS vehicle based upon the type of EMS service the EMS agency is licensed to provide.

 Under 28 Pa. Code § 1027.5(d), EMS providers, other than a PHP, may administer to a patient medications, or assist the patient to administer medications previously prescribed for that patient, as specified in the Statewide EMS protocols or as authorized by a medical command physician. An EMS provider may administer medications contained on this list if the EMS provider is credentialed to do so and the EMS vehicle on which they are providing EMS is properly licensed to carry the medication.

 Unless otherwise stated or restricted to a specific level of provider, listed medications may be given by any acceptable route as listed in protocol or as ordered by a medical command physician.

 Medications that are listed as required must be carried on the specified level of EMS vehicle and must be carried in a quantity sufficient to treat at least one adult using the Statewide EMS protocols. If the protocol identifies repeat doses, then additional medication must be carried. When a pediatric dose option is available (for example a pediatric EPINEPHrine autoinjector), then both the adult and pediatric options must be carried.

 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) and all vasoactive medications must be rate controlled by electronic IV pump or a manual flow control device capable of setting specific numeric flow rates. Nitroglycerin infusion must be regulated with an electronic pump.

 Persons with a disability who require an alternate format of this notice (for example, large print, audiotape, Braille) should contact Richard L. Gibbons, Bureau Director, Department of Health, Bureau of Emergency Medical Services, Room 606, Health and Welfare Building, 625 Forster Street, Harrisburg, PA 17120-0710, (717) 787-8740. Speech or hearing impaired persons may call by using V/TT (717) 783-6154 or the Pennsylvania AT&T Relay Service at (800) 654-5984 (TT).

Table 1. Medications that may be administered by EMS providers when functioning on behalf of an EMS agency based upon the type of EMS service an EMS agency is licensed to provide

