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PA Bulletin, Doc. No. 08-2161


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).

Acting Secretary

[Pa.B. Doc. No. 08-2161. Filed for public inspection November 28, 2008, 9:00 a.m.]

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