Federal EMS Advisory Board Asked to Address Response to Opioid Overdoses

NEMSAC to address the use of naloxone during meeting on April 18 and 19 in Washington

In recent months, hardly a day has passed without a headline related to opioid overdoses or administration of naloxone, a drug that reverses the effect of opioids such as heroin or morphine. While public health officials hope that increased access to naloxone will slow or stop the increase in opioid-related deaths, rapidly changing policies have also led to some opportunities and concerns in the public safety community.

For example, in some states, naloxone administration kits became available to the public or police officers, yet first responders and EMTs could not administer the drug. In others, laws were changed to allow basic life support providers such as EMTs or emergency medical responders (EMRs) to administer the drug, despite naloxone not being part of the national education or scope of practice standards for those certification levels.

In response to these concerns, the National Highway Traffic Safety Administration (NHTSA) has asked the National EMS Advisory Council (NEMSAC) to provide advice on the issue. In a letter to Chief John Sinclair, who chairs NEMSAC, NHTSA Office of EMS Acting Director Michael Brown asked the 25-member advisory panel to address two specific questions related to naloxone:

  • Should NHTSA revise the National EMS Scope of Practice Model to add the administration of narcotic antagonists (such as naloxone) to the Emergency Medical Responder (EMR) and EMT scopes of practice?
  • If so, what supporting materials would States need to implement a change in their scopes of practice?

"Administration of narcotic antagonists, such as naloxone, is included in the National EMS Scope of Practice Model for the Advanced EMT and Paramedic levels, but not the EMR or EMT levels," Brown wrote. "However, as of September 1, 2014, there are 19 States and territories that allow all levels of EMS practitioners to administer naloxone. NHTSA will begin a comprehensive revision of the National EMS Scope of Practice Model in 2016 but is requesting advice from the NEMSAC on whether action should be taken sooner."

Addressing EMS use of naloxone is just one of several efforts underway at the federal level related to the opioid crisis and first responders. In a letter to Michael Boticelli, Director of the Office of National Drug Control Policy, NHTSA Deputy Administrator Blair Anderson outlined some of those activities and why the issue is relevant to the EMS community.

"Around the country EMS personnel are treating opioid overdose patients on a daily basis," wrote Anderson, who currently serves as chair of the Federal Interagency Committee on EMS. "Data from the 2014 National EMS Database, a repository of standard EMS records submitted by 48 U.S. States and territories, indicate that EMS personnel administered naloxone 152,993 times to patients of all ages."

Anderson reiterated the FICEMS position statement on opioid overdoses: "It is the intent of FICEMS that EMS systems be fully integrated and coordinated with community-wide efforts to plan and respond to opioid overdoses." The position statement also recommends that naloxone administration by all responders be "coordinated with EMS system physician medical directors."

Other FICEMS activities related to the rise in narcotics use include:

  • Assessing whether an evidence-based guideline could be developed for prehospital management of opioid overdose;
  • Coordination between NHTSA, the U.S. Centers for Disease Control and Prevention (CDC) and other agencies to research the EMS response to overdoses; and
  • Promoting the use of electronic learning management systems to educate responders on naloxone.

As the National EMS Advisory Council considers issues related to opioids and naloxone, its members will look to the EMS community to provide input and share valuable insight. The letter from NHTSA will be discussed at the NEMSAC meeting in Washington on April 18 and 19, which is open to the public and will have time set aside for public comment. Members of the public are also invited to comment prior to the meeting by emailing nemsac@dot.gov. View the notice in the Federal Registerfor more details on the time and location of the meeting as well as how to register to attend.

Other items on the agenda for the April meeting of the NEMSAC, which is congressionally authorized to provide recommendations on EMS matters to the Department of Transportation and the FICEMS, include the Recognition of EMS Personnel Licensure Interstate Compact (REPLICA), the problem of drug shortages, and first responder mental health.