# Paramedic administration of vaccinations



## medicdan (Sep 11, 2009)

Within the next week or so, MA OEMS is said to announce a program that would authorize and allow for certified EMT-Ps to administer seasonal and H1N1 vaccinations, IM or IN, as trained in medic school.

What is the precedent for this? Are other states already allowing it? What are the protocols? Liability? Training? QA/QI? 

I have many of the answers for MA, but will wait until they are released publicly. I am more interested in other state's policies.

Thanks,

Dan


----------



## akflightmedic (Sep 11, 2009)

Nothing new...during/after the hurricanes we (paramedics) were literally giving hundreds of vaccinations a day. We had shot tents set up all over the place, it was crazy. Long lines, assembly plant style.

I currently administer vaccinations in my medic position as well. 

We do flu, Hep A, Hep B, tetanus, rabies, TB testing (PPD). There is no issue with it as long as you have been trained, do a proper assessment, and watch for adverse reactions for the appropriate amount of time.

Interesting note on flu vaccines for medical providers when deciding whether or not to do IM versus IN...intra nasal flu vaccine is not recommended for health care providers due to the fact that you are now contagious for up to 21 days due to nasal shedding.


----------



## TransportJockey (Sep 11, 2009)

With auth from med control, Basics, I's, and Medics can give IM/SQ vaccinations here in NM


----------



## DV_EMT (Sep 11, 2009)

Currently in Ca... there has been discussion within the county to have Medics do H1N1 Vaccinations. 

IMO I think that its a smart idea, but just so long as everyone is trained to look for the correct S/S.


----------



## VentMedic (Sep 11, 2009)

The CDC site that describes the H1N1 Public Health Action which includes statements from different states:

http://www2a.cdc.gov/phlp/H1N1flu.asp

Some states already have this in their statutes for public health situations.  Florida dusts their statute off each time there is a major hurricane.


----------



## DV_EMT (Sep 11, 2009)

vent... so nice of you to show up this evening!!!

and of course as always.... thanks for the link!!


----------



## austinmedic77 (Sep 11, 2009)

This has been and continues to be standard practice in much of Texas.  Paramedics are used more often then nurses for community health clinics for many purposes to include routine vaccine administration.


----------



## LucidResq (Sep 12, 2009)

The paramedics at the amusement park I work for administer Hep B vaccinations to the rest of the first aid staff (medics and EMT-Bs) and lifeguards annually.


----------



## daedalus (Sep 12, 2009)

A paramedic is trained in IM and SC injections and should have no problem preforming vaccination. 

I do it in a public health clinic along side RNs and medical assistants.


----------



## ah2388 (Sep 18, 2009)

I may be off here, but my instructor mentioned the possibility of us medic students being able to give flu vacc's coming here soon.

this is in missouri


----------



## Ridryder911 (Sep 18, 2009)

Paramedics are "supposed" to be trained and educated in the administration of IM injections. I do not see why they could not administer a vaccine if taught properly. We do it routinely as well. 

R/r 911


----------



## VentMedic (Sep 18, 2009)

It is not just the skill of giving an IM, it is the needed paperwork and the education to the person receivig the vaccine that requires additional training.   Paramedics rarely have time during emergencies to discuss the pros and cons of each medication they give and advise the patient on what to do if this or that occurs and who to call (besides 911).   Patient education is a weak spot in the curriculum.  

Flu vaccines are not given a trial chance as other medications are and they can come with consequences.  Many states already have provisions to release those giving vaccinations from liability.  MA just refined their latest Bill that addresses who gives vaccines and without fear of consequences.   A few states, I believe North Dakota is one, do not allow Paramedics to give vaccines to children.  Florida also went through that issue a few years ago.  Right now some of our FD Paramedics are training to give flu shots.  However, I believe they will still advise those under 18 to go to a peditrician or pedi clinic.


----------



## paccookie (Sep 18, 2009)

ah2388 said:


> I may be off here, but my instructor mentioned the possibility of us medic students being able to give flu vacc's coming here soon.
> 
> this is in missouri



I gave lots of tetanus vaccinations during ER clinicals for medic school.


----------



## VentMedic (Sep 18, 2009)

paccookie said:


> I gave lots of tetanus vaccinations during ER clinicals for medic school.


 
In that situation you are giving the vaccine by a doctor's order. As well, the doctor and/or nurse may also have done the education part.

However, flu vaccinations are given without a doctor's order and to almost anybody that walks up. That is where a special consideration is needed for the training/education/liability of the Paramedics when it comes to giving a med (vaccine) that is not in a protocol, there is not a doctor's order and the patient has never taken this vaccine before.


----------



## Meursault (Sep 18, 2009)

This strikes me as the sort of thing that needs to be reserved for public health emergencies. H1N1 still isn't a public health emergency, and I doubt that most communities in Massachusetts are so short on nurses that they need to resort to paramedics for vaccine administration.

Influenza, including H1N1, is usually a minor, self-limiting illness in the general population. Any additional risk caused by having paramedics administer these vaccines probably isn't worth it.


----------



## arsenicbassist (Sep 18, 2009)

*military folks*

We give every immunization, so I'm not quite sure of state laws governing it. Whether it be Flu, Anthrax, Smallpox, JE, YF, Hep A and B, ppd testing, typhoid, dTap, and all pediatrics...we administer it and some of us run the whole program, depending on location and environment.


