Current through Register Vol. 35, No. 18, September 24, 2024
A. Medical director
means a physician functioning as the service EMS medical director as defined
and described in 7.27.3 NMAC, medical direction for emergency medical services.
Medical control means supervision provided by or under the direction of a
physician.
B. Prior to approving a
new skill, technique, medication, or procedure, it shall be documented by the
service director, medical director, or approved EMS training institution that
the EMS provider has been appropriately trained to perform those new skills,
techniques, medications, or procedures.
C. Service medical director approved: All
service medical director approved skills, techniques, medications, or
procedures are considered advanced life support. Prior to utilizing any skill,
technique, medication or procedure designated as service medical director
approved, it shall be documented by the service director, medical director, or
approved EMS training institution that the EMS provider has been appropriately
trained to administer the medications or perform the skills, techniques,
medications or procedures. Additionally, each EMS provider must have a signed
authorization from the service's medical director on file at the EMS service's
headquarters or administrative offices.
D. Any device in an EMS agency's treatment
guideline/protocol designed and utilized to facilitate successful completion of
a skill or other treatment modality, including but not limited to
cardiopulmonary resuscitation (CPR) devices, intraosseous placement devices,
and positive pressure ventilation devices, must be approved by the service
medical director.
E.
Wilderness protocols: The following skills shall only be used by
providers who have a current wilderness certification from a bureau approved
wilderness caregiver course, who are functioning in a wilderness environment as
a wilderness provider (an environment in which time to a hospital is expected
to exceed two hours, except in the case of an anaphylactic reaction, in which
no minimum transport time is required), and are authorized by their medical
director to provide the treatment:
(1) minor
wound cleaning and management;
(2)
cessation of CPR;
(3) field
clearance of the cervical-spine;
(4) reduction of dislocations resulting from
indirect force of the patella, digit, and anterior shoulder.
F.
Community emergency
medical services and mobile integrated health programs: Community EMS
(CEMS) and mobile integrated health (MIH) programs shall be provided by EMS
caregivers who, after completing a bureau approved CEMS/MIH caregiver course,
are functioning as part of a program that has been reviewed and approved by the
EMS bureau. The providers must be authorized by their medical director to
perform the skills listed in their application as part of the program. These
programs may include referrals that involve transport to non-hospital
locations, and for non-transport decisions. Skills and interventions may
include any of the approved skills and interventions for the appropriate level;
any skill that exceeds the scope of practice must be approved through the
special skill process. Skills may include, but are not limited to:
(1) education of patients in self-medication
administration, and assessment of compliance with physician recommendations for
health conditions;
(2) assessments
for preventing falls and other sources of injury by identifying risks in
patient homes;
(3) provide
education on disease prevention;
(4) administering immunizations;
(5) in collaboration with a healthcare team,
assist in developing a care plan, and educate the patient in following the care
plan;
(6) perform in home patient
assessments commensurate with level of education and licensure and facilitate
telemedicine clinician contact if available in order to provide information to
a care team as to the progress or condition of a patient receiving therapies
for medical conditions;
(7) provide
assistance in locating and contacting appropriate providers of needed social
services;
(8) treat discovered
acute healthcare issues, transporting to emergency department if
necessary;
(9) for chronic and
non-acute issues, confirmed with online medical direction and agreed to by the
patient, options other than EMS transport may be considered, including:
(a) arrange for non-emergent and non-EMS
transportation to and care at an appropriate facility, such as a physician's
office or urgent care center;
(b)
provide referral information and arrange for follow up by appropriate care team
members or social service personnel.
(10) assist with ongoing prescribed wound
care.
G.
