Memo To Ohio EMS Providers, EMS Agencies, And EMS Medical Directors

On June 26, 2024, the State Board of Emergency Medical, Fire, and Transportation Services approved the administration of glucagon via the intranasal or intramuscular routes for hypoglycemia at the emergency medical technician (EMT) level and above for certified Ohio EMS providers as an added competency. Added competencies are elective services that are not required to be taught and are not included in the statewide approved initial training curricula for EMRs, EMTs, AEMTs, and Paramedics. For services classified as added competencies, the medical director is responsible for providing the education and training for each specific service he or she elects to authorize. Analogous to core competencies, the medical director must also provide a written protocol, continuing education, and a quality assurance program for each added competency.

It has been brought to the attention of the Ohio Department of Public Safety, Division of EMS that some EMS medical directors are directing their EMS providers to administer glucagon in its intravenous or intramuscular formulation to patients via the intranasal route. Unlike naloxone where the intravenous formulation is equally effective via the intranasal route, the formulation of glucagon for the intravenous or intramuscular route has poor absorption when administered via the intranasal route. Formulations of glucagon in combination with a surfactant, such as sodium glycocholate or 9-lauryl ether, are most effective for the treatment of hypoglycemia via the intranasal route. Surfactants facilitate the absorption and pharmacologic availability of glucagon when administered via direct contact with the mucous membranes within the nasal cavity.

This communication has been provided for informational purposes in an effort to advise you of the most effective treatment for patients who have hypoglycemia. If you have any questions, please feel free to contact me or a member of our staff at the Ohio Department of Public Safety, Division of EMS at (800) 233-0785. Thank you for your dedicated service to Ohio EMS.