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No. 04 - 02 Date: April 19, 2004 Re: EMT-B Administration
of Nebulized Albuterol Pages: 3 |
Administration Of Nebulized Albuterol By
EMT-Bs
PURPOSE:
To provide
BACKGROUND:
In
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
located in
AUTHORIZATION:
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”[1]
2.
A signed
collaborative agreement[2]
with the Physician Medical Director which shall at a minimum include:
§
The use of the NYS DOH BLS Protocols in conjunction
with the
§
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.
TRAINING
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 [3]
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.
MEDICATION
STORAGE
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.
ADMINISTRATION
OF NEBULIZED ALBUTEROL BY EMT-Bs
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
Chair,