No. 04 - 02
Date: April 19, 2004
Re: EMT-B Administration of Nebulized Albuterol
Administration Of Nebulized Albuterol By EMT-Bs
the spring of 2001, the New York State Emergency Medical Advisory Committee
(SEMAC) established a template protocol for administration of nebulized
albuterol by Emergency Medical Technician – Basic (EMT-B) providers. Prior to the creation of the Westchester EMS
Regional Emergency Medical Advisory Committee (REMAC), the Hudson Valley REMAC
finalized a protocol and application procedure for EMS Agencies to seek
approval allowing certified EMT-Bs within their service to posses and utilize
nebulized albuterol. The Westchester
REMAC approved its regional protocol for nebulized Albuterol administration in
2002 and allowed for the application of the procedure for agencies within the
Westchester Region. Ambulance services
A Westchester Regional EMS agency wishing provide administration of nebulized albuterol by EMT-Bs must submit:
1. A completed WREMAC application to provide “BLS Nebulized Albuterol”
2. A signed collaborative agreement with the Physician Medical Director which shall at a minimum include:
The use of the NYS DOH BLS Protocols in conjunction
§ The use of the NYS DOH EMT-B and Westchester REMAC approved BLS Nebulized Albuterol Administration Training Curriculum for the purpose of training all EMT-B (s) who are participating in the program;
§ Acquisition, use and storage of the medications in accordance with NYS DOH policy and a restocking plan established with the Medical Director.
§ Participation in any NYS DOH and/or Westchester REMAC approved Quality Improvement Plans.
3. A list of the NYS certified EMTs who have received the required training outlined by this policy.
Applications will be reviewed by the Westchester Regional EMS (WREMS) office for completeness and presented to the WREMAC for approval.
While the NYS DOH EMT-B curriculum does include the assisted administration of a pre-prescribed bronchodilator via a metered dose inhaler (MDI), a stand-alone curriculum has been established to train EMTs in providing the medication through a pressurized, oxygen driven nebulizer to patients experiencing an exacerbation of their previously diagnosed asthma. To augment the instruction provided in EMT-B certification, a training course must be completed which follows the attached curriculum  and is approved by the overseeing Physician Medical Director. The Physician, or his or her designee, preferably an ALS provider, shall complete the in-service, which must be repeated yearly. A list of the EMT-B’s trained shall be forwarded to the Regional EMS Office with the initial application and will be re-submitted annually.
The ambulance service must ensure that the albuterol is stocked and stored in accordance with NYS DOH Policy No. 00-15 Re: Storage and safeguarding of medications administered by EMT-B’s, or any superceding policy.
Nebulized albuterol will be administered by EMT-Bs in accordance with the current NYS DOH BLS Treatment Protocol and the Westchester REMAC EMT-B Special Procedure Protocol 1: Nebulized Albuterol Treatment Protocol. All uses must be properly documented on the NYS Patient Care Report (PCR) or other state approved Ambulance Care Report (ACR).
ADVANCED EMTs WORKING FOR BLS SERVICES
Advanced EMTs authorized by NYS to administer medications that are working for a BLS Ambulance Agency in a BLS capacity must be in-serviced in the provision of Nebulized Albuterol as a BLS provider. Significant protocol differences exist between ALS and BLS administration of the medication. Per NYS DOH, providers may not practice outside the level of care regionally approved for the agency.
BLS PROVIDERS WORKING FOR ALS SERVICES
EMT-Bs working for ALS services may participate in the Nebulized Albuterol Program as long as the BLS providers have undergone the required training and the agency has received REMAC authorization. ALS Services utilizing the program as part of a tiered response must continue to ensure the request for and provision of ALS for patients receiving BLS administration of nebulized albuterol.
Issued and Authorized by:
Dr. Nicholas DeRobertis, MD, FACEP