Medicine Protocols

Acetaminophen (Tylenol)

INDICATIONS;Patients ≥3 months with: (1) Mild to moderate discomfort (1–5 on FACES scale) OR (2) Fever ≥100.4°F / 38°C (EMS-documented)

Acetaminophen (Tylenol)

CONTRAINDICATIONS;(1) Head injury (2) Hypotension (3) Acetaminophen given within past 4 hours (incl. cold meds) (4) Unable to swallow/take PO meds (5) Respiratory distress (6) Persistent vomiting (7) Known/suspected liver disease or alcohol ingestion (8) Allergy to acetaminophen (9) Age <3 months

Acetaminophen (Tylenol)

DOSAGE;3 mo: 1.25 mL | 4–11 mo: 2.5 mL | 12–23 mo: 3.75 mL | 2–4 yr: unit dose 160 mg/5 mL | 5–12 yr: TWO unit doses (320 mg/10 mL) | ≥13 yr: FOUR unit doses (640 mg/20 mL) OR 325 mg tablet x2 (650 mg) | Form: 160 mg/5 mL liquid or 325 mg pill

Acetaminophen (Tylenol)

PRECAUTIONS;(1) Giving it does NOT eliminate the need to transport for definitive care (2) Must use 3 mL, 5 mL, or 6 mL syringe to measure doses

Activated Charcoal (without Sorbitol)

INDICATIONS;Poisoning by mouth

Activated Charcoal (without Sorbitol)

CONTRAINDICATIONS;(1) Altered mental status (2) Patient has already received an emetic

Activated Charcoal (without Sorbitol)

ADVERSE EFFECTS;May indirectly induce vomiting and cause nausea

Activated Charcoal (without Sorbitol)

PRECAUTIONS;Does not adsorb all drugs and toxic substances

Activated Charcoal (without Sorbitol)

DOSAGE;Adult: 1 g/kg PO | Pediatric: 1 g/kg PO | Forms: 25 g/125 mL or 50 g/250 mL bottle | ⚠️ Orders must come from approved base station or consultation center

Albuterol (Proventil / Ventolin)

INDICATIONS;(1) Signs/symptoms of respiratory distress (2) Bronchospasm/wheezing from: asthma, COPD/emphysema, or allergic reaction (anaphylaxis)

Albuterol (Proventil / Ventolin)

CONTRAINDICATIONS;Known hypersensitivity

Albuterol (Proventil / Ventolin)

ADVERSE EFFECTS;Tachycardia/palpitations, hypertension, angina, nervousness/anxiety, tremors, dizziness, headache, sweating, nausea/vomiting, sore throat

Albuterol (Proventil / Ventolin)

PRECAUTIONS;May cause severe bronchospasm from repeated excessive use

Albuterol (Proventil / Ventolin)

DOSAGE (INHALER);Adult & Pediatric: max 2 doses (4 puffs) over 30 minutes

Albuterol (Proventil / Ventolin)

DOSAGE (NEBULIZER);Adult: 2.5 mg via nebulized aerosol at 6–8 lpm O₂; may repeat x1 | Peds ≥2 yr: 2.5 mg | Peds <2 yr: 1.25 mg | Additional doses require medical consultation

Aspirin

INDICATIONS;Suspected Acute Coronary Syndrome (ACS) and/or STEMI

Aspirin

CONTRAINDICATIONS;(1) Known hypersensitivity (2) Patient already received full dose (324 mg) prior to EMS arrival

Aspirin

ADVERSE EFFECTS;Heartburn, nausea/vomiting, wheezing

Aspirin

PRECAUTIONS;GI bleeding and upset

Aspirin

DOSAGE;Adult: 324 mg or 325 mg chewed | Pediatric: NOT indicated

Epinephrine 1 mg/mL (Manual Draw-Up)

INDICATIONS;(1) Moderate to severe allergic reaction with respiratory distress OR mild allergic reaction with history of life-threatening allergic reaction (2) Severe asthma

Epinephrine 1 mg/mL (Manual Draw-Up)

CONTRAINDICATIONS;None in the presence of anaphylaxis

Epinephrine 1 mg/mL (Manual Draw-Up)

ADVERSE EFFECTS;Tachycardia/palpitations, angina, headache, nausea/vomiting, dizziness, hypertension, nervousness/anxiety, tremors

Epinephrine 1 mg/mL (Manual Draw-Up)

PRECAUTIONS;Medical consultation required before giving to asthma patients with pregnancy or cardiac history. NOT required for severe allergic reactions with respiratory distress.

