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No. 04 - 01
Date: April 19, 2004 Re: EMT-B Assisted
Delivery of Prescribed Medications Pages: 4 |
Assisted
Patient Administration of Prescribed Medication by EMT-Bs - Nitroglycerin (tablet or spray), Bronchodilator (inhaler), Epinephrine
(auto-injector)
PURPOSE:
To provide Emergency Medical
Technician - Basic (EMT-B) responders belonging to Westchester Regional 911 EMS
agencies with regional guidelines to assist patient administration of certain
pre-prescribed medications; nitroglycerin (tablet or spray), bronchodilator
(metered dose inhaler), epinephrine (auto-injector).
BACKGROUND:
The
State Emergency Medical Advisory Committee (SEMAC) and State Emergency Medical
Services Council (SEMSCO) have established a training curriculum for EMT-Bs
that includes the recognition of medical emergencies pertaining to anaphylaxis,
chest pain and respiratory distress. As
part of the evaluation and treatment for these conditions, EMT-Bs are
instructed in the indications, contra-indications, administration and potential
side effects of epinephrine (auto-injector), nitroglycerin (tablet or spray),
and bronchodilators (metered dose inhalers), when assisting a patient in taking
prescribed medications for each of these situations respectfully.
The
New York State Department of Health (NYSDOH) Basic Life Support (BLS) Adult and
Pediatric Treatment Protocols outlines assisted patient administration of
medications in protocols:
§
M-3: Anaphylactic Reactions With Respiratory Distress or
Hypoperfusion
- M-5:
Adult Cardiac Related Problem
- M-15:
Respiratory Distress - Shortness of Breath, Difficulty Breathing
In
creating this policy, the Westchester Regional Emergency Medical Advisory
Committee (REMAC) is providing off-line medical control for assisted delivery of
pre-prescribed patient medications by regional EMT-Bs completing patient care
in conjunction with these protocols.
With any medication administration, ALS must be requested to
respond.
CLARIFICATION OF NYS DOH DEFINITIONS:
According to NYS DOH policy No.
99-01 Re: EMT-Basic Assisted Medications:
1. Pre-prescribed
medications are those medications that are prescribed for a specific patient
prior to an emergency and are present at the scene of the emergency.
Experience has shown that "assisted medications" may not be
labeled with the patient's name on the container, inhaler or auto-injector
carried by the patient. In this
circumstance if the patient indicates a desire to take the medication, AND the
medication has been identified as being the patient's pre-prescribed medication
by a claim or an appearance (is in the patient's pocket or purse, etc), AND the
patient exhibits signs/symptoms consistent with the indications for the
medication, AND the medication is not contraindicated by protocol or the EMT-B's
training, then the EMT-B should assist in delivering the medication. In no case should an EMT-B assist in the
delivery of a medication from a container, inhaler, or auto-injector that is
not labeled with the name of the medication.
Also, medications
belonging to other family members or bystanders ARE NOT to be utilized under
any circumstances.
2. "Assisting" means delivering a patient's pre-prescribed
medication, regardless of who delivers the medication. A certified EMT-B should deliver pre-prescribed patient who exhibits
signs/symptoms consistent with the indications for the medication and the
medication is not contraindicated by protocol or the EMT-B's training. For cases where a patient indicates a desire
to take a medication but it is contraindicated, the medication should not be
provided.
GUIDELINES FOR
EMT-B ASSISTED MEDICATION DELIVERY
EPINEPHRINE (auto-injector, Epi-Pen):
1.
The
patient has a diagnosed history of anaphylaxis, severe allergic reactions and/or
a recent exposure to an allergen or inciting agent,
AND
2.
If
either cardiac or respiratory status are abnormal,
AND
3.
The
patient having severe respiratory distress or hypoperfusion has been
prescribed an epinephrine auto injector; assist [1]
the patient in administering ONE (1) EPINEPHRINE auto-injector
(Epi-Pen).
4.
No
repeat dosing is allowed. If needed, and
a second Epi-pen is available, on-line Medical Control MUST be contacted.
NITROGLYCERIN (tablet or spray)
1.
If
the patient has a diagnosed history of angina, heart attack or other
significant cardiac condition,
AND
2. Chest pain is present and the
patient possesses nitroglycerin prescribed by his/her physician,
AND
3.
The patient
has a systolic blood pressure of 120mm Hg or greater, the EMT-B may assist
[2]
the patient in the sublingual administration of ONE (1) tablet or metered dose
spray of NITROGLYCERINE.
4.
If inadequate
relief is achieved, assisted
administration may be repeated every five (5) minutes, up to a total of three
(3) tablets or sprays, if the patient’s systolic blood pressure remains 120mm Hg or greater.
BRONCHODILATOR (metered dose inhaler)
1. If the patient is exhibiting respiratory distress caused by an exacerbation of previously diagnosed asthma,
AND
2. The patient has a prescribed
bronchodilator medication metered dose inhaler (MDI),
AND
3. The MDI is not a steroid
based medication, the EMT-B may assist 2
the patient in administering ONE (1) MDI treatment, consisting of TWO
(2) puffs of the BRONCHODILATOR.
4.
A
second, ONE (1) MDI treatment may be repeated in fifteen (15) minutes if
inadequate relief is achieved with the initial treatment.
ON-LINE
MEDICAL CONTROL
Medical Control MUST
be contacted under the following conditions:
- The pre-prescribed medication is out of date
(expired)
- The EMT-B has any questions regarding
contraindications for assisted administration of the medication.
- Patient is insisting on taking a pre-prescribed
medication that is contraindicated
- Repeat assisted dosing is desired above what
allowed for under standing orders
- ALS is not available for transport to the
Emergency Department (notification should be made after completing
protocol.)
ADVANCED
EMTs WORKING FOR BLS SERVICES
Advanced
EMTs that are working for a BLS Ambulance Agency in a BLS capacity may
only assist patient administration of certain pre-prescribed medications;
nitroglycerin (tablet or spray), bronchodilator (metered dose inhaler),
epinephrine (auto-injector) as per NYSDOH BLS Protocols. Significant protocol differences exist
between ALS and BLS administration of these medications. Per NYSDOH, providers may not practice
outside the level of care regionally approved for the agency.
Issued and Authorized by:
Dr.
Nicholas DeRobertis, MD, FACEP
Chair,