Approved Drugs for ALS Amubulance Services [38 Pa.B. 6564]
[Saturday, November 29, 2008]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, 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. Adenosine
3. Albuterol
4. Amiodarone
5. Aspirin
6. Atropine sulfate
7. Benzocaine--for topical use only
8. Bretylium
9. Calcium chloride
10. Calcium gluconate
11. Captopril
12. Dexamethasone sodium phosphate
13. Diazepam
14. Dilaudid--for interfacility transports only*
15. Diltiazem
16. Diphenhydramine HCL
17. Dobutamine
18. Dopamine
19. Enalapril
20. Epinephrine HCL
21. Etomidate
22. Fentanyl
23. Furosemide
24. Glucagon
25. Heparin by intravenous drip--for interfacility transports only*
26. Heparin lock flush
27. Hydrocortisone sodium succinate
28. Glycoprotein IIb/IIIa Inhibitors--for interfacility transports only*
a. Abciximab
b. Eptifibatide
c. Tirofiban
29. Intravenous electrolyte solutions
a. Dextrose
b. Lactated Ringer's
c. Sodium chloride
d. Normosol
e. Potassium--for interfacility transports only*
30. Ipratropium Bromide
31. Isoproterenol HCL--for interfacility transports only*
32. Levalbuterol--for interfacility transports only*
33. Lidocaine HCL
34. Lorazepam
35. Magnesium sulfate
36. Metaproterenol
37. Methylprednisolone
38. Midazolam
39. Morphine sulfate
40. Naloxone HCL
41. Nitroglycerin by intravenous drip must be regulated by an infusion pump
42. Nitroglycerin ointment
43. Nitroglycerin spray
44. Nitroglycerin sublingual tablets
45. Nitrous oxide
46. Ondansetron
47. Oxytocin
48. Pralidoxime CL
49. Procainamide
50. Sodium bicarbonate
51. Sodium thiosulfate
52. Sterile water for injection
53. Terbutaline
54. Tetracaine--for topical use only
55. Verapamil
* During interfacility transport, all medications given by continuous infusion (except intravenous electrolyte solutions with potassium concentrations of no more than 20 mEg/L) must be regulated by an infusion pump.
This list supersedes the list of approved drugs published at 37 Pa.B. 1278 (March 17, 2007).
Changes made are:
(1) Addition of Activated charcoal.
(2) Addition of Calcium gluconate.
(3) Addition of Captopril.
(4) Addition of Enalapril.
(5) Removal of restriction that Nitroglycerin by intravenous drip may only be used for interfacility transports.
(6) During interfacility transports medications by continuous infusion must be regulated by an infusion pump.
(7) Addition of requirement that administration of nitroglycerine by intravenous drip must be regulated by an infusion pump.
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. In addition, under 28 Pa. Code § 1001.161 (relating to research), the Department may approve an ambulance service to engage in a research project that involves use of a drug not included in a region's medical treatment protocols. Finally, under 28 Pa. Code § 1001.4 (relating to exceptions), a ground ALS ambulance service and its ALS ambulance service medical director may apply to the Department for an exception to a region's medical treatment protocols.
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 Cooney at the 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).
A. EVERETTE JAMES,
Acting Secretary[Pa.B. Doc. No. 08-2161. Filed for public inspection November 28, 2008, 9:00 a.m.]
