Evolution of Statewide EMS Drug Formularies andRegulations

Abstract

Objective. To characterize andfollow the variability present in statewide emergency medical services (EMS) medication formularies across the United States over a ten-year period.Methods. Investigators contacted the lead EMS agencies in all 50 states during three years (1992, 1997, and2002). Using a standardized form, the investigators collected information about each state's prehospital medication policies, including whether a statewide EMS medication formulary existed, the authority of local medical directors to modify it, andwhat medications it contained. The investigators then sorted states into categories based on the regulatory intent of their EMS medication policies andcompared medication listings across years.Results. Responses were obtained from all 50 states (n = 50, 100%) during each of the survey periods. There appeared to be a trend toward stricter state control andtoward less variation between statewide formularies. State regulations in seven states stopped allowing local medical directors to retain full control of their systems' formularies, andeight states implemented mandatory statewide formularies. There was a trend toward more consistency between states, with more “most commonly” listed medications (6.9% in 1992 versus 22.1% in 2002) andfewer “least commonly” listed medications (58.3% in 1992 versus 42.3% in 2002). Controversial medications such as neuromuscular blockers andthrombolytics appeared in a small but increasing number of statewide formularies.Conclusions. Considerable variation was found among statewide EMS medication formularies, both in how they were established andin their contents. Although several states continued to rely solely on local medical direction, there seemed to be a trend toward more uniformity andstricter state control over prehospital medication formularies during the study period.Key words: emergency medical services; legislation, medical; medical directors; clinical practice variation; formularies; medication.

Keywords:

• emergency medical services
• legislation,medical
• medical directors
• clinical practice variation;
• formularies
• medication