Critical
Care Transport services skills: Paramedic critical care transport skills
shall be used only by paramedic providers who have successfully completed a
bureau approved critical care transport paramedic or critical care flight
paramedic course. Subsequent to completing the approved course, the critical
care paramedic must successfully complete a bureau administered or approved
third party exam within one year. Additionally, the paramedics shall be
functioning as part of a ground or air EMS agency with an approved critical
care transport special skill and authorized by the agency medical director to
utilize these skills. Critical care transport program skills are only
authorized for use during inter-facility critical care transport activities,
with the exception of air ambulance agencies providing emergency scene
response; or ground critical care agencies requested to a scene by the local
authorized and certified 911 response and transport agencies. Critical care
transport special skills and medications that may be administered include, but
are not limited to any of the below skills and medications; service specific
skills and medication requests must be listed on the EMS agency critical care
transport special skill application completed per
7.27.11.10
NMAC:
(1) monitoring of infusions including
but not limited to anti-arrhythmics, nitrates, vasopressors, blood products,
thrombolytics, sedation, pain management and antihypertensive medications that
have required titration within the past two hours and may need to have their
dosages adjusted during transport;
(2) performance of skills not listed in the
paramedic scope of practice, such as but not limited to escharotomy,
fasciotomy, insertion of chest tubes, pericardiocentesis, blood administration,
and nerve blocks; administration of medications, initiation of infusions, and
utilization of routes, not listed on the paramedic scope but requested in the
EMS agency's special skill application and approved by the medical direction
committee and EMS bureau;
(3)
utilization of advanced patient monitoring, such as invasive hemodynamic
monitoring via monitoring of central venous pressure, pulmonary artery
pressure, intracranial pressure monitoring, Swan-Ganz catheters, arterial
lines, fetal monitoring, point of care lab values, and other monitoring or
tests not listed in the paramedic scope, but requested in the EMS agency's
special skill application and approved by the medical direction committee and
EMS Bureau;
(4) utilization of
intensive care unit (ICU) level ventilator support, to include ventilators
delivering positive end expiratory pressure, with multiple adjustable mode and
setting parameters that include inspiratory plateau pressures, pressure
regulated volume control, pressure support ventilation, pressure control
ventilation, airway pressure release ventilation and others; also, any
ventilator delivering a mixture of nitric oxide or other beneficial gas
mixtures;
(5) transport of patients
with intra-aortic balloon pump, temporary internal cardiac pacing, left
ventricular assist device or a bi-ventricular assist device and other
appropriate devices to address hemodynamic instability as requested in the EMS
agency's special skill application and approved by the medical direction
committee and EMS bureau;
(6)
administer paralytics and sedatives to maintain airway control previously
initiated, and administer and perform rapid sequence airway pharmacology and
techniques in order to secure an airway in response to patient condition, as
requested in the EMS agency's special skill application and approved by the
medical direction committee and EMS bureau;
(7) pediatric intubation or endotracheal tube
management as requested in the EMS agency's special skill application and
approved by the medical direction committee and EMS bureau.
H. Utilization of pharmacological
agents for the primary purpose of sedation, induction, or muscle relaxation to
facilitate placement of an advanced airway requires medical direction committee
special skills approval.
I.
Over the counter (OTC) medications and products: A physician
medical director may approve a list of over the counter (OTC) medications and
products (i.e. NSAID's, antihistamines, anti-diarrheal, laxatives,
antacids, vitamin supplements, hygiene products and other products) for
distribution by an EMS caregiver working under medical direction to a
requesting individual during scheduled stand-by situations. Examples are
long-term wildfire responses, public events (concerts, rodeos, etc), various
industry situations such as movie production and ski patrol, long-term
construction & manufacturing projects, long-term search and rescue or
tactical operations, and other situations where scheduled stand-by EMS is
provided.
(1) The OTC medication/product must
be properly labeled in individual dose packaging when distributed to the
patient. Distribution from a bulk or multi-dose container is not permitted by
this scope of practice, as well as other state and federal laws and
regulations; medications will be distributed per manufacturer recommendations
and labeling directions.
(2) The
agency/EMS caregiver will maintain a written guideline that contains the list
of physician approved OTC medications/products and the conditions for which
they may be distributed. Specific dosing information and indications for
pediatric patients must be included.
(3) The EMS agency/EMS caregiver must develop
a method of documentation for the appropriate distribution of the OTC
medications/products. This documentation shall include the OTC medication
documentation and appropriate patient care report, per
7.27.10.12
NMAC (records and data collection) and
7.27.11.11
NMAC. Public regulation commission (PRC) certified ambulance agencies shall
complete patient care documentation per
18.3.14.24
NMAC.
(4) OTC medications/products
are distributed for the patient's self-administration and use. EMS caregivers
will not administer OTC medications/products, unless approved elsewhere in the
scope of practice for specific EMS patient care situations.
J.
