During the 2017 Virginia General Assembly, Senate Bill 1244 (SB1244) was introduced by Senator Siobhan S. Dunnavant to amend § 54.1-3408 of the Code of Virginia relating to glucagon administration by Emergency Medical Services (EMS) providers following concerns expressed by a constituent. Glucagon is a glucose elevating agent used to treat low blood sugar and is included in the scope of practice formulary for both Basic Life Support (BLS) and Advanced Life Support (ALS) EMS providers.

SB1244 provided as follows:

“Pursuant to regulations of the Board of Health, emergency medical services providers who are certified and authorized to administer drugs and devices and who hold an advanced life support certificate or basic life support certificate issued by the Commissioner of Health may possess and administer glucagon for the emergency treatment of hypoglycemia in accordance with existing protocols." (Code of Virginia, § 54.1-3408. Professional use by practitioners)

The Office of EMS in consultation with the Old Dominion EMS Alliance, Inc., the Goochland County Department of Fire Rescue and Emergency Services, and Hanover County Fire EMS leadership met to review the concerns that resulted in the introduction of SB1244. The meetings involved the EMS agency medical directors for Goochland and Hanover Counties and the State EMS Medical Director.

Existing EMS protocols allow for both BLS EMS providers (i.e., Emergency Medical Technicians (EMTs)) and ALS EMS providers (i.e., Advanced and Intermediates EMTs and Paramedics) to administer glucagon provided that the agency’s Operational Medical Director (OMD) endorses this activity. A review of the EMS patient care reports for Goochland and Hanover Counties indicated there were no adverse outcomes utilizing their current practice pertaining to the treatment of hypoglycemic patients with glucagon administered by ALS providers. The administration of glucagon by BLS providers has not been identified as a priority in these counties because ALS coverage and response is adequate, and there is no evidence of any incident where BLS providers would have needed the capability to administer glucagon.

Glucagon administration is included within the scope of practice for BLS and ALS EMS providers in the Commonwealth of Virginia. The Scope of Practice document may be accessed for reference through the Office of EMS website. (Virginia EMS Regulations 12VAC5-31-1050 - Scope of Practice)

Authorization to administer medications by EMS providers requires EMS providers to possess current certifications issued by the Virginia Department of Health, to be affiliated with a Virginia-licensed EMS agency, and to follow patient care protocols approved by their EMS agency OMD. Glucagon may be accessed through the Regional EMS Council (i.e., Old Dominion EMS Alliance, Inc.), an EMS drug kit, medications maintained on fire/rescue response apparatus outside of a drug kit with OMD approval, or in the personal possession of the EMS provider with approval of the EMS agency OMD. Glucagon is uniformly available in EMS medication kits across the Commonwealth and incorporated in regional patient care guidelines. Present operational standards, which have been utilized for decades, suggest the current patient care guidelines are safe and effective and serve the patient’s best interest. (2015 Regional Prehospital Patient Care Protocols, n.d.)

The ability of basic and advanced life support EMS providers to possess and administer glucagon for the emergency treatment of patients with low blood sugar currently exists; and, therefore, it is not necessary to propose the statutory changes recommended in SB1244 to allow this practice to occur or continue. (Scope of Practice - Procedures, 2013) (Scope of Practice - Formulary for EMS Personnel, 2015)

SB1244 was subsequently passed by indefinitely by the Senate Committee on Education and Health with a letter from the Clerk of the Senate to the State Health Commissioner directing the Virginia Department of Health to further study the matter (see Appendix A for the letter from the Clerk of the Senate to the State Health Commissioner).