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PA Bulletin, Doc. No. 03-1076



Approved Drugs for ALS Ambulance Services

[33 Pa.B. 2713]

   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.  Adenosine
  2.  Albuterol
  3.  Amiodarone
  4.  Aspirin
  5.  Atropine sulfate
  6.  Benzocaine or benzocaine/tetracaine--for topical         use only
  7.  Bretylium
  8.  Calcium chloride
  9.  Dexamethasone sodium phosphate
10.  Diazepam
11.  Dilaudid--for interfacility transports only
12.  Diltiazem
13.  Diphenhydramine HCL
14.  Dobutamine
15.  Dopamine
16.  Epinephrine HCL
17.  Fentanyl
18.  Furosemide
19.  Glucagon
20.  Heparin by intravenous drip--for interfacility
        transports only
21.  Heparin lock flush
22.  Hydrocortisone sodium succinate
23.  Glycoprotein IIb/IIIa Inhibitors--for interfacility
        transports only
   a.  Abciximab
   b.  Eptifibatide
   c.  Tirofiban
24.  Intravenous electrolyte solutions
   a.  Dextrose
   b.  Lactated Ringer's
   c.  Sodium chloride
   d.  Normosol
   e.  Potassium--for interfacility transports only
25.  Isoproterenol HCL--for interfacility transports only
26.  Lidocaine HCL
27.  Lorazepam
28.  Magnesium sulfate
29.  Metaproterenol
30.  Methylprednisolone
31.  Midazolam
32.  Morphine sulfate
33.  Naloxone HCL
34.  Nitroglycerin by intravenous drip--for interfacility
        transports only
35.  Nitroglycerin ointment
36.  Nitroglycerin spray
37.  Nitroglycerin sublingual tablets
38.  Nitrous oxide
39.  Oxytocin
40.  Phenergan
41.  Pralidoxime CL
42.  Procainamide
43.  Sodium bicarbonate
44.  Sodium thiosulfate
45.  Sterile water for injection
46.  Terbutaline
47.  Verapamil

   This list supercedes the list of approved drugs published at 32 Pa.B. 2817 (June 8, 2002). Changes made are: (1) addition of dilaudid for interfacility transports only; (2) deletion of ''interfacility transport only'' limitation on dobutamine; (3) addition of fentanyl; (4) deletion of meperidine; (5) addition of methylprednisolone; (6) addition of phenergan; (7) addition of pralidoxime CL; and (8) addition of sodium thiosulfate. 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.

   Section 1005.11 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 Gaumer, Department of Health, Emergency Medical Services Office, Room 1032, Health and Welfare Building, Harrisburg, PA 17120, (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. 03-1076. Filed for public inspection June 6, 2003, 9:00 a.m.]

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