Licensed emergency medical
dispatcher (EMD):
(1) Medical
direction is required for all items in the EMD scope of practice.
(2) The following allowable skills may be
performed by EMDs who are licensed by the EMS bureau and functioning with an
EMS bureau certified New Mexico emergency medical dispatch agency utilizing
protocols and any EMD priority reference system approved by the EMS bureau and
service medical director.
(a) Process calls
for medical assistance in a standardized manner, eliciting required information
for evaluating, advising, and treating sick or injured individuals, and
dispatching an appropriate EMS response.
(b) Provide pre-arrival instructions to the
patient through the caller when possible and appropriate to do so while
functioning in compliance with an emergency medical dispatch priority reference
system (EMDPRS).
K.
EMS first responders (EMSFR):
(1)
The following allowed drugs may be
administered and skills and procedures may be performed without medical
direction:
(a) basic airway
management;
(b) use of basic
adjunctive airway equipment;
(c)
suctioning;
(d) cardiopulmonary
resuscitation, according to current ECC guidelines;
(e) obstructed airway management;
(f) bleeding control via direct pressure and
appropriate tourniquet use;
(g)
spinal motion restriction;
(h)
splinting (does not include femoral traction splinting);
(i) scene assessment, triage, scene
safety;
(j) use of statewide EMS
communications system;
(k)
emergency childbirth;
(l)
glucometry;
(m) oxygen;
(n) other non-invasive procedures as taught
in first responder courses adhering to United States Department of
Transportation curricula.
(2)
The following require service
medical director approval:
(a)
allowable skills:
(i) mechanical positive
pressure ventilation utilizing a device that may have controls for rate, tidal
volume, FiO2, and pressure relief/alarm and does not have multiple automatic
ventilation modes; this skill includes devices that provide non-invasive
positive pressure ventilation via continuous positive airway pressure
(CPAP);
(ii) application and use of
semi-automatic defibrillators, including cardiac rhythm acquisition for ALS
caregiver interpretation or transmission to a care facility; this includes
multi-lead documentation;
(iii)
hemostatic dressings for control of bleeding;
(iv) insertion of laryngeal and supraglottic
airway devices (examples: king airway, LMA), excluding multi-lumen
airways).
(b)
administration of approved medications via the following routes:
(i) nebulized inhalation;
(ii) nasal mucosal atomization
(MA);
(iii) intramuscular or
subcutaneous;
(iv) oral
(PO).
(c) allowable
drugs:
(i) oral glucose
preparations;
(ii) aspirin PO for
adults with suspected cardiac chest pain;
(iii) atropine and pralidoxime via IM
auto-injection for treatment of chemical or nerve agent exposure;
(iv) albuterol (including isomers) via
inhaled administration;
(v)
naloxone via nasal mucosal atomizer;
(vi) epinephrine, 1:1000, no single dose
greater than 0.3 ml, subcutaneous or intramuscular injection with a
pre-measured syringe (including autoinjector) or 0.3 ml TB syringe for
anaphylaxis or status asthmaticus refractory to other treatments.
(d) patient's own medication that
may be administered:
(i) bronchodilators using
pre-measured or metered dose inhalation device;
(ii) naloxone, if provided with a nasal MA or
IM delivery system.
L.
EMT-BASIC (EMT-B):
(1)
The following allowed drugs may be
administered and skills and procedures may be performed without medical
direction:
(a) basic airway
management;
(b) use of basic
adjunctive airway equipment;
(c)
suctioning;
(d) cardiopulmonary
resuscitation, according to current ECC guidelines;
(e) obstructed airway management;
(f) bleeding control to include appropriate
tourniquet usage;
(g) spinal motion
restriction;
(h)
splinting;
(i) scene assessment,
triage, scene safety;
(j) use of
statewide EMS communications system;
(k) childbirth (imminent delivery);
(l) glucometry;
(m) oxygen;
(n) other non-invasive procedures as taught
in EMT-B courses adhering to DOT curricula;
(o) wound management.
