Pennsylvania Code & Bulletin
COMMONWEALTH OF PENNSYLVANIA

• No statutes or acts will be found at this website.

The Pennsylvania Bulletin website includes the following: Rulemakings by State agencies; Proposed Rulemakings by State agencies; State agency notices; the Governor’s Proclamations and Executive Orders; Actions by the General Assembly; and Statewide and local court rules.

PA Bulletin, Doc. No. 21-1531

NOTICES

DEPARTMENT OF HEALTH

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

[51 Pa.B. 5881]
[Saturday, September 11, 2021]

 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 (P), 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 Aaron M. Rhone, EMS Program Manager, Department of Health, Bureau of Emergency Medical Services, 1310 Elmerton Avenue, Harrisburg, PA 17110, (717) 787-8740. Speech or hearing impaired persons may call by using V/TT: (717) 783-6154 or the Pennsylvania Hamilton 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 (including providers at or above the level of EMR) BLS (including providers at or above the level of EMT)IALS (including providers at or above the level of AEMT)ALS (including providers above the level of AEMT)CCT (including providers above the level of AEMT with additional approved training) Air (including providers above the level of AEMT with additional approved training)
AbciximabNONONOYES5YES5 or 6YES5 or 6
AcetaminophenNOYESYESYESYESYES
Acetylcysteine NONONOYES5YES5YES5
Activated charcoalNOYESYESYESYESYES
AdenosineNONONOYESYESYES
AlbuminNONONONOYES5,6YES5,6
Albuterol (nebulizer solution)NOYESYESYESYESYES
Albuterol with ipratropium bromide (nebulizer solution)NOYESYESYESYESYES
AmiodaroneNONONOYESYESYES
Anti-coagulants/Platelet Inhibitors: all types (unless otherwise specifically listed)NONONONOYES5,6YES5,6
Anticonvulsants: all types (unless otherwise specifically listed)NONONONOYES6YES6
Anti-emetics: all types (not otherwise specifically listed)NONONONOYES5,6YES5,6
Anti-hypertensives: all types (unless otherwise specifically listed)NONONONOYES6YES6
Antimicrobials: all typesNONONOYESYESYES
Antivenom: all typesNONONONOYES5,6YES5,6
Aspirin, oralNOYESYESYESYESYES
AtenololNONONONOYES5,6YES5,6
Atropine sulfateNONONOYESYESYES
Barbiturates: all typesNONONONOYES6YES6
Benzocaine, topicalNONONOYESYESYES
BivalirudinNONONOYES5YES6YES6
Blood products: all typesNONONONOYES5YES6
Bronchodilators, short-acting medications listed in Statewide BLS protocol and contained in multidose inhaler (MDI), assist with patient's own prescribed medicationNOYESYESYESYESYES
Calcium chloride/calcium gluconateNONONOYESYESYES
CaptoprilNONONOYESYESYES
ClopidogrelNONONONOYES6YES6
Crystalloid hypertonic solutionsNONONONOYES6YES6
Crystalloid isotonic solutions, including but not limited to: Isolyte, Lactated Ringers, Normosol, saline (NaCl) (unless otherwise specifically listed). Note—Normal Saline Solution and Dextrose listed separatelyNONONOYESYESYES
Crystalloid solution containing potassium, interfacility transport only, potassium concentration may not exceed 20 mEq/kg unless managed by qualified CCT or Air Medical providerNONONOYES5YES5YES5
Dexamethasone sodium phosphateNONONOYESYESYES
DextranNONONONOYES5,6YES5,6
Dextrose (for intravenous bolus in concentrations between 5%—50%)NONOYESYESYESYES
DiazepamNONONOYESYESYES
DigoxinNONONONOYES6YES6
DiltiazemNONONOYESYESYES
DiphenhydrAMINE HClNONOYESYESYESYES
DOBUTamineNONONOYESYESYES
DOPamineNONONOYESYESYES
DroperidolNONONOYESYESYES
EMLA creamNONONOYESYESYES
EnalaprilNONONOYESYESYES
EPINEPHrine HCl 1 mg/mL (unless otherwise specifically listed)NONOYES3YESYESYES
EPINEPHrine HCl 0.1 mg/mL solution and diluted concentrations for intravenous infusionNONONOYESYESYES
EPINEPHrine HCl 0.1 mg/mL for cardiac arrestNONOYESN/AN/AN/A
EPINEPHrine HCl autoinjector, assist with patient's own prescribed medicationNOYESYESYESYESYES
