Fire-based EMS: IAFC outlines new DEA registration pathway
Iain Hoey
Share this content
Fire-based EMS and the new DEA rule
A final rule from the Drug Enforcement Administration (DEA) implementing the Protecting Patient Access to Emergency Medications Act of 2017 (PPAEMA) was published on February 5, 2026 and takes effect on March 9, 2026.
The International Association of Fire Chiefs (IAFC) said the rule aligns federal controlled-substance requirements with operational models that use distributed stations, mobile units and protocol-driven care.
The rule establishes an EMS agency registration framework for handling controlled substances, with multi-state operations generally requiring separate registrations in each state where the agency operates.
DEA also confirmed that government-operated agencies, including most municipal fire departments providing EMS, are exempt from DEA application fees.
Registration and stationhouse delivery
The IAFC set out a “hub-and-spoke” delivery approach, allowing controlled substances to be moved from a registered location to an unregistered location when that site is designated as a stationhouse and DEA is notified at least 30 days before the first delivery.
DEA also clarified that distributors cannot deliver directly to those unregistered locations under this framework.
Related information included by the IAFC from the National Association of EMS Physicians (NAEMSP) described a new “Emergency Medical Services Agency” registration category, with a three year fee equal to other dispenser registrations at $888.
NAEMSP said an EMS agency may choose a single DEA registration per state instead of separate registrations for each station, so long as it is authorised under that state’s law.
NAEMSP also said hospital based EMS agencies may continue to operate under the hospital’s existing practitioner registration and are not required to obtain a separate EMS agency registration.
Standing orders, storage and records
The IAFC said EMS clinicians may administer Schedule II to V medications outside the medical director’s physical presence when authorised by state law and carried out under valid standing orders or verbal orders.
It said standing-order records are expected to be maintained at the registered location.
It also said controlled substances may be carried on-person or in a jump bag during active emergency response, with an expectation that medications return to secure storage when not actively responding.
The IAFC also described limited pathways for hospitals and EMS agencies to transfer controlled substances during shortages, public health emergencies or mass casualty incident situations, with written DEA approval required.
It said recordkeeping expectations cover controlled substances received, administered, transferred and destroyed, with specified information recorded for each dose administered or disposed of.
It also described a hospital restocking pathway for vehicles after an emergency response, with records maintained by the EMS agency and the hospital and additional notification steps when a vehicle is primarily based at a designated location.