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What's New
* The EMT/epinephrine bill ( S 66) has been enacted in South Carolina! The new law will make epinephrine more widely available from Emergency Medical Technicians (EMTs) in that state.
* Legislation is also being considered in Washington, D.C.The Emergency Access to Epinephrine Act ( B16-392) would authorize all EMTs in the District of Columbia to carry and administer epinephrine.
Overview of the Issue
According to physicians, prompt administration of epinephrine is the treatment of choice for anaphylaxis. However, FAAN learned a number of years ago that, in many states, certain types of EMTs may not be authorized to carry and administer this precious medication.
States generally have three types of EMTs:
1) EMT-Basics
2) EMT-Intermediates
3) EMT-Paramedics
FAAN found that, in the vast majority of states, only EMT-Paramedics (and sometimes Intermediates) were allowed to administer epinephrine. EMT-Basics, in fact, were only permitted to "assist" a patient with the patient's own prescribed epinephrine auto-injector. This surprised us because EMT-Basics generally make up the majority of EMTs in any given state.
Clearly, restricting the ability of EMT-Basics to administer epinephrine overlooks the possibility that a patient, or a patient’s family, may not be in possession of prescribed epinephrine at the time of a reaction. In such a situation, EMT-Basics responding to an anaphylactic emergency would be forced to transport the individual to the nearest hospital or to call for Paramedic (or Intermediate) backup. Either scenario delays treatment and could result in tragedy.
Because of this problem, FAAN members, along with medical professionals, allergists, lawmakers, and emergency personnel, undertook an initiative to implement laws or regulations that would make epinephrine more available from EMT-Basics in all states.
Thanks in part to this initiative, laws or regulations have been enacted in 30 states: New York and Washington (1999); Connecticut (2000); Colorado, Iowa, Illinois, Louisiana, and Texas (2001); Indiana, Kansas, Kentucky, Massachusetts, Maryland, Maine, Minnesota, Mississippi, New Hampshire and Oklahoma (2002); Idaho, Michigan, Missouri, Nebraska, New Jersey, North Carolina and Pennsylvania (2003); Virginia (2004); Arizona, Utah, and West Virginia (2005); and South Carolina (2006).
THE NATIONAL MAP
FAAN has reconfigured the national map (.jpg ~ 80 KB) regarding EMTs and epinephrine. Each state (as well as the District of Columbia) has been placed into one of three categories according to its EMT/epinephrine policy. This classification, though based on correspondence between FAAN and state EMS agencies, should not be considered absolutely precise, because decisions pertaining to EMTs often vary within each state. FAAN has always advised that individuals contact their state EMS agency and their local ambulance provider in order to clarify the coverage in their particular locality.
GROUP A [Excellent Coverage]
All EMTs are authorized, by law or regulation, to access and administer epinephrine.
Connecticut
Florida
Illinois
Iowa
Kentucky
Louisiana
Massachusetts
Maryland
Michigan
Minnesota
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New Hampshire
North Carolina
Oregon
Rhode Island
Tennessee
Utah
Virginia
Washington
Wisconsin
Wyoming
Total: 20 |
GROUP B [Locality-Dependent]
The legal/regulatory framework is in place that allows all EMTs to access and administer epinephrine, but this is determined by local factors, such as optional training and/or local medical control. In the case of Delaware and Hawaii, EMT-Basics are not allowed to access and administer epinephrine; however, due to the small size of the states, Advanced Life Support (ALS) ambulances staffed by Paramedics cover virtually the entire area.
Alaska
Arizona
California
Colorado
Delaware
Georgia
Hawaii
Idaho
Indiana
Kansas
Maine
Mississippi
Missouri |
Nebraska
New Jersey
New Mexico
New York
North Dakota
Ohio
Oklahoma
Pennsylvania
South Carolina
Texas
Washington, DC
West Virginia
Total: 25 |
GROUP C [Needs Improvement]
EMT-Basics are not allowed to access and administer epinephrine, and may only assist a patient in administering the patient's own prescribed epinephrine auto-injector.
Alabama
Arkansas
Montana
Nevada
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South Dakota
Vermont
Total: 6 |
FAAN hopes that soon EMT/epinephrine coverage will be seamless across the nation so that, no matter where an individual experiences an anaphylactic episode, EMTs will arrive at the scene both equipped with epinephrine and authorized to administer this precious medication.
If you’re interested in helping improve the state affairs regarding EMTs and epinephrine in your state, please send an e-mail.
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