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house Bill H.R. 4365

Do Paramedics Need to Legally be Able to Administer Narcotics to Patients?

Argument in favor

Paramedics and other emergency medical technicians often assist patients when they are in dire need of pain medication or anti-seizure drugs, so it needs to be legally clear that they can administer those medications.

Erika's Opinion
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11/14/2016
As an ICU nurse, I can tell you that when a patient's heart stops, we don't wait for a doctor to arrive. We give life saving medicine based off of pre-prescribed protocols until a doctor arrives. I guarantee you that if you're ever mangled in a horrible accident, you're going to wish you supported narcotics being given as soon as possible.
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Ian's Opinion
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11/14/2016
I'm a career firefighter and paramedic of 20 years and I personally know the value of this bill. Please contact me if you have any thoughts or questions.
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Jeff's Opinion
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02/13/2016
Painful conditions (broken bones, abdominal pain, chest pain) are among the most common reasons for requesting EMS assistance. Current DEA regulations are prevented by outdated law from allowing paramedics to give narcotic pain medications to these patients based on protocol or 'standing orders'. Requiring a physician's order for each administration of pain medication will clearly decrease the rate of appropriate analgesia. The current practice of providing these medications is actually in violation of these outdated regulations. This bill will put in place the framework to allow this practice.
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Argument opposed

Existing law doesn’t need to be clarified to ensure that paramedics can administer drugs that are considered controlled substances without a doctor being present, it’s already permitted and that policy will remain in effect.

Betsy's Opinion
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11/14/2016
EMS should do just what their name suggests, administer emergency meds to keep the person alive so they can be treated at the hospital. Narcotics, generally speaking, are not a part of that. Sometimes narcotics can mask symptoms so that the patient is harder to diagnose and treat at the hospital. The fewer substances introduced into the patient by EMS, the better. There is also the problem of the narcotics being taken/stolen from them. It puts the EMTs needlessly at risk.
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Stefnic's Opinion
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11/14/2016
The scope of emergency personnel the bill gives power to administer narcotics is too broad. This means training and licensure regulations would need to be revamped as well. As it stands not all emergency responders have adequate training or backgrounds for this expansion of service. I would feel more comfortable with a change in licensure requirements and training added to the language of the bill.
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Luke's Opinion
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11/14/2016
Once again of the Federal government needs to stay out of the states business. Most states paramedics can give narcotics already. Wisconsin paramedics give narcotics on a regular basis. It all depends on your medical Director who decides protocols for that specific ambulance service.
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What is House Bill H.R. 4365?

This bill would clarify existing law to ensure that emergency medical responders are able to administer controlled substances — like pain narcotics and anti-seizure medications — under the supervision of a physician. It would let paramedics, nurses, or emergency medical service (EMS) providers give patients those medicines based on instructions given by physicians ahead of time.

An existing policy that allows standing orders to be granted by a physician about the administration of controlled substances would be made into law. The physician would retain oversight over medical decisions.

EMS responsible would be liable for receiving, storing, and tracking controlled substances under their care in a manner similar to current procedures at hospitals.

Impact

Emergency medical responders; their patients; and doctors.

Cost of House Bill H.R. 4365

A CBO cost estimate is unavailable.

More Information

In-Depth: Sponsoring Rep. Richard Hudson (R-NC) introduced this bill to ensure that the law clearly allows emergency medical responders to administer controlled substances when treating patients:

“Without this solution, we risk sacrificing emergency care and endangering patients simply because law and regulation have no kept up with the evolution of modern medicine. This legislation is an important clarification of law that allows our first responders to continue administering life-saving medications when they need them most.”

This legislation passed the House Energy and Commerce Committee on a voice vote, and has the bipartisan support of 134 cosponsors in the House — including 89 Republicans and 45 Democrats.


Media:

Summary by Eric Revell
(Photo Credit: James Hellman, MD / Creative Commons)

AKA

Protecting Patient Access to Emergency Medications Act of 2016

Official Title

To amend the Controlled Substances Act with regard to the provision of emergency medical services.

bill Progress


  • Not enacted
    The President has not signed this bill
  • The senate has not voted
  • The house Passed November 14th, 2016
    Passed by Voice Vote
      house Committees
      Committee on Energy and Commerce
      Health
      Committee on the Judiciary
      Crime, Terrorism and Homeland Security
    IntroducedJanuary 12th, 2016

