Patrick Lee

Dear Members of the House Health, Human Services and Elderly Affairs committee: I am writing to provide medical justification for the provision of elective intravenous (IV) therapy services in an outpatient setting, with administration performed by licensed paramedics operating under direct physician supervision. I am requesting an amendment to the proposed HB 1321 to add paramedics as another class of medical professional who can administer elective IV therapy. If unable to amend, I am opposing the passage of this bill in hopes an amendment can be added to include paramedics in a future bill regarding this matter. Rationale based on clinical evidence: Paramedics are highly trained healthcare professionals with extensive experience in peripheral IV catheter insertion and IV fluid/medication administration. Studies demonstrate that paramedics achieve IV cannulation success rates of 80-92% across diverse patient populations and clinical settings. A population-based study of over 56,000 patients found that IV access established by EMS personnel was associated with favorable clinical outcomes, with no increased risk of adverse events. The safety profile of paramedic administered IV therapy is well-established. Both basic life support and advanced life support paramedics are trained in patient assessment, vital sign monitoring, and the administration of IV fluids, operating under medical directives and physician oversight. The American Heart Association recognizes peripheral IV access as a standard skill within paramedic scope of practice, with established protocols for vascular access and medication administration. Regulatory Framework and Oversight: Community paramedicine programs, in which paramedics provide care outside traditional emergency response roles, are recognized in numerous U.S. states with appropriate regulatory frameworks. These programs demonstrate that paramedics can safely practice with an expanded scope under physician supervision, improving patient access to care while maintaining safety standards in or outside a hospital or office setting. State policies generally recognize that the provision of IV therapy constitutes a practice of medicine requiring physician oversight, with administration performed by licensed professionals (including paramedics) with medication administration within their scope of practice. Proposed Model of Care (i.e. adding paramedics to who may administer IV therapy) The outpatient IV therapy services described herein will operate under the following safeguards: 1. Physician Supervision: All IV therapy will be prescribed by a licensed physician/PA/NP following individualized patient assessment. A supervising physician or PA or ARNP will be available or immediately accessible for consultation during all treatment sessions, while in an office or mobile setting. 2. Qualified Personnel: IV catheter insertion and infusion administration will be performed by licensed paramedics with current certifications and demonstrated competency in IV access procedures. 3. Standardized Protocols: Written protocols and standing orders will govern patient selection criteria, IV insertion techniques, infusion monitoring parameters, and management of potential complications. 4. Patient Monitoring: Patients will be monitored throughout the infusion for adverse reactions, with established protocols for emergency response if needed. 5. Documentation: Complete records will be maintained for each patient encounter, including indication for therapy, vital signs, infusion details, and any adverse events. Conclusion The evidence supports that IV therapy administered by paramedics under physician supervision is safe, effective, and consistent with established standards of care. This model of care delivery expands patient access to necessary treatments while maintaining appropriate medical oversight and quality standards. Please do not hesitate to contact me if you require additional information or clarification regarding this matter. Sincerely, Patrick Lee MD FACEP Medical Director, Hydropeutics LLC, Granvera LLC 50 S. Willow Street, unit 7 Manchester, NH 03103