TO: All MA Licensed Ambulance Services and MA Accredited EMT Training Institutions
CC: EMCAB Members
FROM: Dr. Jonathan Burstein, State Emergency Medical Services (EMS) Medical Director
DATE: September 16, 2016, updated January 19, 2017, September 26, 2017 and October 26, 2017
RE: Required Medications on ALS Ambulances per Statewide Treatment Protocols, v. 2016, including v. 3
In order for ambulances services licensed at the advanced life support (ALS)-Advanced EMT and Paramedic levels to provide care in accordance with the updated Statewide Treatment Protocols (STP), v. 2016.3, which become effective January 1, 2018, they will need to make some changes in the medications or medication levels they carry.
Services must complete training and medication changes for STP v.2016.3 by December 31, 2017. Once a service has successfully trained all of their providers, and adjusted vehicle medication levels, they may begin operating under the revised protocols.
Norepinephrine may only be administered via infusion pump. Services may use Dopamine instead of Norepinephrine until they have pumps available on their ambulances. Services that have trained and equipped their EMS personnel may begin having them use the pumps immediately. Norepinephrine should be packaged with 250mL 5% Dextrose diluent, or may be supplied as a premixed infusion from the pharmacy.
Paramedic units must carry full doses of Midazolam, and at least minimum quantities of either Diazepam or Lorazepam. It is permissible to carry all three benzodiazepines. Fentanyl must be carried, but Morphine is optional. Ketamine has been added to 2.4 Behavioral Emergencies, also as an optional medication.
Minimum medication quantities reflect operational use and reasonable restocking time. For those services that have high volume and/or limited access to drug replacement through their affiliate hospital’s pharmacy, adjustments to minimum drug quantities may be needed. Alternative drug replacement for off hours may be necessary in order to maintain minimum par levels.
• Medications may be available in concentrations not listed below, and should be maintained in consultation with the hospital pharmacist and affiliate hospital medical director.