Epinephrine 1 mg/mL (Manual Draw-Up)

DOSAGE;≥5 years: 0.5 mg in 0.5 mL IM in lateral thigh | <5 years: 0.15 mg in 0.15 mL IM in lateral thigh | Additional doses require medical consultation | Forms: Vial (1 mg/1 mL) or preloaded syringe

Epinephrine Auto-Injector

INDICATIONS;(1) Moderate to severe allergic reaction with respiratory distress OR mild allergic reaction with history of life-threatening allergic reaction (2) Severe asthma

Epinephrine Auto-Injector

CONTRAINDICATIONS;None in the presence of anaphylaxis

Epinephrine Auto-Injector

ADVERSE EFFECTS;Tachycardia/palpitations, angina, headache, nausea/vomiting, dizziness, hypertension, nervousness/anxiety, tremors

Epinephrine Auto-Injector

PRECAUTIONS;Medical consultation required before giving to asthma patients with pregnancy or cardiac history. NOT required for severe allergic reactions with respiratory distress.

Epinephrine Auto-Injector

DOSAGE;<5 years: 0.15 mg IM lateral thigh | ≥5 years: 0.3 mg IM lateral thigh | Additional doses require medical consultation | Forms: Adult 0.3 mg / Pediatric 0.15 mg auto-injector

Naloxone (Narcan)

INDICATIONS;Reverse respiratory depression caused by opioid/narcotic agent

Naloxone (Narcan)

CONTRAINDICATIONS;Patients under 28 days of age

Naloxone (Narcan)

ADVERSE EFFECTS;Opioid withdrawal

Naloxone (Narcan)

PRECAUTIONS;(1) May induce opiate withdrawal in physically dependent patients (2) Some drugs require much higher doses for reversal (3) Titrate so respiratory effort returns

Naloxone (Narcan)

DOSAGE;Adult: 2 mg IN divided equally between nares (max 1 mL/nare) OR 4 mg/0.1 mL IN in one nare | Pediatric (28 days–adult): same as adult dosing | Repeat as needed to maintain respiratory activity | ⚠️ Medical consultation required if patient refuses transport after administration

Nitroglycerin

INDICATIONS;Chest pain

Nitroglycerin

CONTRAINDICATIONS;(1) SBP

Nitroglycerin

ADVERSE EFFECTS;Hypotension, headache, dizziness, tachycardia

Nitroglycerin

PRECAUTIONS;(1) BLS can only give patient-prescribed sublingual nitro (2) Reassess BP before and after each dose (3) If SBP drops >20 mmHg per dose, get medical consultation before continuing

Nitroglycerin

DOSAGE;Adult: 0.4 mg SL (1 tablet or 1 spray) | Repeat q3–5 min if chest pain persists | Max: 3 doses total (patient + EMT combined) | Pediatric: contraindicated <13 years | Additional doses require medical consultation

Oral Glucose

INDICATIONS;(1) Altered mental status with known diabetic history (2) Unconscious for unknown reason (3) Blood glucose <70 mg/dL

Oral Glucose

CONTRAINDICATIONS;Not clinically significant

Oral Glucose

ADVERSE EFFECTS;Not clinically significant

Oral Glucose

PRECAUTIONS;Patient without gag reflex may aspirate

Oral Glucose

DOSAGE;Adult & Pediatric: 10–15 g between gum and cheek | May give single additional dose if not improved after 10 min | Forms: 24 g, 30 g, or 37.5 g tube

Oxygen

INDICATIONS;(1) Hypoxia (SpO₂ <94%) (2) Respiratory distress (3) Cardiopulmonary arrest (4) Trauma (5) Suspected CO exposure (6) Dyspnea

Oxygen

CONTRAINDICATIONS;Not clinically significant

Oxygen

ADVERSE EFFECTS;High concentrations may reduce respiratory drive in some COPD patients

Oxygen

PRECAUTIONS;(1) Never withhold O₂ from those who need it (2) Use caution in COPD patients (3) Simple/partial rebreather mask: minimum 6 lpm (4) NRB mask: minimum 12 lpm

Oxygen

DOSAGE & SpO₂ GUIDE;94–100% = Normal: give O₂ as needed | 91–93% = Mild hypoxia: give O₂ as needed | 86–90% = Moderate hypoxia: 100% O₂, assist ventilations if needed | ≤85% = Severe hypoxia: 100% O₂, assist ventilations, intubate if indicated | Adult: 12–15 lpm NRB or 2–6 lpm NC | CO exposure: NRB, maintain SpO₂ 100%