EMT-Basic Assisted Medication Administration

Bureau of EMS Policy Statement
Policy Statement # 04-07
Date 07/28/04
Subject EMT-Basic Assisted Medication Administration
Supercedes/Updates 84-22 Bee Sting Policy & 99-01 EMT-B Assisted Medication

Background

This policy is intended to delineate the role of the EMT-B in assisting a patient in taking his or herown pre-prescribed medication(s). The only medications included in the training curriculum and protocols are Nitroglycerin (tablet or spray), Bronchodilator (metered dose inhaler) and epinephrine in an auto-injector.

Definitions

  1. Pre-prescribed medications are those medications that are prescribed by a physician for a specific patient prior to an emergency and are present at the scene of the emergency.
  2. "Assisting" means delivering a patient's pre-prescribed medication, regardless of who delivers the medication.
  3. "Contraindication" or "contraindicated" means that the condition of the patient does not require, or may be dangerous to the patient if administered or the patient does not meet the criteria set forth by the published protocols.

Procedure

  1. A certified EMT-B should deliver pre-prescribed nitroglycerin or a brochodilator to a patient if the patient indicates (verbally, by gesture, etc.) their desire to take their medication and the delivery of such medication is not contraindicated by protocol or the EMT-B's training. If there is any question, contact Medical Control.
  2. NOTE: There is no circumstance when it would be proper to deliver either nitroglycerin or a bronchodilator to a patient who can not indicate their desire to take their pre-prescribed medication.
  3. NOTE: As stated, this procedure prevents an EMT-B from delivering either of these medications to an unconscious or unwilling patient. The contraindication statement is added for cases where the patient indicates their desire to take their medication but it is contraindicated by the patient's presentation or condition.
  4. A certified EMT-B should deliver pre-prescribed epinephrine by auto-injector to a patient who exhibits signs/symptoms consistent with the indications for the medication and protocol or the EMT-B's training does not contraindicate the medication. If there is any question, contact Medical Control.

NOTE: There are many scenarios in which the patient may not be able to indicate their desire to take their pre-prescribed epinephrine and the EMT-B must make the decision to do so. The EMT-B is trained to recognize the signs and symptoms of anaphylaxis and the contraindications for epinephrine. In cases of an allergic reaction, where the patient is conscious and alert, the patient should be able to participate in the decision and the delivery of the epinephrine auto-injector.

Special Circumstances

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, the following should be considered:

  • The medication has been identified as being the patient's pre-prescribed medication by a claim (the patient or family member states that it belongs to the patient) or an appearance (is in the patient's pocket or purse, etc).
  • The patient exhibits signs/symptoms consistent with the indications for the medication.
  • Protocol or the EMT-B's training does not contraindicate the medication.

Only then should the EMT-B assist in delivering the medication. In addition, the container, inhaler or auto-injector may not be labeled with the name of 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.
  • In cases where the label indicates that the medication is outdated, the EMT-B must contact Medical Control for direction. If there is any question, contact Medical Control.

NOTE: Signs/symptoms and indications for the assisted medication are included in the New York State EMT-B curricula.

Issued and Authorized by:
Edward Wronski, Director