(2)
The following require service
medical director approval:
(a)
allowable skills:
(i) mechanical positive
pressure ventilation utilizing a device that may have controls for rate, tidal
volume, fraction of inspired oxygen (FiO2) and pressure
relief/alarm and does not have multiple automatic ventilation modes; this skill
includes devices that provide non-invasive positive pressure ventilation via
continuous positive airway pressure (CPAP);
(ii) use of multi-lumen, supraglottic, and
laryngeal airway devices (examples: PTLA, combi-tube, king airway, LMA) to
include gastric suctioning;
(iii)
application and use of semi-automatic defibrillators, including cardiac rhythm
acquisition for ALS caregiver interpretation or transmission to a care
facility; this includes multi-lead documentation;
(iv) acupressure;
(v) transport of patients with gastric tubes,
urinary catheters, heparin/saline locks, PEG tubes, or vascular access devices
intended for outpatient use;
(vi)
performing point of care testing; examples include serum lactate values,
cardiac enzymes, electrolytes, and other diagnostic values;
(vii) hemostatic dressings for control of
bleeding.
(b)
administration of approved medications via the following routes:
(i) nebulized inhalation;
(ii) subcutaneous;
(iii) intramuscular;
(iv) nasal mucosal atomization
(MA);
(v) oral (PO);
(vi) intradermal.
(c) allowable drugs:
(i) oral glucose preparations;
(ii) aspirin PO for adults with suspected
cardiac chest pain;
(iii) activated
charcoal PO;
(iv) acetaminophen PO
;
(v) atropine and pralidoxime via
IM autoinjection for treatment of chemical or nerve agent exposure.
(vi) albuterol (including isomers), via
inhaled administration;
(vii)
ibuprofen PO in pediatric or adults to treat fever or pain;
(viii) ipratropium, via inhaled
administration, in combination with or after albuterol
administration;
(ix) naloxone by
SQ, IM, or IN route;
(x)
epinephrine, 1:1000, no single dose greater than 0.3 ml, subcutaneous or
intramuscular injection with a pre-measured syringe (including autoinjector) or
0.3 ml TB syringe for anaphylaxis or status asthmaticus refractory to other
treatments.
(d) patient's
own medication that may be administered:
(i)
bronchodilators using pre-measured or metered dose inhalation device;
(ii) sublingual nitroglycerin for unrelieved
chest pain, with on line medical control only;
(iii) situations may arise involving patients
with uncommon conditions requiring specific out of hospital administered
medications or procedures; family members or the designated caregiver trained
and knowledgeable of the special needs of the patient should be recognized as
the expert regarding the care of the patient; EMS can offer assistance in
airway management appropriate to their level of licensure, and administer the
patient's prescribed medications where appropriate only if the medication is in
the EMS provider's scope of practice; EMS services are not expected to provide
the prescribed medications for these special needs patients.
(3)
Immunizations
and biologicals: Administration of immunizations, vaccines, biologicals,
and TB skin testing is authorized under the following circumstances:
(a) to the general public as part of a
department of health initiative or emergency response, utilizing department of
health protocols; the administration of immunizations is to be under the
supervision of a physician, nurse, or other authorized health
provider;
(b) TB skin tests may be
applied and interpreted if the licensed provider has successfully completed
required department of health training;
(c) in the event of a disaster or emergency,
the state EMS medical director or chief medical officer of the department of
health may temporarily authorize the administration of pharmaceuticals or tests
not listed above.
M.
EMT-INTERMEDIATE (EMT-I):
(1)
The following allowed drugs may be
administered and skills and procedures may be performed without medical
direction:
(a) basic airway
management;
(b) use of basic
adjunctive airway equipment;
(c)
suctioning;
(d) cardiopulmonary
resuscitation, according to ECC guidelines;
(e) obstructed airway management;
(f) bleeding control including appropriate
use of tourniquet;
(g) spinal
motion restriction;
(h)
splinting;
(i) scene assessment,
triage, scene safety;
(j) use of
statewide EMS communications system;
(k) childbirth (imminent delivery);
(l) glucometry;
(m) oxygen;
(n) wound management.
