In recognition of recent medication shortages, the Office of the State EMS Medical Director is addressing strategies that will allow EMS providers to continue to administer the correct dosage of medication for their patients without errors due to changes in dose concentrations and packaging. These medication shortages have varied in severity, duration, and impact on EMS systems.

EMS Medications in Alternative Forms

EMSSyringeDraw_smDuring times of shortage, some medications are being provided in alternative forms or concentrations rather than the pre-loaded emergency syringes that are usually available to EMS providers. The medications affected include atropine, calcium chloride, epinephrine 1:10,000, dextrose 50%, lidocaine 2%, naloxone, and sodium bicarbonate. And that’s not all of them so check with your suppliers and what’s in your med bags. Some of these medications are now being supplied as vials, pre-mixed bags, or ampoules in a concentration different from the emergency pre-loaded syringe form.

My Maryland Protocols for EMS Providers defines the dose of a medication given to patients but does not specify the type of container or concentration. This has two effects under this shortage. First it frees up the providers and systems to put different medication concentrations and doses on the ambulance and second, it forces the providers to be more aware of what they are giving to come up with the correct concentrations for the medications being supplied in alternative forms.

Training and Education for Medication Safety

This means that leadership must ensure awareness and training for all personnel on how to deliver the correct dose of the medication when using these alternative concentrations. Are you being affected by these shortages and have you had any close calls with dosing? I’d love to hear from you about it. Check in with me by email and let me know at I’ll keep your information confidential but I think it’s important to report on these types of things here on the MedicCast.


Check out the links for this news item and all of the other resources in the show notes for this episode of the MedicCast — Dr. Kevin Seaman on Cardiac Arrest Survival and Episode 324.


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