EPINEPHrine HCl autoinjector (adult and pediatric dose sizes), (unless otherwise specifically listed)NONOYESYESYESYES
EPINEPHrine HCl autoinjector (adult and pediatric dose sizes), applies only to EMTs in BLS services approved for EMT EPINEPHrine programNOYESN/AN/AN/AN/A
EPINEPHrine HCl, including racemic (by nebulizer)NONOYESYESYESYES
EptifibatideNONONOYES5YES5 or 6YES5 or 6
EsmololNONONONOYES6YES6
EtomidateNONONOYES4YES4YES4
FentaNYLNONONOYESYESYES
Fibrinolytics/thrombolytics: all typesNONONONOYES6YES6
FurosemideNONONOYESYESYES
FlumazenilNONONONOYES5YES5
GlucagonNONOYESYESYESYES
Glucagon intranasal (nasal powder spray) or intramuscular autoinjector. Note—EMTs must complete additional required educationNOYES1YESYESYESYES
Glucocorticoids/mineralcorticoids (unless otherwise specifically listed)NONONONOYES5,6YES5,6
Glucose, oralNOYESYESYESYESYES
Heparin (unless otherwise specifically listed)NONONONOYES6YES6
Heparin (by continuous intravenous infusion)NONONOYES5YES5 or 6YES5 or 6
HespanNONONONOYES4,5YES4,5
HydralazineNONONONOYES5,6YES5,6
Hydrocortisone sodium succinateNONONOYESYESYES
HYRDROmorphoneNONONOYES5YES5 or 6YES5 or 6
HydroxocobalaminNONONOYESYESYES
IbuprofenNOYESYESYESYESYES
ImmunizationsNONONOYES10YES10YES10
InsulinNONONONOYES6YES6
Isoproterenol HClNONONOYES5YES5YES5
KetamineNONONOYES4YES45,6YES43,56
KetorolacNONOYESYESYESYES
LabetololNONONONOYES5,6YES56
LevalbuterolNONONOYES5YES5YES5
LevetiracetamNONONOYES5YES5YES5
Lidocaine HClNONONOYESYESYES
LORazepamNONONOYESYESYES
Magnesium sulfateNONONOYESYESYES
MannitolNONONONOYES6YES5
MetaproterenolNONONONOYES5,6YES5,6
MethylPREDNISoloneNONONOYESYESYES
MetoprololNONONONOYES5,6YES5,6
MidazolamNONONOYESYESYES
Milrinone NONONOYES5YES5,6YES5,6
Morphine sulfateNONONOYESYESYES
Naloxone (unless otherwise specifically listed). Note—autoinjector listed separatelyNONOYESYESYESYES
Naloxone, intranasal or intramuscular autoinjector. Note—EMRs and EMTs must complete additional required education with QRS or BLS service participating in naloxone programYES1YES1YESYESYESYES
Nerve agent antidote kit, autoinjector only (may include atropine, pralidoxime, and diazepam)NOYES7,8YES7,8YESYESYES
Non-depolarizing neuromuscular blocking agents: all types, intravenous bolus during rapid sequence induction, assisting PHRN, PHPE, or PHPNONONONOYES6YES6
Non-depolarizing neuromuscular blocking agents: all types, intravenous infusion during interfacility transportNONONONOYES5YES5
Nitroglycerin, intravenous and topical NONONOYESYESYES
Nitroglycerin, sublingual (unless otherwise specifically listed)NONOYESYESYESYES
Nitroglycerin, sublingual, assist with patient's own prescribed medication NOYESYESYESYESYES
Nitrous oxideNONOYESYESYESYES
NorepinephrineNONONOYES5YES5YES5
Normal Saline Solution (0.9% NaCl solution for intravenous volume infusion)NONOYESYESYESYES
OndansetronNONOYESYESYESYES
Oxygen, delivered by devices within the published scope of practice for the EMS providerYESYESYESYESYESYES
OxytocinNONONOYESYESYES
PantoprazoleNONONOYES5YES5,6YES5,6
PhenylephrineNONONOYES5YES5YES5
Potassium Cl (in concentrations above 20 mEq/L)NONONONOYES5,6YES5,6
PlasmanateNONONONOYES5,6YES5,6
PralidoximeNONONOYESYESYES
ProcainamideNONONOYESYESYES
PropofolNONONONOYES5,6YES5,6
PropranololNONONONOYES5,6YES5,6
Prostaglandins: all typesNONONONOYES6YES6
Quinidine sulfate/quinidine gluconateNONONONOYES6YES6
Sodium bicarbonateNONONOYESYESYES
Sodium thiosulfateNONONOYESYESYES
Sterile water, for injection NONONOYESYESYES
SuccinylcholineNONONONOYES6YES6
TerbutalineNONONOYESYESYES
Tetracaine, topicalNONOYESYESYESYES
TheophyllineNONONONOYES5,6YES5,6
TirofibanNONONOYES4YES5 or 6YES5 or 6
Tocolytics: all types (unless otherwise specifically listed)NONONONOYES6YES6
Total Parenteral NutritionNONONOYES5YES5YES5
Tranexamic AcidNONONOYESYESYES
VerapamilNONONOYESYESYES
Medications not listed previously, but within Department-approved air ambulance service protocol for use by PHRN, PHPE and PHP.NONONONONOYES6

