Approved Drugs for ALS Ambulance Services [41 Pa.B. 1974]
[Saturday, April 9, 2011]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 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
2. Acetaminophen
3. Adenosine
4. Albuterol
5. Amiodarone
6. Antimicrobials (for interfacility transport only)
7. Aspirin
8. Atropine sulfate
9. Benzocaine—for topical use only
10. Bretylium
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. Etomidate (only permitted for services approved by a regional EMS council and participating in the required QI program)
24. Fentanyl
25. Furosemide
26. Glucagon
27. Heparin by intravenous drip—for interfacility transports only*
28. Heparin lock flush
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*
32. Ipratropium Bromide
33. Isoproterenol HCL—for interfacility transports only*
34. Levalbuterol—for interfacility transports only*
35. Lidocaine HCL
36. Lorazepam
37. Magnesium sulfate
38. Methylprednisolone
39. Midazolam
40. Morphine sulfate
41. Naloxone HCL
42. Nitroglycerin (all forms/routes, but continuous intravenous infusion must be regulated by an infusion pump)
43. Nitrous oxide
44. Ondansetron
45. Oxytocin
46. Pralidoxime CL
47. Procainamide
48. Sodium bicarbonate
49. Sodium thiosulfate
50. Sterile water for injection
51. Terbutaline
52. Tetracaine—for topical use only
53. Total parental nutrition (for interfacility transport only)
54. 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 38 Pa.B. 6564 (November 29, 2008).
The following changes are:
(1) Addition of acetaminophen
(2) Addition of antimicrobials (for interfacility transport only)
(3) Addition of total parenteral nutrition (for interfacility transport only)
(4) Clarification that etomidate can only be used by regionally approved services that are participating in the required QI program
(5) Removal of metaproteranol (Alupent)
(6) All forms of nitroglycerin can be administered.
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 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).
ELI N. AVILA, MD, JD, MPH, FCLM,
Acting Secretary[Pa.B. Doc. No. 11-625. Filed for public inspection April 8, 2011, 9:00 a.m.]