(2)
The following require service
medical director approval:
(a)
allowable skills:
(i) mechanical positive
pressure ventilation utilizing a device that may have controls for rate, tidal
volume, FiO2, and pressure relief/alarm and does not
have multiple automatic ventilation modes; this skill includes devices that
provide non-invasive positive pressure ventilation via continuous positive
airway pressure (CPAP);
(ii) use of
multi-lumen, supraglottic, and laryngeal airway devices (examples: PTLA,
combi-tube, king airway, LMA) to include gastric suctioning;
(iii) application and use of semi-automatic
defibrillators, including cardiac rhythm acquisition for ALS caregiver
interpretation or transmission to a care facility; this includes multi-lead
documentation;
(iv)
acupressure;
(v) transport of
patients with gastric tubes, urinary catheters, heparin/saline locks, PEG
tubes, or vascular access devices intended for outpatient use;
(vi) peripheral venous
puncture/access;
(vii) blood
drawing;
(viii) pediatric
intraosseous tibial access;
(ix)
adult intraosseous access;
(x)
point of care testing; examples include serum lactate values, cardiac enzymes,
electrolytes, and other diagnostic values;
(xi) hemostatic dressings for control of
bleeding.
(b)
administration of approved medications via the following routes:
(i) intravenous;
(ii) nasal mucosal atomization
(MA);
(iii) nebulized
inhalation;
(iv)
sublingual;
(v)
intradermal;
(vi)
intraosseous;
(vii) endotracheal
(for administration of epinephrine only, under the direct supervision of an
EMT-paramedic, or if the EMS service has an approved special skill for
endotracheal intubation);
(viii)
oral (PO);
(ix)
intramuscular;
(x)
subcutaneous.
(c)
allowable drugs:
(i) oral glucose
preparations;
(ii) aspirin PO for
adults with suspected cardiac chest pain;
(iii) activated charcoal PO;
(iv) acetaminophen;
(v) ibuprofen PO to pediatrics and adults for
pain or fever; IV or IM ketorolac for pain;
(vi) IM autoinjection of the following agents
for treatment of chemical or nerve agent exposure: atropine,
pralidoxime;
(vii) albuterol
(including isomers) via inhaled administration;
(viii) ipratropium, via inhaled
administration in combination with or after albuterol administration;
(ix) naloxone;
(x) I.V. fluid therapy (except blood or blood
products);
(xi) dextrose;
(xii) epinephrine (1:1000), SQ or IM
(including autoinjector) for anaphylaxis and known asthmatics in severe
respiratory distress (no single dose greater than 0.3 cc);
(xiii) epinephrine (1:10,000) in pulseless
cardiac arrest for both adult and pediatric patients; epinephrine may be
administered via the endotracheal tube in accordance with most current ACLS and
PALS guidelines;
(xiv)
nitroglycerin (sublingual); must have intravenous access established prior to
administration or approval of online medical control if IV access is
unavailable;
(xv) morphine,
fentanyl, or dilaudid for use in pain control with approval of on-line or
off-line (written protocol) medical control;
(xvi) diphenhydramine for allergic reactions
or dystonic reactions;
(xvii)
glucagon, to treat hypoglycemia in diabetic patients when intravenous access is
not obtainable;
(xviii) anti-emetic
agents, for use as an anti-emetic only;
(xix) corticosteroids for respiratory illness
or allergic reaction;
(xx)
hydroxycobalamine;
(xxi) lidocaine
two percent, preservative and epinephrine free for IV use) for administration
into the intraosseous space on pain responsive adult patients while receiving
intraosseous fluids or medications.
(d) patient's own medication that may be
administered:
(i) bronchodilators using
pre-measured or metered dose inhalation device;
(ii) sublingual nitroglycerin for unrelieved
chest pain; must have intravenous access established prior to administration or
approval of online medical control if IV access is unavailable;
(iii) glucagon;
(iv) situations may arise involving patients
with uncommon conditions requiring specific out of hospital administered
medications or procedures; family members or the designated caregiver trained
and knowledgeable of the special needs of the patient should be recognized as
the expert regarding the care of the patient; EMS can offer assistance in
airway management appropriate to their level of licensure, IV access, and the
administration of the patient's prescribed medications where appropriate only
if the medication is in the EMS provider's scope of practice; online (direct
contact) medical control communication must be established with the medical
control physician approving the intervention; EMS services are not expected to
provide the prescribed medications for these special needs patients.
