STORAGE NAME: h0519.HPP
DATE: 3/12/2025
1
FLORIDA HOUSE OF REPRESENTATIVES
BILL ANALYSIS
This bill analysis was prepared by nonpartisan committee staff and does not constitute an official statement of legislative intent.
BILL #: HB 519
TITLE: Administration of Controlled Substances by
Paramedics
SPONSOR(S): Bartleman
COMPANION BILL: None
LINKED BILLS: None
RELATED BILLS: None
Committee References
Health Professions & Programs
Health & Human Services
SUMMARY
Effect of the Bill:
The bill allows certain health care practitioners to authorize a certified paramedic, under their direction and
supervision, to administer a controlled substance.
Fiscal or Economic Impact:
None
JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
ANALYSIS
EFFECT OF THE BILL:
Current Florida law does not expressly authorize or prohibit paramedics from administering controlled
substances.
The Controlled Substances Act (CSA) of 1970 is the federal drug policy under which the manufacture, importation,
possession, use and distribution of controlled substances are regulated. Prior to 2017, the CSA did not include
guidance on administration of controlled substances by emergency medical services (EMS) personnel, which led to
confusion among states concerning their authority to allow EMS professionals to administer controlled substances.
The Federal Protecting Patient Access to Emergency Medications Act of 2017 (PPAEMA) amended the CSA to
authorize emergency medical services (EMS) professionals to administer controlled substances outside the
physical presence of a medical director or other authorizing professional, under certain circumstances:
The bill allows certain health care practitioners to authorize a certified paramedic, under their direction and
supervision, to administer a controlled substance. (Section 1)
The bill shall take effect upon becoming a law. (Section 2) JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
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RELEVANT INFORMATION
SUBJECT OVERVIEW:
Paramedics
Emergency medical responders include paramedics and emergency medical technicians (EMTs) certified by DOH.
The nomenclature used to describe emergency medical responders has evolved as the workforce has
professionalized in the years since the first training program for ambulance attendants was developed in the
1950s.
1 For roughly 40 years, the terms “emergency medical responder” and “first responder” were used as rough
approximations of one another, in both state law
2 and federal guidelines.
3 In the late 1990s and early 2000s, the
profession underwent a wave of national standardization which led to the term “first responder” falling out of use
as the National Highway Traffic Safety Administration (NHTSA), under the U.S. Department of Transportation,
transitioned to exclusive use of the more specific term “emergency medical responder.”
4
The profession has specialized into two classes of emergency medical responders; EMTs who are certified to
provide basic life support (BLS), and paramedics who are certified to provide both basic and advanced life support
(ALS) to patients. BLS refers to any emergency medical service that uses only basic life support techniques.
5 BLS
includes basic non-invasive interventions to reduce morbidity and mortality associated with out-of-hospital
medical and traumatic emergencies.
6 The services provided may include stabilization and maintenance of airway
and breathing, some pharmacological interventions, trauma care, and transportation to an appropriate medical
facility.
7
ALS refers to any emergency medical or non-transport service that uses advanced life support techniques.
8 ALS
includes the assessment or treatment of a person by a qualified individual, such as a paramedic, who is trained in
the use of techniques such as the administration of drugs or intravenous fluid, endotracheal intubation, telemetry,
cardiac monitoring, and cardiac defibrillation.
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To be certified as a paramedic, a person must complete an approved Florida paramedic training course, submit an
application to DOH, and pass the National Registry of Emergency Medical Technicians examination.
10
Controlled Substances
Florida Law
Chapter 893, F.S., the Florida Comprehensive Drug Abuse Prevention and Control Act (Act), classifies controlled
substances into five categories, called schedules. These schedules regulate the manufacture, distribution,
preparation, and dispensing of the substances listed therein. The distinguishing factors between the different drug
1 U.S. Department of Transportation, National Highway Traffic Safety Administration, National Emergency Medical Services, Education
Standards. (2021). Available at https://www.ems.gov/assets/EMS_Education-Standards_2021_FNL.pdf (last visited March 12, 2025).
2 See, Ch. 401, F.S.; See also, Ch. 95-408, Laws of Fla.
3 See, U.S. Department of Transportation, National Highway Safety Administration, First Responder: National Standard Curriculum (1995).
Available at https://www.ems.gov/assets/FR_1995.pdf (last visited March 12, 2025).
4 Supra, note 1, p. 10. See also, U.S. Department of Transportation, National Highway Traffic Safety Administration, National Emergency
Medical Services, Education Standards. (2000). Available at https://www.ems.gov/assets/EMS_Education_Agenda-1663283496.pdf (last
visited March 12, 2025).
5 S. 401.23(8), F.S.
6 S. 401.23(7), F.S., and U.S. Department of Transportation, National Highway Safety Administration, National EMS Scope of Practice Model
23-24. Available at www.nhtsa.gov/people/injury/ems/pub/emtbnsc.pdf (last visited March 12, 2025).
7 Id.
8 S. 401.23(3), F.S.
9 S. 401.23(2), F.S.
10 Florida Department of Health, Licensing, Notice to Paramedic Students, available at https://www.floridahealth.gov/licensing-and-
regulation/emt-paramedics/licensing/index.html (last visited March 12, 2025). JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
3
schedules are the “potential for abuse”
11 of the substance and whether there is a currently accepted medical use for
the substance.
12
The controlled substance schedules are as follows:
Schedule I substances have a high potential for abuse and currently have no accepted medical use in the
United States, including substances such as cannabis and heroin.
