Memo: Medication Shortage

The Western Regional Emergency Medical Advisory Committee (WREMAC) has issued notice concerning medication replacements to be used during this time of shortage.  All Advanced EMS providers should review the memorandum and implement the directive as appropriate.  The full memorandum will be available on the Office of Prehospital Care Web site within 24 hours: www.OPCEMS.org

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Adult Protocols

1.       Lack of D50/25:  D10W bolus, Glucagon 1 mg IM, or oral glucose (awake patients only for oral glucose) in that order for the following protocols:

Altered Mental Status

2.  Lack of Epi 1:10,000:  Vasopressin should be substituted in the following protocols:

          Asystole

          Pulseless Electrical Activity (PEA)

          VF/VT

          Remove from following protocol:

          Suspected Allergic Reaction

3.  Lack of Epi 1:1,000:   EpiPen auto injector should be substituted in the following protocols:

          Respiratory Signs and Symptoms

          Suspected Allergic Reaction

4.  Lack of Lasix:  There will be no replacement for Lasix.  Remove from following protocols:

          Respiratory Signs and Symptoms

5.  Lack of Lidocaine:  Amiodarone is first line agent for all protocols.  Remove Lidocaine as Medical Control Treatment Option from the following protocols:

          Tachycardia

          VF/VT

Pediatric Protocols

1.        Lack of Epi 1:10,000:  Dilute Epi 1:1000 1 ml vial in 9 ml of Normal Saline (waste 1 ml from 10 ml vial of NS and then add 1 ml of Epi 1:1000) for the following protocols:

Asystole

          Pulseless Electrical Activity (PEA)

          VF/VT

          Remove from following protocol:

          Suspected Allergic Reaction

2.       Lack of Epi 1:1,000:  EpiPen Jr auto injector should be substituted for patients 1 year or older (contact Medical Control for under 1 year of age) in the following protocols:

Respiratory Signs and Symptoms

          Suspected Allergic Reaction

3.       Lack of D50/25:  D10W bolus, Glucagon 1 mg IM, or oral glucose (awake patients only for oral glucose) in that order for the following protocols:

Altered Mental Status

4.  Lack of Lidocaine:  Amiodarone is first line agent for all protocols.  Remove Lidocaine as Medical Control Treatment Option from the following protocols:

          Tachycardia

          VF/VT

Note:  Unlike in adults, Vasopressin has not been approved for pediatric ACLS.  This requires dilution of Epinephrine.  By limiting the dilution of Epinephrine to pediatric patients only, the hope is to limit the potential shortage of Epi 1:1,000 for the foreseeable future.