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)

MedicationQRSBLSIALSALSCCTAIR
AdenosineRRR
Aspirin, oral RRRRR
Atropine sulfateRRR
Benzodiazepines (diazepam, lorazepam or midazolam) At least one type must be carried.R11,13R11,13R11,13
Bronchodilators (nebulizer solution), (albuterol or albuterol with ipratropium bromide) At least one type must be carried.R9R9R9R9
Dextrose (for intravenous bolus in concentration between 10%—50%)RRRR
DiphenhydrAMINE HClRRR
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)RRRR
EPINEPHrine HCl, 0.1 mg/mL concentrationRRR
EPINEPHrine, autoinjector (adult and pediatric dose sizes)—applies only to BLS services approved for EMT EPINEPHrine programR4
Etomidate—applies only to ALS services approved by regional etomidate programR4R4R4
GlucagonRR
Glucose, oralRRRRR
Lidocaine HClRRR
Naloxone (restrictions on forms for QRS/BLS services listed separately)RRRR
Naloxone, intranasal kit or intramuscular autoinjector—applies only to QRS/BLS services that meet training requirements.R4R4
Narcotic analgesics (fentaNYL or morphine sulfate) At least one type must be carried.R12,13R12,13R12,13
Nitroglycerin, sublingualRRRR
Normal Saline Solution (0.9% NaCl solution for intravenous volume infusion)RRRR
OxygenRRRRR
Sodium bicarbonateRRR
Medication within Department-approved air ambulance service protocol for use by PHRN, PHPE, or PHP on crewR

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

 3. 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.

 4. 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.

 5. During interfacility transport, Ps 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.

 6. If carried on a CCT ambulance, this medication must be secured so that it is only accessible when a PHRN, PHPE or PHP is part of the crew. Ps 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.

 7. 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.

 8. For self or peer rescue only.

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

 10. Appropriate for community or peer programs under the oversight of the EMS Agency Medical Director, but not for responses to 9-1-1 calls.

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

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

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

ALISON BEAM, 
Acting Secretary

[Pa.B. Doc. No. 21-1531. Filed for public inspection September 10, 2021, 9:00 a.m.]



No part of the information on this site may be reproduced for profit or sold for profit.

This material has been drawn directly from the official Pennsylvania Bulletin full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.