13
Schedule II substances have a high potential for abuse and have a currently accepted but severely
restricted medical use in the United States, including substances such as raw opium, fentanyl, and
codeine.
14
Schedule III substances have a potential for abuse less than the substances contained in Schedules I and II
and have a currently accepted medical use in the United States, including substances such as stimulants and
anabolic steroids.
15
Schedule IV substances have a low potential for abuse relative to substances in Schedule III and have a
currently accepted medical use in the United States, including substances such as benzodiazepines and
barbiturates.
16
Schedule V substances have a low potential for abuse relative to the substances in Schedule IV and have a
currently accepted medical use in the United States, including substances such as mixtures that contain
small quantities of opiates, narcotics, or stimulants.
17
Under the Act, a practitioner
18 in good faith and in the course of his or her professional practice only, may
prescribe, administer, dispense, mix, or otherwise prepare a controlled substance, or the practitioner may
authorize a controlled substance to be administered by a licensed nurse or an intern practitioner under his or her
direction and supervision only.
19
Federal Law
The Federal Controlled Substances Act (CSA) also classifies controlled substances into schedules based on the
potential for abuse and whether there is a currently accepted medical use for the substance. The Drug Enforcement
Administration (DEA) is required to consider the following when determining where to schedule a substance:
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The substance’s actual or relative potential for abuse;
Scientific evidence of the substance’s pharmacological effect, if known;
The state of current scientific knowledge regarding the substance;
The substance’s history and current pattern of abuse;
The scope, duration, and significance of abuse;
What, if any, risk there is to public health;
The substance’s psychic or physiological dependence liability; and
11
S. 893.035(3)(a), F.S., “potential for abuse” means that a substance has properties as a central nervous system stimulant or depressant or a
hallucinogen that create a substantial likelihood of its being: 1) used in amounts that create a hazard to the user’s health or safety of the
community; 2) diverted from legal channels and distributed through illegal channels; or 3) taken on the user’s own initiative rather than on
the basis of professional medical advice.
12
See s. 893.03, F.S.
13
S. 893.03(1), F.S.
14
S. 893.03(2), F.S.
15
S. 893.03(3), F.S.
16
S. 893.03(4), F.S.
17
S. 893.03(5), F.S.
18
S. 893.02(23), F.S., “Practitioner” means a physician licensed under chapter 458, a dentist licensed under chapter 466, a veterinarian
licensed under chapter 474, an osteopathic physician licensed under chapter 459, an advanced practice registered nurse licensed under
chapter 464, a naturopath licensed under chapter 462, a certified optometrist licensed under chapter 463, a psychiatric nurse as defined in s.
394.455, a podiatric physician licensed under chapter 461, or a physician assistant licensed under chapter 458 or chapter 459, provided
such practitioner holds a valid federal controlled substance registry number.
19
S. 893.05(1), F.S.
20
21 U.S.C. § 811(c). JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
4
Whether the substance is an immediate precursor of a substance already controlled.
Emergency medical services (EMS) agencies use controlled substances for ALS patient care. However, until 2017,
the CSA did not include guidance on administration of controlled substances by EMS agencies or EMS personnel.
This lack of guidance led to confusion among states and EMS agencies concerning their authority, or lack thereof, to
allow EMS professionals to administer controlled substances.
Prior to 2017, the CSA required physicians, pharmacists, manufacturers, and researchers to register with the DEA
before making, distributing, administering, or studying substances on the national list of controlled substances.
While the CSA did not specifically provide such authority to EMS agencies, some states and EMS agencies
interpreted the rule to allow them to administer controlled substances under the DEA registration of the medical
director or the hospital overseeing the EMS agency’s patient care.
21 Additionally, some states
22 interpreted the CSA
as allowing controlled substance administration by EMS professionals pursuant to a standing order.
23
The Protecting Patient Access to Emergency Medications Act of 2017 (PPAEMA) amended the CSA to create a
single set of rules, relevant to the EMS setting of care, to be applied consistently across the county.
24 The PPAEMA
authorizes EMS professionals
25 of a registered EMS agency to administer controlled substances in schedule II, III,
IV, or V outside the physical presence of a medical director or authorizing medical professional, only if the EMS
agency:
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Is authorized to do so by state law;
Is registered with the DEA; and
Has a standing order or verbal order from a medical director or an authorizing medical professional.
BILL HISTORY
COMMITTEE REFERENCE ACTION DATE
STAFF
DIRECTOR/
POLICY CHIEF
ANALYSIS
PREPARED BY
Health Professions & Programs
Subcommittee
McElroy Guzzo
Health & Human Services
Committee
21
See 64J-1.004(3)(c), F.A.C., Or. Admin R. 333-250-0300 (2017), and N.D. Admin. Code 61-09-01-01 (2017).
22
See e.g. N.D. Admin. Code 61-09-01-01 (2017), N.Y. Comp. Codes R. & Regs. 10, § 80.136 (2017), and 172 Neb. Admin. Code Ch. 12, § 004.
23
Standing orders are written protocols pre-approved by a medical director and commonly used in the practice of pre-hospital emergency
medicine, see e.g., rule 64J-1.001(3)(a), F.A.C.
24
Protecting Patient Access to Emergency Medications Act, H.R. 304, 115th Cong. (2017).
25
21 U.S.C. § 823(k)(13)(E), “Emergency medical services professional” means a health care professional (including a nurse, paramedic, or
emergency medical technician) licensed or certified by the State in which the professional practices and credentialed by a medical director of
the respective emergency medical services agency to provide emergency medical services within the scope of the professional's State license
or certification.
26
21 U.S.C. § 823(k)(4).