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    As an ICU nurse, I can tell you that when a patient's heart stops, we don't wait for a doctor to arrive. We give life saving medicine based off of pre-prescribed protocols until a doctor arrives. I guarantee you that if you're ever mangled in a horrible accident, you're going to wish you supported narcotics being given as soon as possible.
    Like (75)
    Follow
    Share
    EMS should do just what their name suggests, administer emergency meds to keep the person alive so they can be treated at the hospital. Narcotics, generally speaking, are not a part of that. Sometimes narcotics can mask symptoms so that the patient is harder to diagnose and treat at the hospital. The fewer substances introduced into the patient by EMS, the better. There is also the problem of the narcotics being taken/stolen from them. It puts the EMTs needlessly at risk.
    Like (17)
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    I'm a career firefighter and paramedic of 20 years and I personally know the value of this bill. Please contact me if you have any thoughts or questions.
    Like (39)
    Follow
    Share
    Painful conditions (broken bones, abdominal pain, chest pain) are among the most common reasons for requesting EMS assistance. Current DEA regulations are prevented by outdated law from allowing paramedics to give narcotic pain medications to these patients based on protocol or 'standing orders'. Requiring a physician's order for each administration of pain medication will clearly decrease the rate of appropriate analgesia. The current practice of providing these medications is actually in violation of these outdated regulations. This bill will put in place the framework to allow this practice.
    Like (21)
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    Share
    The scope of emergency personnel the bill gives power to administer narcotics is too broad. This means training and licensure regulations would need to be revamped as well. As it stands not all emergency responders have adequate training or backgrounds for this expansion of service. I would feel more comfortable with a change in licensure requirements and training added to the language of the bill.
    Like (15)
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    Of course they should be allowed! There people involved in horrible accidents that require immediate attention before and during transportation to a medical facility and the pain that is suffered could cause the to go onto major shock and further trauma while in route to any facility! Medics and Corpsmen in the Military administer certain pain medication to the wounded on the battlefield and so should our paramedics!
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    As long as there is a physician oversight, then yes.
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    When I broke my ankle, the pain relief the first responders gave me helped me answer their questions at the site of the accident, in the ambulance, and talk to the doctors at the hospital. I would have been much less coherent with the paramedics if they hadn't been able to give me pain relief, and I know they need those answers to safely keep treating me and to get me to the hospital as quickly as possible.
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    Oh my god I've read the naysayers comments and I'd be deeply embarrassed if anyone I knew felt that way. Yes. I'm a paramedic. I carry narcs. We need them for many things. I have lots and lots of training for their use. They are highly regulated and we must account for all of them. If they are missing or stolen, we must fill out hours of paperwork and file police work.
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    The last thing I would want to hear if I had a broken leg would be - sorry, I can't give you pain meds cuz law ¯\_(ツ)_/¯ help our injured civilians through their most vulnerable times
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    This is often necessary to wean narcotic addicts off of substance abuse. Going cold turkey can risk lives with many narcotics, and some federal narcotics, like marijuana, have medicinal uses.
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    Saving lives must take priority over bureaucratic rules.
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    If this can immediately help in saving someone's life, then I'm all for it.
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    Once again of the Federal government needs to stay out of the states business. Most states paramedics can give narcotics already. Wisconsin paramedics give narcotics on a regular basis. It all depends on your medical Director who decides protocols for that specific ambulance service.
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    As a paramedic, administering a large amount of medications to patients is one of the few things that separates us from regular EMTs. We go through a very long program as well as countless hours of hospital clinical time and ride time on an ambulance to learn how and when to administer medications. Not to mention, everything we do is based off protocols that are written and signed off by a physician. Control substances are always kept monitored and checked every day. Also, if a particular call involves a combative, violent, or otherwise dangerous patient, the police department is always involved. The chance of a patient stealing controlled substances is and will always be there. It's just a matter of it being worth the risk to provide pain medications and sedatives to patients who need it.
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    If it save their lives they should be able too!
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    Absolutely! They are qualified and a first responder. I trust their judgement as they are the ones between me and a doctor. We, also, need to be paying ALL first responders a lot more!
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    Certified emergency personnel in the military handle a much broader range of tasks requiring trained independent judgement than are permitted to civilian emergency personnel. There are no essential differences in their training or competency assessments from civilian first responders. So it has always puzzled me, as a critical care RN, why a patient in pain must wait until arriving in the ER and going through a full medical triage before having their severe pain at least partially relieved. With the waits in many ERs, it would only seem logical to adequately train, regulate and routinely evaluate the performance of first responders in the handling of a specific number of narcotics. There is certainly plenty of documented evidence from the military to warrant this. In my experience, EMTs and paramedics are, generally speaking, overly vigilant regarding the limitations of their practice. Their accountability for drugs and for their performance in their use would follow similar lines as RNs in the field. This could be addressed through modifications of current laws and regulations and implemented through regulations designed to provide a limited number and dosage of narcotics, as well as a modified form of computer-type devices to manage usage monitoring.
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    This just clarifies current law. Giving paramedics the ability to administer narcotics within standard operating procedures set by physicians, especially in rural areas where a hospital may be upwards of an hour away, is generally accepted as being in the patient's best interest.
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    This would greatly help patients that are in serious pain caused by their injuries. Having a small cache of these will help our emergency responders with their patients to help ease them.
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