(e) drugs allowed for monitoring
during interfacility transport:
(i) potassium;
intermediate EMT's may monitor IV solutions that contain potassium during
transport (not to exceed 20 mEq/1000cc or more than 10 mEq/hour);
(ii) antibiotics and other anti-infectives
utilizing an infusion pump; intermediate EMT's may monitor antibiotic or other
anti-infective agents, provided a hospital initiated infusion has been running
for a minimum of 30 minutes prior to the intermediate initiating the transfer,
and the intermediate EMT is aware of reactions for which to monitor and the
appropriate action to take before assuming responsibility for patient
care.
(f) immunizations
and biologicals: administration of immunizations, vaccines, biologicals, and TB
skin testing is authorized under the following circumstances:
(i) to the general public as part of a
department of health initiative or emergency response, utilizing department of
health protocols; the administration of immunizations is to be under the
supervision of a physician, nurse, or other authorized health
provider;
(ii) administer vaccines
to EMS and public safety personnel;
(iii) TB skin tests may be applied and
interpreted if the licensed provider has successfully completed required
department of health training;
(iv)
in the event of a disaster or emergency, the state EMS medical director or
chief medical officer of the department of health may temporarily authorize the
administration of pharmaceuticals or tests not listed above.
N.
EMT-PARAMEDIC (EMT-P):
(1)
The following allowed drugs may be administered and skills and procedures
may be performed without medical direction:
(a) basic airway management;
(b) use of basic adjunctive airway
equipment;
(c)
suctioning;
(d) cardiopulmonary
resuscitation, according to current ECC guidelines;
(e) obstructed airway management;
(f) bleeding control including the
appropriate use of tourniquet;
(g)
spinal motion restriction;
(h)
splinting;
(i) scene assessment,
triage, scene safety;
(j) use of
statewide EMS communications system;
(k) childbirth (imminent delivery);
(l) glucometry;
(m) oxygen;
(n) wound management.
(2) The following require service medical
director approval:
(a)
allowable
skills:(i) mechanical positive
pressure ventilation utilizing a device that may have controls for rate, tidal
volume, FiO2, and pressure relief/alarm and has multiple
automatic ventilation modes; this skill includes devices that provide
non-invasive positive pressure ventilation (including continuous positive
airway pressure (CPAP) and bi-level positive airway pressure (BPAP);
(ii) use of multi-lumen, supraglottic, and
laryngeal airway devices (examples: PTLA, combi-tube, king airway, LMA) to
include gastric suctioning;
(iii)
transport of patients with gastric tubes, urinary catheters, heparin/saline
locks, PEG tubes, or vascular access devices;
(iv) application and use of semi-automatic
defibrillators;
(v)
acupressure;
(vi) peripheral venous
puncture/access;
(vii) blood
drawing;
(viii) I.V. fluid
therapy;
(ix) direct laryngoscopy
for endotracheal intubation and removal of foreign body in patients 13 and
older; for patients 12 and under, for removal of foreign body only;
(x) endotracheal intubation for patients over
the age of 12;
(xi) thoracic
decompression (needle thoracostomy);
(xii) surgical cricothyroidotomy;
(xiii) insertion of gastric tubes;
(xiv) cardioversion and manual
defibrillation;
(xv) external
cardiac pacing;
(xvi) cardiac
monitoring;
(xvii) use of infusion
pumps;
(xviii) initiation of blood
and blood products with on-line medical control;
(xix) intraosseous access;
(xx) performing point of care testing;
examples include serum lactate values, cardiac enzymes, electrolytes, and other
diagnostic values;
(xxi) hemostatic
dressings for control of bleeding;
(xxii) vagal maneuvers.
(b)
administration of approved
medications via the following routes:
(i) intravenous;
(ii) nasal mucosal atomization
(MA);
(iii) nebulized
inhalation;
(iv)
sublingual;
(v)
intradermal;
(vi)
intraosseous;
(vii)
endotracheal;
(viii) oral
(PO);
(ix) intramuscular;
(x) topical;
(xi) rectal;
(xii) IV drip;
(xiii) subcutaneous.
