NOTICES
DEPARTMENT OF HEALTH
Approved and Required Medications Lists for Emergency Medical Service Agencies and Emergency Medical Service Providers
[51 Pa.B. 5887]
[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) Abciximab
NO NO NO YES4 YES4 or 5 YES4 or 5 Acetaminophen
NO YES YES 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 YES YES YES YES YES Albuterol with ipratropium bromide
(nebulizer solution)
NO YES 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 YES YES 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 YES YES YES 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 YES4 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 hypertonic solutions
NO NO NO NO YES5 YES5 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 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 5%—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 YES YES YES YES DOBUTamine
NO NO NO YES YES YES DOPamine
NO NO NO YES YES YES EMLA cream
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 0.1 mg/mL for cardiac
arrest
NO NO YES N/A N/A N/A 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 YES YES YES YES Eptifibatide
NO NO NO YES4 YES 4 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 YES 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 YES 4 or 5 Hydroxocobalamin
NO NO NO YES YES YES Ibuprofen
NO YES YES YES YES YES Immunizations
NO NO NO YES9 YES9 YES9 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 YES YES YES YES Labetolol
NO NO NO NO YES4,5 YES4,5 Levalbuterol
NO NO NO YES4 YES4 YES4 Levetiracetam
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 YES4 YES4,5 YES4,5 Morphine sulfate
NO NO NO YES YES YES Naloxone
(unless otherwise specifically listed).
Note—autoinjector listed separately
NO NO YES 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 YES YES YES YES Nerve agent antidote kit, autoinjector only
(may include atropine, pralidoxime and
diazepam)
NO YES6,7 YES6,7 YES YES YES Nondepolarizing neuromuscular blocking
agents: all types, intravenous bolus during
rapid sequence induction, assisting PHRN,
PHPE or PHP
NO NO NO NO YES5 YES5 Nondepolarizing 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 YES4 YES4 YES4 Normal Saline Solution
(0.9% NaCl solution for intravenous volume infusion)
NO NO YES YES YES YES Ondansetron
NO NO YES 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 Pantoprazole
NO NO NO YES4 YES4,5 YES4,5 Phenylephrine
NO NO NO YES4 YES4 YES4 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 YES<4.5> 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 listed previously, 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 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, 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.
5. 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.
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. Appropriate for community or peer programs under the oversight of the EMS Agency Medical Director, but not for responses to 9-1-1 calls.
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.
ALISON BEAM,
Acting Secretary
[Pa.B. Doc. No. 21-1532. 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.