Medication QRS
(incl. providers at or above the level of EMR)
BLS
(incl. providers at or above the level of EMT)
IALS
(incl. providers at or above the level of AEMT)
ALS
(incl. providers above the level of AEMT)
CCT
(incl. providers above the level of AEMT with additional approved training)
Air
(incl. providers above the level of AEMT with additional approved training)
Abciximab NO NO NO YES4 YES4 or 5 YES4 or 5
Acetaminophen NO NO NO YES YES YES
Acetylcysteine NO NO NO YES4 YES4 YES4
Activated charcoal NO YES YES YES YES YES
Adenosine NO NO NO YES YES YES
Albumin NO NO NO NO YES4,5 YES4,5
Albuterol (nebulizer solution) NO NO YES YES YES YES
Albuterol with ipratropium bromide (nebulizer solution) NO NO YES YES YES YES
Amiodarone NO NO NO YES YES YES
Anti-coagulants/Platelet Inhibitors: all types (unless otherwise specifically listed) NO NO NO NO YES4,5 YES4,5
Anticonvulsants: all types (unless otherwise specifically listed) NO NO NO NO YES5 YES5
Anti-emetics: all types (not otherwise specifically listed) NO NO NO NO YES4,5 YES4,5
Anti-hypertensives: all types (unless otherwise specifically listed) NO NO NO NO YES5 YES5
Antimicrobials: all types NO NO NO YES4 YES4 YES4
Antivenom: all types NO NO NO NO YES4,5 YES4,5
Aspirin, oral NO YES YES YES YES YES
Atenolol NO NO NO NO YES4,5 YES4,5
Atropine sulfate NO NO NO YES YES YES
Barbiturates: all types NO NO NO NO YES5 YES5
Benzocaine, topical NO NO NO YES YES YES
Bivalirudin NO NO NO YES4 YES5 YES5
Blood products: all types NO NO NO NO YES5 YES5
Bronchodilators, short-acting medications listed in Statewide BLS protocol and contained in multidose inhaler (MDI), assist with patient's own prescribed medication NO YES YES YES YES YES
Calcium chloride/calcium gluconate NO NO NO YES YES YES
Captopril NO NO NO YES YES YES
Clopidogrel NO NO NO NO YES5 YES5
Crystalloid solutions (the following solutions may be administered separately or in combination in various concentrations of each: dextrose, Lactated Ringers, Normosol, saline (NaCl)) (unless otherwise specifically listed). Note—Normal Saline Solution listed separately NO NO NO YES YES YES
Crystalloid solution containing potassium, interfacility transport only, potassium concentration may not exceed 20 mEq/kg unless managed by qualified CCT or Air Medical provider NO NO NO YES4 YES4 YES4
Dexamethasone sodium phosphate NO NO NO YES YES YES
Dextran NO NO NO NO YES4,5 YES4,5
Dextrose (for intravenous bolus in concentrations between 10%—50%) NO NO YES YES YES YES
Diazepam NO NO NO YES YES YES
Digoxin NO NO NO NO YES5 YES5
Diltiazem NO NO NO YES YES YES
DiphenhydrAMINE HCl NO NO NO YES YES YES
DOBUTamine NO NO NO YES YES YES
DOPamine NO NO NO YES YES YES
Enalapril NO NO NO YES YES YES
EPINEPHrine HCl 1 mg/mL (unless otherwise specifically listed) NO NO YES2 YES YES YES
EPINEPHrine HCl 0.1 mg/mL solution and diluted concentrations for intravenous infusion NO NO NO YES YES YES
EPINEPHrine HCl autoinjector, assist with patient's own prescribed medication NO YES YES YES YES YES
EPINEPHrine HCl autoinjector (adult and pediatric dose sizes), (unless otherwise specifically listed) NO NO YES YES YES YES
EPINEPHrine HCl autoinjector (adult and pediatric dose sizes), applies only to EMTs in BLS services approved for EMT EPINEPHrine program NO YES N/A N/A N/A N/A
EPINEPHrine HCl, including racemic (by nebulizer) NO NO NO YES YES YES
Eptifibatide NO NO NO YES4 YES4 or 5 YES4 or 5
Esmolol NO NO NO NO YES5 YES5
Etomidate NO NO NO YES3 YES3 YES3
FentanNYL NO NO NO YES YES YES
Fibrinolytics/thrombolytics: all types NO NO NO NO YES5 YES5
Furosemide NO NO NO YES YES YES
Flumazenil NO NO NO NO YES4 YES4
Glucagon NO NO YES9 YES YES YES
Glucocorticoids/mineralcorticoids (unless otherwise specifically listed) NO NO NO NO YES4,5 YES4,5
Glucose, oral NO YES YES YES YES YES
Heparin (unless otherwise specifically listed) NO NO NO NO YES5 YES5
Heparin (by continuous intravenous infusion) NO NO NO YES4 YES4 or 5 YES4 or 5
Hespan NO NO NO NO YES4,5 YES4,5
Hydralazine NO NO NO NO YES4,5 YES4,5
Hydrocortisone sodium succinate NO NO NO YES YES YES
HYRDROmorphone NO NO NO YES4 YES4 or 5 YES4 or 5
Hydroxocobalamin NO NO NO YES YES YES
Insulin NO NO NO NO YES5 YES5
Isoproterenol HCl NO NO NO YES4 YES4 YES4
Ketamine NO NO NO YES3 YES3,4,5 YES3,4,5
Ketorolac NO NO NO NO YES4,5 YES4,5
Labetolol NO NO NO NO YES4,5 YES4,5
Levalbuterol NO NO NO YES4 YES4 YES4
Lidocaine HCl NO NO NO YES YES YES
LORazepam NO NO NO YES YES YES
Magnesium sulfate NO NO NO YES YES YES
Mannitol NO NO NO NO YES5 YES5
Metaproterenol NO NO NO NO YES4,5 YES4,5
MethylPREDNISolone NO NO NO YES YES YES
Metoprolol NO NO NO NO YES4,5 YES4,5
Midazolam NO NO NO YES YES YES
Milrinone NO NO NO NO YES4,5 YES4,5
Morphine sulfate NO NO NO YES YES YES
Naloxone (unless otherwise specifically listed). Note—autoinjector listed separately NO NO YES9 YES YES YES
Naloxone, intranasal or autoinjector. Note—EMRs and EMTs must complete additional required education with QRS or BLS service participating in naloxone program YES1 YES1 YES9 YES YES YES
Nerve agent antidote kit, autoinjector only (may include atropine, pralidoxime and diazepam) NO YES6,7 YES6,7 YES YES YES
Non-depolarizing neuromuscular blocking agents: all types, intravenous bolus during rapid sequence induction, assisting PHRN, PHPE or PHP NO NO NO NO YES5 YES5
Non-depolarizing neuromuscular blocking agents: all types, intravenous infusion during interfacility transport NO NO NO NO YES4 YES4
Nitroglycerin, intravenous and topical NO NO NO YES YES YES
Nitroglycerin, sublingual (unless otherwise specifically listed) NO NO YES YES YES YES
Nitroglycerin, sublingual, assist with patient's own prescribed medication NO YES YES YES YES YES
Nitrous oxide NO NO YES YES YES YES
Norepinephrine NO NO NO NO YES5 YES5
Normal Saline Solution (0.9% NaCl solution for intravenous volume infusion) NO NO YES YES YES YES
Ondansetron NO NO NO YES YES YES
Oxygen, delivered by devices within the published scope of practice for the EMS provider YES YES YES YES YES YES
Oxytocin NO NO NO YES YES YES
Phenylephrine NO NO NO NO YES5 YES5
Potassium Cl (in concentrations above 20 mEq/L) NO NO NO NO YES4,5 YES4,5
Plasmanate NO NO NO NO YES4,5 YES4,5
Pralidoxime NO NO NO YES YES YES
Procainamide NO NO NO YES YES YES
Propofol NO NO NO NO YES4,5 YES4,5
Propranolol NO NO NO NO YES4,5 YES4,5
Prostaglandins: all types NO NO NO NO YES5 YES5
Quinidine sulfate/quinidine gluconate NO NO NO NO YES5 YES5
Sodium bicarbonate NO NO NO YES YES YES
Sodium thiosulfate NO NO NO YES YES YES
Sterile water, for injection NO NO NO YES YES YES
Succinylcholine NO NO NO NO YES5 YES5
Terbutaline NO NO NO YES YES YES
Tetracaine, topical NO NO NO YES YES YES
Theophylline NO NO NO NO YES4,5 YES4,5
Tirofiban NO NO NO YES4 YES4 or 5 YES4 or 5
Tocolytics: all types (unless otherwise specifically listed) NO NO NO NO YES5 YES5
Total Parenteral Nutrition NO NO NO YES4 YES4 YES4
Tranexamic Acid NO NO NO YES4 YES4 or 5 YES4 or 5
Verapamil NO NO NO YES YES YES
Medications not previously listed, but within Department-approved air ambulance service protocol for use by PHRN, PHPE and PHP. NO NO NO NO NO YES5