(c)
allowable drugs:
(i) acetaminophen;
(ii) activated charcoal;
(iii) adenosine;
(iv) albuterol (including isomers);
(v) amiodarone;
(vi) aspirin;
(vii) atropine sulfate;
(viii) benzodiazepines;
(ix) blood and blood products;
(x) calcium preparations;
(xi) corticosteroids;
(xii) dextrose;
(xiii) diphenhydramine;
(xiv) epinephrine;
(xv) furosemide;
(xvi) glucagon;
(xvii) hydroxycobalamine;
(xviii) ipratropium;
(xix) lidocaine;
(xx) magnesium sulfate;
(xxi) naloxone;
(xxii) narcotic analgesics;
(xxiii) nitroglycerin;
(xxiv) nonsteroidal anti-inflammatory drugs
(NSAIDS) to pediatric or adult patients with pain or fever;
(xxv) oral glucose preparations;
(xxvi) oxytocin;
(xxvii) phenylephrine nasal spray;
(xxviii) pralidoxime, IM auto-injection for
treatment of chemical and nerve agent exposure;
(xxix) anti-emetic agents, for use as an
anti-emetic only;
(xxx) sodium
bicarbonate;
(xxxi)
thiamine;
(xxxii) topical
anesthetic ophthalmic solutions;
(xxxiii) tranexamic acid; for patients >
15 years of age;
(xxxiv)
vasopressor agents;
(xxxv)
intravenous fluids.
(3)
Drugs allowed for monitoring during
inter-facility transports: (initiated and administered by the sending
facility with defined dosing parameters and requiring an infusion pump when
given by continuous infusion unless otherwise specified); any titration of one
of these medications outside of the predefined dosing parameters requires
online physician medical control:
(a)
potassium (no infusion pump needed if concentration not greater than
20mEq/1000cc;
(b) anticoagulation
type blood modifying agents (such as fibrolytic drugs, heparin, glycoprotein
IIb-IIIa inhibitors/antagonists);
(c) procainamide;
(d) mannitol;
(e) aminophylline;
(f) antibiotics and other anti-infective
agents;
(g) sodium
nitroprusside;
(h)
insulin;
(i) terbutaline;
(j) octreotide;
(k) nutritional supplements;
(l) beta blockers;
(m) calcium channel blockers;
(n) dobutamine
(o) nesiritide;
(p) propofol in patients that are intubated
prior to transport;
(q) proton pump
inhibitors and H2 antagonists;
(r)
crotalidae polyvalent immune fab (ovine) ("crofab") or anavip (crotalidae
immune fab2 (equine)); either may be monitored during inter-facility transport
provided the facility initiated infusion has been running for a minimum of 30
minutes prior to the paramedic initiating the transfer and assuming
responsibility for patient care.
(4)
Immunizations and
biologicals: administration of immunizations, vaccines, biologicals, and
TB skin testing is authorized under the following circumstances:
(a) to the general public as part of a
department of health initiative or emergency response, utilizing department of
health protocols; the administration of immunizations is to be under the
supervision of a physician, nurse, or other authorized health
provider;
(b) administer vaccines
to EMS and public safety personnel;
(c) TB skin tests may be applied and
interpreted if the licensed provider has successfully completed required
department of health training;
(d)
in the event of a disaster or emergency, the state EMS medical director or
chief medical officer of the department of health may temporarily authorize the
administration of other pharmaceuticals or tests not listed above.
(5)
Skills approved for
monitoring in transport:
(a) internal
cardiac pacing;
(b) chest
tubes.
(6)
Medications for administration during patient transfer:
(a) retavase (second dose only);
(b) protamine sulfate;
(c) non-depolarizing neuromuscular blocking
agents in patients that are intubated prior to transport;
(d) acetylcysteine.
(7)
Patient's own medication that may
be administered:
(a) epoprostenol
sodium, treprostinil sodium, or other medications utilized for certain types of
pulmonary hypertension;
(b)
bronchodilators using pre-measured or metered dose inhalation device;
(c) sublingual nitroglycerin for unrelieved
chest pain; must have intravenous access established prior to
administration;
(d)
glucagon;
(e) situations may arise
involving patients with uncommon conditions requiring specific out of hospital
administered medications or procedures; family members or the designated
caregiver trained and knowledgeable of the special needs of the patient should
be recognized as the expert regarding the care of the patient; EMS can offer
assistance in airway management appropriate to their level of licensure, IV
access, and the administration of the patient's prescribed medications where
appropriate only if the medication is in the EMS provider's scope of practice;
online (direct contact) medical control communication must be established with
the medical control physician approving the intervention; EMS services are not
expected to provide the prescribed medications for these special needs
patients.