Nor-Cal EMS Policy & Procedure Manual
BLS PROTOCOLS MODULE
1003 – EMT Optional Scope Drug Formulary
INTRODUCTION TO DRUG FORMULARY
1. Communications Failure: In the event that a field provider is unable to establish or maintain voice
contact and reasonably determines that a delay in treatment may jeopardize patient outcome, the
provider may initiate any of the medications for which they have been trained and approved to use by
Nor-Cal EMS. The only exception to this is when there is a Base Hospital Physician Order (BHPO)
required. Medications/procedures requiring a BHPO shall not be performed during communications
failure. Refer to the Communications Failure policy, in Miscellaneous Policies Module.
2. Drug Allergy (hypersensitivity): If the patient has a known allergy to any medication listed in this
formulary, it is considered a contraindication for administration.
3. Scope of Practice: Only those providers which are accredited as an “EMT-OS” on duty for a provider
with an EMT-OS provider agreement shall utilize the medications and skills listed in this policy.
EPINEPHRINE
Indications: Allergic reactions, anaphylaxis, asthma.
Adult dose: Epinephrine 1:1000, 0.3 mg
May repeat every five (5) minutes twice for a total of three (3) doses.
Pediatric dose: Based on patient weight: as follows:
a. If patient weight is less than 15 kg, consult base hospital physician for medication dosage.
b. If patient weight is between 15 and 30 kg, give epinephrine 1:2000, 0.15 mg IM via auto-injector.
i. May repeat every five (5) minutes twice 2 for a total of three (3) doses.
ii. If patient has received a self-administered dose, may repeat once for a total of three (3)
doses.
c. If patient weight is greater than 30 kg give epinephrine 1:1000, 0.3 mg IM via auto-injector.
i. May repeat every five (5) minutes twice 2 for a total of three (3) doses.
ii. If patient has received a self-administered dose, may repeat once for a total of three (3)
doses.
Route of Administration: IM via auto-injector
Trade Name: Adrenalin
Classification: Endogenous catecholamine, sympathomimetic
Actions: Epinephrine contains both alpha and beta adrenergic properties. It is because of these
properties, epinephrine will increase heart rate, increase peripheral vascular resistance (PVR), increase
blood pressure, and automaticity of the heart. It is a positive chronotropic and inotropic medication, as
well as a potent bronchodilator.
Contraindications: Tachyarrhythmias. No contraindications if the patient is in cardiac arrest or
anaphylactic shock.
Relative Contraindications: Severe hypertension, known coronary artery disease, patients greater than
50 years of age.
Side Effects: Palpitations, anxiousness, headache, tachyarrhythmias, hypertension, and vomiting.
Special Considerations: Epinephrine is slightly light sensitive, keep out of direct sunlight.
Originated: January 1, 2006
Last Revision: August 28, 2012
Page: 1 of 3
BLS PROTOCOLS MODULE
EMT Optional Scope Drug Formulary #1003
NALOXONE
Indications: Known or suspected narcotic-induced respiratory depression or apnea.
Dosage: Adult dose: 2 mg IM or IN. May repeat as needed for a maximum dose of 6 mg.
NOTE: If no response after 6 mg has been administered, narcotic-induced toxicity should be questioned.
Pediatric dose: 0.1 mg/kg IM or IN, maximum dose 2 mg. May repeat once.
Consult Base Hospital Physician for order and dosage recommendation for infants less than 8 kg.
Route of Administration: IM or Intra-nasal, (IN)
Generic Name: Naloxone HCL
Classification:
Narcotic (opiate) antagonist
Actions: Specific antidote for narcotic agents.
Contraindications: Hypersensitivity and/or allergy.
Do not give patient naloxone after the King Airway device has been inserted.
Side Effects: May precipitate acute opiod withdrawal syndrome; may cause cardiac arrhythmias,
vomiting, hypertension and severe agitation.
Special Considerations: Consult base hospital before using with patients who take opioid medication
routinely. Naloxone may have a shorter half-life than the narcotic and the patient may need repeat
dosing. Large doses may be required to reverse the effects of Darvon and Darvocet. Patient may
become combative, prepare to restrain as needed.
PRALIDOXIME CHLORIDE:
Indications: Nerve Agent Exposure and exposures to organophosphate compounds that produce
signs and symptoms, of the pneumonic “SLUDGEM.”
Dosage: One auto-injector, may repeat as needed up to a maximum of three (3) injections.
Pediatric dosage: 50mg/kg/dose, maximum dose 2000 mg.
Route of Administration: IM via Auto-injector
Trade Name: 2-Pam CL, Protopam Chloride, Duodote
Classification: oxime
Actions: Reactivates cholinesterase that has been inactivated by a Nerve Agent/Organophosphate.
Contraindications: Treatment is NOT TO BE GIVEN PROPHYLACTICALLY.
Special Considerations:
1. Auto-injectors may be used on EMS personnel if they become exposed and have signs and
symptoms of nerve agent exposure.
2. It is important that the auto-injectors are given into a large muscle area, preferable anterior thigh.
3. Accidental injections into the hand WILL NOT deliver an effective dose of the antidote.
Originated: January 1, 2006
Last Revision: August 28, 2012
Page: 2 of 3
BLS PROTOCOLS MODULE
EMT Optional Scope Drug Formulary #1003
ATROPINE:
Indications: Nerve Agent Exposure and exposures to organophosphate compounds that produce
signs and symptoms of the pneumonic “SLUDGEM.”.
Dosage: May repeat atropine to dry pulmonary secretions to decrease respiratory distress.
Pediatric dose: 0.05 mg/kg/dose, maximum dose 2 mg.
Route of Administration: IM via auto-injector
Trade Name: Duodote, prepackaged kit
Classification: Parasympatholytic, anticholinergic
Actions: In organophosphate poisoning, atropine competes for post synaptic receptors at neuromuscular
and neuroglandular junctions which block the action of the poison.
Contraindications: None when used for life-threatening emergencies.
Relative contraindications: Hypertension, tachycardia.
Side Effects: Pupil dilation, dry mouth, blurred vision, tachycardia arrhythmias.
Toxic Effects: May produce an anticholinergic toxicity in extreme dosages. The pneumonic for
anticholinergic toxicity is: Hot - as a Hare; Blind - as a bat; Dry - as a bone; Red - as a beet; Mad – as a
hatter.
Originated: January 1, 2006
Last Revision: August 28, 2012
Page: 3 of 3