Table 2. Medications required to be carried by a specified EMS vehicle based upon the type of EMS service an EMS agency is licensed to provide (R=Required)

Medication QRS BLS IALS ALS CCT AIR
Adenosine R R R
Aspirin, oral R R R R R
Atropine sulfate R R R
Benzodiazepines (diazepam, lorazepam or midazolam) At least one type must be carried. R10,12 R10,12 R10,12
Bronchodilators (nebulizer solution), (albuterol or albuterol with ipratropium bromide) At least one type must be carried. R8 R8 R8 R8
Dextrose (for intravenous bolus in concentration between 10%—50%) R R R R
DiphenhydrAMINE HCl R R R
EPINEPHrine HCl, 1 mg/mL concentration (IALS may meet requirement with EPINEPHrine as autoinjector—both adult and pediatric dose sizes—or as solution in vial/ampoule; ALS, CCT and Air must carry 1 mg/mL in vial or ampoule) R R R R
EPINEPHrine HCl, 0.1 mg/mL concentration R R R
EPINEPHrine, autoinjector (adult and pediatric dose sizes)—applies only to BLS services approved for EMT EPINEPHrine program R3
Etomidate—applies only to ALS services approved by regional etomidate program R3 R3 R3
Glucagon R R R
Glucose, oral R R R R R
Lidocaine HCl R R R
Naloxone (restrictions on forms for QRS/BLS services listed separately) R R R R
Naloxone, intranasal kit or intramuscular autoinjector—applies only to QRS/BLS services that meet training requirements. R3 R3
Narcotic analgesics (fentaNYL or morphine sulfate) At least one type must be carried. R11,12 R11,12 R11,12
Nitroglycerin, sublingual R R R R
Normal Saline Solution (0.9% NaCl solution for intravenous volume infusion) R R R R
Oxygen R R R R R
Sodium bicarbonate R R R
Medication within Department-approved air ambulance service protocol for use by PHRN, PHPE or PHP on crew R

 QRS—Quick Response Service; BLS—Basic Life Support ambulance service; IALS—Intermediate Advanced Life Support ambulance service; ALS—Advanced Life Support ambulance service; CCT—Critical Care Transport ambulance service; Air—Air ambulance service.

 1. EMRs and EMTs are restricted to administering this medication by intranasal and intramuscular autoinjector routes only, consistent with Statewide BLS protocols.

 2. AEMTs are restricted to administering this medication by intramuscular route only, consistent with Statewide AEMT protocols. AEMTs may not administer this medication by intravenous or intraosseous route.

 3. Permitted for services that meet Department requirements for training, medication stocking and any agency or quality improvement requirements, as verified by the agency's assigned regional EMS council.

 4. During interfacility transport, paramedics who are authorized to function for an EMS agency that has been licensed as an ALS, CCT or air ambulance service are restricted to the maintenance and monitoring of medication administration that is initiated at the sending medical facility.

 5. This medication must be carried on a CCT ambulance so that it is only accessible when a PHRN, PHPE or PHP is part of the crew. Paramedics who are authorized to function for an EMS agency that has been licensed as a CCT or air ambulance service may only administer this medication when in the direct physical presence of, and supervised by, a PHRN, PHPE or PHP.

 6. May administer to a patient when assisting an EMS provider above the level of AEMT who has determined the dose for the patient consistent with Statewide ALS protocols.

 7. For self or peer rescue only.

 8. One listed type of bronchodilator medication must be carried on each licensed vehicle.

 9. AEMTs are restricted to administering this medication by intransasal, intramuscular or subcutaneous routes only, consistent with Statewide AEMT protocols. AEMTs may not give this medication by intravenous route.

 10. One benzodiazepine class medication must be carried on each licensed vehicle.

 11. One opioid class medication must be carried on each licensed vehicle.

 12. For additional information relating to security and medication tracking requirements for controlled substances, see 28 Pa. Code § 1027.5.

KAREN M. MURPHY, PhD, RN, 
Secretary

[Pa.B. Doc. No. 17-964. Filed for public inspection June 9, 2017, 9:00 a.m.]



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