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NEMSAC: EMTs should be able to give Narcan

The council emphasized proper training of EMTs and EMRs for both medication administration and assessment of the patient


By EMS1 Staff

WASHINGTON — 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 stating 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 the National Highway Traffic Safety Administration (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 Sep. 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.

Anne Montera, a public health nurse consultant in Eagle, Colo., 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 frontline of this crisis.”