NEMSAC Recommends Addition of Naloxone to EMT, EMR Scope of Practice

Council also moves forward several other recommendations and elects new leadership

Bypassing the 3-step, 12-18 month process normally followed to approve a recommendation, the National Emergency Medical Services Advisory Council (NEMSAC) issued a strongly worded advisory saying that both EMRs and EMTs throughout the nation should be able to administer naloxone to patients with suspected opioid overdoses.

Driven to action by the severity of the opioid overdose epidemic, Council members formed an ad hoc committee earlier this year to respond to a request from NHTSA to look at whether the National EMS Scope of Practice Model should be changed to allow for wider use of opioid antagonists such as naloxone. At a meeting in Washington on September 7 and 8, the Council recommended a revision to this model that EMTs and EMRs in all states and territories should be trained to use opioid antagonists. This is the first time NEMSAC has advised a change to the Scope of Practice Model. Currently, six states do not allow EMTs to administer naloxone, while 15 states plus Washington, D.C. do not allow EMRs to do so. (Several of those states are considering proposals to make those changes.)

Anne Montera, a public health nurse consultant in Eagle, Colorado, headed the ad hoc committee. With the White House Office of National Drug Control Policy (ONDCP) involved in this issue, Montera and fellow committee members were eager to identify the important role of EMS providers in responding to the crisis.

“When the White House comes to you and asks for a solution, you have to deliver,” Montera said.

In the recommendation, the Council emphasized proper training of EMTs and EMRs for both medication administration and assessment of the patient. It also directs NHTSA to fund the development of an evidence-based guideline on naloxone administration in the field. NEMSAC suggested that the guideline should include information on the “specific risks and benefits of immediate versus deferred naloxone administration” as well as information on side effects and adverse reactions, ways to mitigate hazards to the responder and the patient, airway management, options if naloxone is not available or does not work, and resources for prevention and rehabilitation.

When discussing the recommendation, NEMSAC members agreed with the ad hoc committee’s assertion that improving access to naloxone “may stem the immediate mortality of an individual,” but doesn’t address the larger problem of addiction, lack of treatment plans and difficult access to rehabilitation programs.

“We have to focus on the cure part of this, or we are just temporizing an issue,” said Douglas Hooten, Executive Director of MedStar Mobile Healthcare in Fort Worth, Texas and NEMSAC member. “An emphasis on rehab has got to be a part of this document. Are we really making a difference?” A representative from the ONDCP, Luis Molero, addressed the NEMSAC members on behalf of the ONDCP director.

“There are 478 overdoses per day in this country,” Molero noted. “Overdose deaths now outnumber traffic crash deaths, and all of EMS needs access to naloxone. Emergency medical services are the front line of this crisis.”

New leadership for NEMSAC, NHTSA Office of EMS

Council members also elected a new chair, Vincent Robbins, who is the president and CEO of MONOC, one of New Jersey’s largest EMS and mobile healthcare providers. The newly-elected vice chair, Sabina Braithwaite, MD, is an emergency medicine physician, associate professor and EMS fellowship director in Saint Louis, Missouri.

Robbins represents hospital-based EMS on the council, and Braithwaite, Chair of the National Association of EMS Physicians Quality Improvement Committee, represents emergency physicians. They will serve one-year terms in their elected leadership roles on NEMSAC, whose members are appointed by the Secretary of Transportation every two years.

Before handing the gavel to Robbins, outgoing Chair John Sinclair, Fire Chief and Emergency Manager for Kittitas Valley Fire Rescue in Ellensburg, Washington, reiterated that NEMSAC members need to be bold and make their mark on what could be a number of turning points for EMS policy.

“This is a council of 25 rock stars of the EMS world,” Sinclair said. “With the new executive branch and a change in congressional make-up, we have an opportunity to make a fundamental change. Be mindful of where we are at in history. Let’s make a statement.”

Jon Krohmer, MD, was also introduced as the new director of the NHTSA Office of EMS. Krohmer is a physician with a long history in EMS, and he expressed his appreciation for the appointment and noted the achievements of his predecessor, Drew Dawson, who retired last year.

“I’ve got the same blood type as you folks do,” Krohmer said. “I now have the opportunity to be involved in the post-Dawson era, and I welcome the support that the Office of EMS gets from NHTSA and DOT.”

Council debates and votes to further consider other recommendations

In the Council’s discussion of other draft advisory statements, members engaged in passionate dialogue about the potential recommendation to require a college degree for all paramedic certifications. In fact, the Provider and Community Education Committee’s proposed recommendations spurred some contentious debate, as several committee members were skeptical of the value of requiring a baccalaureate degree for paramedics.

Brett Garrett, a firefighter/paramedic at Tuscaloosa Fire and chief of the Green Pond Volunteer Fire Department in Alabama, noted “people may have a knee-jerk reaction to this. We’re still young as a community, but I’m afraid we are going to scare a lot of rural and volunteer-based systems.” Other members were skeptical of the notion that a college degree would lead to higher compensation for providers.

The Council uses a two-step process for adopting recommendations for the DOT and FICEMS. Before a recommendation is finalized it must be reviewed and voted on twice at two different NEMSAC meetings.

Other recommendations adopted on an interim basis included:

  • Recognizing EMS as “Providers” under Medicare regulations and developing a plan for comprehensive payment reform;
  • Developing a standardized data managers training course to ensure high quality EMS data capture;
  • Organizing and facilitating a national community paramedicine (CP) and mobile integrated healthcare (MIH) data collection summit to create a national CP/MIH data dictionary;
  • Supporting the global sharing and transmission of health data through Health Information Exchanges (HIE) with bidirectional flow to all who care for patients.

The NEMSAC will consider these recommendations again at their December 1-2, 2016 meeting in Washington, DC. To review draft recommendations and provide your opinion on the future of EMS to NEMSAC, go to www.EMS.gov/nemsac.html.