NOTICES
DEPARTMENT OF HEALTH
Approved and Required Medications Lists for Emergency Medical Service Agencies and Emergency Medical Service Providers
[53 Pa.B. 8138]
[Saturday, December 30, 2023]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 and norepinephrine infusions must be regulated with an electronic pump.
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 YES5 YES5 or 6 YES5 or 6 Acetaminophen NO YES YES YES YES YES Acetylcysteine NO NO NO YES5 YES5 YES5,6 Activated Charcoal NO YES YES YES YES YES Adenosine NO NO NO YES YES YES Albumin NO NO NO YES5 YES5,6 YES5,6 Albuterol (nebulizer solution) NO YES YES YES YES YES Albuterol with ipratropium bromide (nebulizer solution) NO YES YES YES YES YES Alcohol prep pad YES YES YES YES YES YES Amiodarone NO NO NO YES YES YES Anticoagulants/Platelet Inhibitors: all types (unless otherwise specifically listed) NO NO NO NO YES5,6 YES5,6 Anticonvulsants: all types (unless otherwise specifically listed) NO NO NO NO YES6 YES6 Anti-emetics: all types (not otherwise specifically listed) NO NO NO NO YES5,6 YES5,6 Anti-hypertensives: all types (unless otherwise specifically listed) NO NO NO NO YES6 YES6 Antimicrobials: all types NO NO NO YES YES YES Antivenom: all types NO NO NO NO YES5,6 YES5,6 Aspirin, oral NO YES YES YES YES YES Atropine sulfate NO NO NO YES YES YES Barbiturates: all types NO NO NO NO YES6 YES6 Benzocaine, topical NO NO NO YES YES YES Bivalirudin NO NO NO YES5 YES6 YES6 Blood products: all types NO NO NO YES4,5 YES5 YES6 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 Clevidipine NO NO NO YES5 YES5,6 YES5,6 Clopidogrel NO NO NO NO YES6 YES6 Crystalloid hypertonic solutions NO NO NO NO YES6 YES6 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 YES 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 YES5 YES5 YES5 Dexamethasone sodium phosphate NO NO NO YES YES YES Dextran NO NO NO NO YES5,6 YES5,6 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 YES6 YES6 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 droPERidol 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 YES4 YES 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 YES YES YES 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 YES4 YES YES YES YES EPINEPHrine HCl, including racemic (by nebulizer) NO NO YES YES YES YES Eptifibatide NO NO NO YES5 YES5 or 6 YES55 or 6 Esmolol NO NO NO YES5 YES6 YES6 Etomidate NO NO NO YES4 YES4 YES4 FentaNYL NO NO NO YES YES YES Fibrinolytics/thrombolytics: all types NO NO NO NO YES6 YES6 Furosemide NO NO NO YES YES YES Flumazenil NO NO NO NO YES5 YES5 Glucagon NO NO YES YES YES YES Glucagon intranasal (nasal powder spray) or intramuscular autoinjector. Note—EMTs must complete additional required education NO YES2,4 YES YES YES YES Glucocorticoids/
mineralocorticoids (unless otherwise specifically listed)NO NO NO NO YES5,6 YES5,6 Glucose, oral NO YES YES YES YES YES Heparin (unless otherwise specifically listed) NO NO NO NO YES6 YES6 Heparin (by continuous intravenous infusion) NO NO NO YES5 YES5 or 6 YES5 or 6 Hetastarch NO NO NO NO YES4,5 YES4,5 Hydrocortisone sodium succinate NO NO NO YES YES YES Hydromorphone NO NO NO YES5 YES5 or 6 YES5 or 6 Hydroxocobalamin NO NO NO YES YES YES Ibuprofen NO YES YES YES YES YES Immunizations NO NO NO YES10 YES10 YES10 Insulin NO NO NO NO YES6 YES6 Isoproterenol HCl NO NO NO YES5 YES5,6 YES5,6 Ketamine NO NO NO YES4 YES4,5 YES4,5 Ketorolac NO NO YES YES YES YES Levalbuterol NO YES YES YES YES YES Levetiracetam NO NO NO YES5 YES5,6 YES5,6 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 YES6 YES5 Metaproterenol NO NO NO NO YES5,6 YES5,6 MethylPREDNISolone NO NO YES YES YES YES Midazolam NO NO NO YES YES YES Milrinone NO NO NO YES5 YES5,6 YES5,6 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 YES8 YES8 YES YES YES Nicardipine NO NO NO YES5 YES5,6 YES5,6 Nondepolarizing neuromuscular blocking agents: all types, intravenous bolus during rapid sequence induction, assisting PHRN, PHPE or PHP NO NO NO NO YES6 YES6 Nondepolarizing neuromuscular blocking agents: all types, intravenous infusion during interfacility transport NO NO NO NO YES5 YES5 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 YES YES YES 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 YES5 YES5,6 YES5,6 Phenylephrine NO NO NO YES5 YES5 YES5 Potassium Cl (in concentrations above 20 mEq/L) NO NO NO NO YES5,6 YES5,6 Plasma Protein Fraction NO NO NO YES5 YES5,6 YES5,6 Pralidoxime NO NO NO YES YES YES Procainamide NO NO NO YES YES YES Propofol NO NO NO YES5 YES5,6 YES5,6 Prostaglandins: all types NO NO NO NO YES6 YES6 Quinidine sulfate/
quinidine gluconateNO NO NO NO YES6 YES6 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 YES6 YES6 Terbutaline NO NO NO YES YES YES Tetracaine, topical, ophthalmic NO NO YES YES YES YES Theophylline NO NO NO NO YES5,6 YES5,6 Tirofiban NO NO NO YES5 YES5,6 YES5,6 Tocolytics: all types (unless otherwise specifically listed) NO NO NO NO YES6 YES6 Total Parenteral Nutrition NO NO NO YES5,14 YES5 YES5 Tranexamic Acid NO NO NO YES YES YES 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 YES6
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 Alcohol prep pad R R 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. R11,13 R11,13 R11,13 Bronchodilators (nebulizer solution), (albuterol, albuterol with ipratropium or levalbuterol)—At least one type must be carried. R R R R 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 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 Narcotic analgesics (fentaNYL or morphine sulfate)—At least one type must be carried. R12,13 R12,13 R12,13 Nitroglycerin, sublingual R R R R Normal Saline Solution (0.9% NaCl solution for intravenous volume infusion) R15 R15 R15 R15 Oxygen R R R R R Sodium bicarbonate R R R Medications within Department-approved air ambulance service protocol for use by PHRN, PHPE and PHP. 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. 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 and blood 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.
14. May be continued by a P if potassium concentration is 20 mEq/L or less.
15. May substitute an isotonic crystalloid solution in accordance with written medical director agreement and Statewide protocols.
Persons with a disability who require an alternate format of this notice (for example, large print, audiotape, Braille) should contact Jenni Hoffman, EMS Program Manager, Department of Health, Bureau of Emergency Medical Services, 1310 Elmerton Avenue, Harrisburg, PA 17110, (717) 787-8740. Persons with a speech or hearing impairment may call by using V/TT at (717) 783-6154 or the Pennsylvania Hamilton Relay Service at (800) 654-5984 (TT).
DR. DEBRA L. BOGEN,
Acting Secretary
[Pa.B. Doc. No. 23-1797. Filed for public inspection December 29, 2023, 9:00 a.m.]
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