ACEP Advocacy Win: DEA Issues Long-Awaited EMS “Standing Orders” Final Rule

In a long-awaited victory, the federal Drug Enforcement Administration (DEA) issued the Registering Emergency Medical Services Agencies under the Protecting Patient Access to Emergency Medications Act of the 2017 Final Rule to ensure continued access to pain and anti-seizure medications for patients experiencing medical emergencies.

This regulation implements the ACEP-supported “Protecting Patient Access to Emergency Medications Act of 2017,” originally sponsored by one of ACEP’s longtime legislative champions, Rep. Richard Hudson (R-NC). Signed into law on November 17, 2017, the measure addressed issues regarding how EMS agencies store, handle, and administer controlled substances. The final regulation explicitly permits physician medical directors to issue standing orders to EMS personnel so that they may administer controlled substances to their patients.

ACEP was largely supportive of the DEA’s proposed rule issued in 2020 but did provide the agency with technical and clarifying comments, many of which were accepted in the final rule. Of note, the DEA agreed with our suggestions to more accurately reflect the way that EMS agencies operate throughout the country, and ease burdensome recordkeeping requirements to provide greater logistical flexibility — especially important for EMS in rural areas.

ACEP and National Health Care Groups Issue Joint Statement on Pediatric Readiness in Emergency Departments

An estimated 2,000 children could be saved if emergency departments follow a set of new recommendations focused on caring for young people in emergencies, leading organizations in emergency medicine stated. ACEP, the American Academy of Pediatrics, the Emergency Nurses Association, and the American College of Surgeons outline critical steps that emergency departments can take to be ready to care for sick or injured children.

“More than 80 percent of children who come to an emergency department go to a local community hospital, not a children’s hospital,” said Kate Remick, MD, FAAP, FACEP, FAEMS, lead author of the statement. “Every emergency department should be fully prepared for kids, no matter how often they see them. These recommendations save lives.”

The statement informs the work of the National Pediatric Readiness Project (NPRP), an initiative of the Emergency Medical Services for Children Program — part of the Department of Health and Human Services’ Health Resources and Services Administration — in collaboration with multidisciplinary organizations. The NPRP supports more than 5,000 emergency departments nationwide to improve their pediatric capabilities through self-assessments, benchmarking, checklists, quality dashboards, and other resources.

Updates to the previous recommendations include decision support tools; nationally vetted pediatric quality measures; an emphasis on a multidisciplinary review surrounding pediatric deaths and adverse events for local quality improvement; a deeper focus on pediatric mental health; reinforcement of the importance of immediately available, portable, weight-based pediatric resuscitation carts and use of medication dosage tools; and broader expectations for pediatric considerations in disaster preparedness.

The previous assessment published in 2023 noted improvements in five of six categories measured since 2013, including an increase in the number of emergency departments with pediatric equipment and supplies (90 to 97 percent) and the number of emergency departments with a pediatric mental health care policy (44 to 73 percent).

This year’s nationwide NPRP Assessment period starts on March 3 and runs through May 31. Emergency departments will be assessed on a 100-point scale and receive a score for benchmarking and a gap report identifying areas for improvement. 

“The 2026 assessment is our chance to see where we stand — and where we can do better,” said Marianne Gausche-Hill, MD, FACEP, FAAP, FAEMS, and a statement co-author. “The NPRP Assessment helps emergency care teams lead efforts to quantify the progress made and improvements needed to optimize emergency care for children. Further, participation in pediatric readiness efforts is among [the] criteria for ACEP’s ED Accreditation (EDAc) program, which demonstrates a commitment to quality and safety.”