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ASPPH/NHTSA Fellow Leads Policy Review on EMS Authority to Administer Naloxone

Mr. Jeremy Kinsman (Tulane University School of Public Health and Tropical Medicine), a third year ASPPH/National Highway Traffic Safety Administration (NHTSA) Fellow, along with Ms. Kathy Robinson, a colleague from the National Association of State EMS Officials (NASEMSO), conducted a policy review of state policies on emergency medical services licensure levels’ authority to administer opioid antagonists. They found that as of September 1, 2017, 49 of the 52 US Jurisdictions reviewed authorize all their EMS licensure levels to administer naloxone.  Published online in the journal Prehospital Emergency Care on February 6, National Systematic Legal Review of State Policies on Emergency Medical Services (EMS) Licensure Levels’ Authority to Administer Opioid Antagonists, provides an updated description of policy on EMS licensure levels’ (emergency medical responder, emergency medical technician, advanced emergency medical technician, and paramedic) authority to administer naloxone for all 50 US States, the District of Columbia (DC), and the Commonwealth of Puerto Rico.

Following publication of the article the remaining two states, Wyoming and Montana, made state policy changes authorizing naloxone administration for all their EMS licensure levels as well. A March 20 announcement from NASEMSO declared that all 50 US states and DC now authorize their EMS licensure levels to administer naloxone.

“I think this is a great example of research driving policy and practice,” says Mr. Kinsman. “Research published in 2013 by Corey Davis from the Network for Public Health Law showed that while every state allowed paramedics to administer naloxone, EMTs could only administer it in 13 states, and only 3 states allowed EMRs to do so, and we’ve got this massive opioid crisis going on. Folks in public health and EMS realized this was a problem especially in rural areas that often have fewer paramedics, and so states started making emergent changes to their EMS licensure levels’ scope of practice law or policy so that EMTs and EMRs could administer naloxone. And now it seems the policy review Kathy Robinson and I conducted may have encouraged the last few states to make changes to their EMS naloxone policies as well.”

Mr. Kinsman and Ms. Robinson used a multi-tiered approach to review each state’s EMS policy on naloxone that involved first determining the EMS licensure levels defined in state law and second whether each of those defined licensure levels were authorized to administer naloxone. “Some states do not have EMRs or AEMTs, and every state is a little different in how they authorize procedures and medications for EMS,” says Mr. Kinsman. “Some have a scope of practice for every licensure level defined in state statute or code. Other states have protocols or guidelines for each licensure level that are defined by a state office of EMS or a state medical board. So, it was great to have Kathy Robinson and NASEMSO as a partner on this research because they have knowledge of the different ways states define what medications can be administered by EMS.”

The article concluded that as of September 1, 2017, 48 states and DC authorized Emergency Medical Technicians (EMTs) to administer naloxone and of the 40 US Jurisdictions (39 states and DC) that define the Emergency Medical Responder (EMR) licensure level (or an equivalent medical first responder licensure) in state law, 37 states and DC authorize the EMR to administer naloxone. Following changes since the articles publication all 50 US States and DC now authorize their EMTs and EMRs to administer naloxone.  With these policy changes, EMTs and EMRs have access to a lifesaving medication that can give patients who suffer an opioid overdose a second chance at life.

“My ASPPH fellowship with NHTSA has been outstanding,” says Mr. Kinsman. “It was great to transition from my MPH program into the fellowship, where I could immediately start putting the skills and knowledge that I learned as a student to work impacting population health. This is the fifth research project I have worked on related to EMS and the opioid crisis and the second that has been published.  So as an ASPPH fellow, I have had a lot of great opportunities to improve the public’s health while developing my public health career.”