Final Rule for Protecting Patient Access to Emergency Medications Act (PPAEMA)

The PPAEMA was unanimously approved by both the House and Senate on a bipartisan basis as a stand-alone bill and signed into law on November 17, 2017.  It was strongly supported by 17 organizations representing numerous interests in emergency medical services (EMS) and emergency medicine.  The Drug Enforcement Agency (DEA) promulgated a proposed rule on October 5, 2020.  As we are now approaching almost six years since enactment of this critical law, it is essential that the DEA finalize the regulation to provide clarity to the DEA offices and agents in the field and the entire EMS community.     

PPAEMA constitutes a new statutory framework that allows EMS agencies, professionals and medical directors to fulfill their mission to save lives and alleviate pain while also enabling the Drug Enforcement Administration (DEA) appropriate oversight to prevent drug diversion.  More specifically, it explicitly permits medical directors to issue standing orders to enable emergency medical services professionals to administer life-saving controlled substances to patients with emergency medical conditions.  It also clarifies and codifies who is authorized to provide verbal orders for controlled substances.  It provides the option for a single EMS agency registration as well as guidance and clarification regarding receipt, movement and storage of controlled substances for the EMS agency.   Most importantly, the law allows the EMS community to continue serving vulnerable emergency medical patients and providing the best possible care to those who need immediate life-saving and pain medications. 

One of the critical reasons for establishing a new statutory framework for the use of controlled substances in EMS, was to ensure a single set of rules, relevant to the EMS setting of care, and consistent application of those rules across the country.  Once the final rule is in place, it will provide the EMS community with a clear set of rules and DEA with auditable records and the necessary authority to prevent drug diversion.   The long delay of the final rule is contributing to continued confusion and inconsistent application of the law among DEA offices across the country and impeding a functioning system for use of controlled substances in EMS that the Congress intended to modernize on a completely bipartisan basis. 

NAEMSP Advocacy: ‎

  • Representatives Richard Hudson (R-NC) and Steve Cohen (D-TN) led a Congressional sign on letter to the DEA to urge him to finalize the final rule on PPAEMA.  The letter was also signed by Mike Ezell, Hank Johnson, Jasmine Crockett, Wiley Nickel, Colin Allred, Kelly Armstrong and Anthony Desposito.  We are most grateful for their efforts to secure promulgation of the final rule.
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