Syringe Epinephrine for Basic EMTs

Bureau of Emergency Medical Services and Trauma Systems Policy Statement
Policy Statement # 17-06
Date May 24, 2017
Subject Syringe Epinephrine for Basic EMTs
Supercedes/Updates New

Based on the results of a State Emergency Medical Advisory Committee (SEMAC) demonstration project, the New York State Emergency Medical Service Advisory Council (SEMSCO) approved Syringe Epinephrine for Emergency Medical Technicians (Check & Inject NY) at the September 14, 2016 meeting. The project established that EMTs, with the appropriate training may administer the proper dose of epinephrine for a patient experiencing a severe anaphylactic reaction using a specific 1cc syringe. Additionally, the project realized a significant cost saving over maintaining epinephrine auto-injectors.

The Commissioner of Health has approved the addition of Syringe Epinephrine and at the request of the SEMAC, this approval includes the intramuscular administration of 1:1000 epinephrine using a 1cc syringe, a 23 gauge, 1 inch intramuscular safety needle and a single dose 1:1000 epinephrine packaged in a 1mg/ml vial as an addition to the scope of practice for an EMT.



Every EMT original, refresher and continuing medical education (CME) certification training program must include the didactic content and psychomotor skills for the administration of 1:1000 epinephrine using a syringe for treating a patient with severe anaphylaxis.

The NYS EMS Instructional Guidelines have been updated and an Intramuscular Injection Psychomotor Evaluation Tool (practical skills sheet) has been developed to assist EMS course sponsors, Certified Instructor Coordinators (CIC) and EMS agencies in providing initial and ongoing training. An instructor update can be found at under "All Courses" in "Instructors" section. The course is entitled "2017 Instructor Update – Epi for EMTs". The education resources are available at: on pages 2 through 4.

BLS EMS Agencies

EMS Agencies intending to implement a Syringe Epinephrine program, in consultation with their medical director, should develop written policies and procedures for the use of Syringe Epinephrine that are consistent with regional policies and protocols. This should include, but not be limited to the following:

  • Written policies and procedures requiring an approved training program, requirements for continuing education, maintenance of competencies and the documentation for authorized providers;
  • Written policies and procedures requiring for the use of a 1cc syringe, a 23 gauge, 1 inch intra-muscular safety needle and single dose 1:1000 epinephrine packaged in a 1mg/ml vial;
  • A description of how the syringes, needles and medication will be kept secure in the vehicles and the station(s);
  • A plan for appropriate and safe disposal of medical waste;
  • A description of how the medication will be maintained within manufacturer's approved temperature and light ranges; and
  • Documentation of an administration and the medical director's plan for quality assurance and appropriateness review of utilization.

Once the EMS service has decided to implement a syringe epinephrine program, the EMS Service must provide the Department with an updated Medical Director Verification Form (DOH-4362).


Medical Director Verification Form (DOH-4362) – fill-in-able

Check & Inject NY

Anaphylactic Reaction with Respiratory Distress and Hypoperfusion Protocol – M-3

Emergency Medical Technician Instructional Guidelines – Intramuscular Injections and Psychomotor Evaluation Tool (pages 2 – 4)