May 19, 2016 at 1:42 PM
Re: Opioid Overdose and Naloxone: Collaboration for Policy Innovation
A recent Ministerial Order (MO) granted BC Emergency Health Services (BCEHS) the authority to require that BC’s Emergency Medical Assistants Licensing Board (EMALB) endorse first responders (FRs) and Emergency Medical Responders (EMRs), the two lowest tiers of Emergency Medical Assistants licensed by EMALB, “to dispense and administer narcotic antagonistic drugs”. Since the MO, BCEHS has trained a number of FR fire fighters to administer the drug intramuscularly.
Opioid overdose is undoubtedly a serious and complex issue because of the range of factors and the wide demographic affected. This issue involves health care, public policy, and drug policy, which are themselves domains of complex issues.
Policy decisions that have consequences for patient and provider safety from both clinical and regulatory perspectives need to be made carefully, taking into account relevant contextual factors and stakeholder concerns. The APBC has substantial concerns about the impact of this regulatory change on patient and practitioner safety, the regulatory environment, and in particular the policy-making process that led to this decision, as briefly detailed below.
- Prior to the Ministerial Order, only emergency medical assistants at the primary care paramedic (PCP) level and above were endorsed to perform intramuscular injections. PCPs have over 1,300 hours of training, whereas FR training is 42 hours. In order to be endorsed to administer naloxone, FRs attend an additional 4 hour training program.
- A further area of concern is that the MO has also authorized EMA FRs and EMRs, the two lowest tiers of EMAs, to dispense narcotic antagonist drugs. It should be noted that the upper tiers of paramedic practitioners do not have dispensing in their scope of practice.
- The Ministerial Order also presents regulatory inconsistencies. For example, for higher tiered EMAs, the legal authority for the naloxone administration lies with the EMALB, whereas for EMA FRs and EMRs, the legal authority lies with BCEHS. This has the potential to result in differences in education and examination standards for the same skill within the same profession, and to potentially lead to conflicts of procedure in the field.
As part of APBC’s contribution to such collaborative policy-making, we are pleased to offer the following report to stakeholders and all of BC’s residents, to encourage dialogue about the issue and, we hope, to inspire creative approaches to resolving it.
Click here to download a PDF version of the report.
Should you have any question or comments, please contact our office.
Ambulance Paramedics of BC
CUPE Local 873
Click here to download a PDF version of this message.