----------



## VentMedic (Sep 18, 2009)

arsenicbassist said:


> We give every immunization, so I'm not quite sure of state laws governing it. Whether it be Flu, Anthrax, Smallpox, JE, YF, Hep A and B, ppd testing, typhoid, dTap, and all pediatrics...we administer it and some of us run the whole program, depending on location and environment.


 
The military is a very different ballgame. 




MrConspiracy said:


> This strikes me as the sort of thing that needs to be reserved for public health emergencies. H1N1 still isn't a public health emergency, and I doubt that most communities in Massachusetts are so short on nurses that they need to resort to paramedics for vaccine administration.
> 
> Influenza, including H1N1, is usually a minor, self-limiting illness in the general population. Any additional risk caused by having paramedics administer these vaccines probably isn't worth it.


 
Did you read MA Senate Bill 2028?

http://www.mass.gov/legis/bills/senate/186/st02/st02028.htm

And, did you read the link I posted earlier?

http://www2a.cdc.gov/phlp/H1N1flu.asp


----------



## arsenicbassist (Sep 18, 2009)

True, but don't forget where most paramedic medicine was developed. I could expect the future to hold some good IMM's for us to use.


----------



## VentMedic (Sep 18, 2009)

arsenicbassist said:


> True, but don't forget where most paramedic medicine was developed. I could expect the future to hold some good IMM's for us to use.


 
And the military has done what to develop the Paramedic in the U.S.?   The field of medicine has also trialled many procedures and medications in the military which later became available for EMS.  

Freedom House Ambulance probably took those concepts to heart more than any other including Miami FD and Seattle.


----------



## Meursault (Sep 19, 2009)

VentMedic said:


> Did you read MA Senate Bill 2028?
> 
> http://www.mass.gov/legis/bills/senate/186/st02/st02028.htm
> 
> ...



After looking at those two, my point stands. I'm not arguing that paramedics who administer H1N1 vaccine are doing so outside of their scope of practice, nor that the state isn't legally treating this as an emergency. Normal, immunocompetent adults who don't work with high-risk populations and don't have critical jobs don't really need vaccinations. There's little need to cover the entire population and correspondingly little need to use other healthcare providers to vaccinate people. 





That said, I can't really judge the relative risks of vaccinating everyone versus assuming that healthy people won't die or become seriously ill because they get a bit of a fever (I know cytokine storms are suspected to have killed a lot of "normal, immunocompetent adults" during the 1918 pandemic, but I haven't seen anything to suggest that that's happening this time around). I don't think VAERS has anything yet. 

Sidenote: I saw a bit of a documentary the other day that ended by talking about the next emerging infectious disease that threatened to become a pandemic: H5N1. It's amusing how quickly that seems dated. Not that it's gone away, of course, but we're also not all dead from the Canada geese in our backyards.


----------



## VentMedic (Sep 19, 2009)

MrConspiracy said:


> After looking at those two, my point stands. I'm not arguing that paramedics who administer H1N1 vaccine are doing so outside of their scope of practice, nor that the state isn't legally treating this as an emergency. Normal, immunocompetent adults who don't work with *high-risk populations and don't have critical jobs don't really need vaccinations*.


 
Health care workers who are taking the necessary precautions around patients are not the ones getting the flu. If there weren't patients presenting to EMS and the hospitals with the flu, the health care workers wouldn't even be at risk. If you have read or even seen some of the patients getting H1N1, you would know this is not the typical flu. 

The Bill I linked to you for MA is also covers all of issues that should have been covered before Hurricane Katrina. The CDC link shows how many of the states are now prepared. The flu is only one example. Yes an area can run short of nurses and many other health care works. The MA Bill, as do others, addresses licenses from other states being recognized with a pandemic or disaster strikes. It was because of Hurricanes that Florida addressed Paramedics giving vaccinations. They have had a section in the Public Health statutes for many years. It is sad when a state waits for a disaster to happen and then wonder why important issues hadn't already been addressed. It is also sad when those in EMS don't see their own role in a disaster or pandemic. EMS should be just as prepared as the hospitals. 

Right now, even though we haven't declared a "state of emergency" our hospitals are full and we are using agency and traveling health care workers. That was something the hospitals had been trying to cut back on. However, when a patient arrives in the ICU for treatment of Flu associated ARDS, they may be there for a month easily. We've even expanded our ICUs into makeshift wings to accommodate the overflow. 

You are thinking too one dimensional here. Paramedics can be allowed to give vaccinations but it consists of a little more than just doing an IM injection. A little education or information about how, what and why should go with it. If an elderly person or parents with their child ask questions, the Paramedic should be able to say more than "because we can".



MrConspiracy said:


> Sidenote: I saw a bit of a documentary the other day that ended by talking about the next emerging infectious disease that threatened to become a pandemic: H5N1. It's amusing how quickly that seems dated. Not that it's gone away, of course, but we're also not all dead from the Canada geese in our backyards.


 
You only saw a bit? Did you see the parts with the different strains which is also related to why we are now calling the flu we have here in the U.S. H1N1? Did you also know there are variants to it which makes testing very complex?


----------

