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Approved Drugs for ALS Ambulance Services

[41 Pa.B. 2286]
[Saturday, April 30, 2011]

 An error occurred in the preparation of the notice that appeared at 41 Pa.B. 1974 (April 9, 2011). The correct version of the notice is as follows and contains the following corrections:

 The removal of the drug ''Bretylium'' (previously listed at no. 10).

 The removal of an asterisk next to the drug ''Levalbuterol'' (currently listed at no. 33).

 The addition of an asterisk next to ''Total parental nutrition'' (currently listed at no. 52).

 The correction of the abbreviation ''mEg/L'' to ''mEq/L'' (in the paragraph under no. 53).

 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 transports only
7. Aspirin
8. Atropine sulfate
9. Benzocaine—for topical use only
10. Calcium chloride
11. Calcium gluconate
12. Captopril
13. Dexamethasone sodium phosphate
14. Diazepam
15. Dilaudid—for interfacility transports only*
16. Diltiazem
17. Diphenhydramine HCL
18. Dobutamine
19. Dopamine
20. Enalapril
21. Epinephrine HCL
22. Etomidate (only permitted for services approved by a regional EMS council and participating in the required QI program)
23. Fentanyl
24. Furosemide
25. Glucagon
26. Heparin by intravenous drip—for interfacility transports only*
27. Heparin lock flush
28. Hydrocortisone sodium succinate
29. Glycoprotein IIb/IIIa Inhibitors—for interfacility transports only*
a. Abciximab
b. Eptifibatide
c. Tirofiban
30. Intravenous electrolyte solutions
a. Dextrose
b. Lactated Ringer's
c. Sodium chloride
d. Normosol
e. Potassium—for interfacility transports only*
31. Ipratropium Bromide
32. Isoproterenol HCL—for interfacility transports only*
33. Levalbuterol—for interfacility transports only
34. Lidocaine HCL
35. Lorazepam
36. Magnesium sulfate
37. Methylprednisolone
38. Midazolam
39. Morphine sulfate
40. Naloxone HCL
41. Nitroglycerin (all forms/routes, but continuous intravenous infusion must be regulated by an infusion pump)
42. Nitrous oxide
43. Ondansetron
44. Oxytocin
45. Pralidoxime CL
46. Procainamide
47. Sodium bicarbonate
48. Sodium thiosulfate
49. Sterile water for injection
50. Terbutaline
51. Tetracaine—for topical use only
52. Total parental nutrition—for interfacility transport only*
53. Verapamil

 *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 infusion pump.

 This list supersedes the list of approved drugs published at 38 Pa.B. 6564 (November 29, 2008).

 The following changes have been made:

 (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. 11-736. Filed for public inspection April 29, 2011, 9:00 a.m.]



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