As a result of the recent severe weather events along the east coast, a major manufacturer of intravenous fluids has been adversely impacted, resulting in the temporary closure of one of their facilities. This closure may cause a supply chain disruption for an undetermined length of time.
To help ensure crystalloid solutions are available for patients requiring IV infusions, the Medical Advisory Committee would like to offer the following advice to EMS clinicians in conjunction with guidance offered by your agency’s medical director while awaiting more formal guidance from the Bureau of EMS.
- Whenever possible, use a saline lock/flush to obtain and maintain a patent IV in patients who would benefit from prehospital IV placement.
- Only initiate IV fluid boluses when necessary for specific clinical indications as outlined in the statewide ALS and ALS protocols. For example, nausea/vomiting for those with clinical signs of dehydration and inability to tolerate any PO, volume-related hypotension, or continuous medication infusions.
- Statewide Protocol #1000 (excerpted below) provides guidance on the substitution of other crystalloids in place of normal saline at the discretion of your agency medical director.
“(3) Crystalloid isotonic solutions, including normal saline solution (NSS): NSS is a safe and useful “isotonic” solution for hydration and medication delivery by EMS. When intravenous fluids are indicated, NSS is used throughout these protocols. NSS has the advantage of being compatible with all EMS medications and being preferred for patients with traumatic head injury. Lactated Ringers and other balanced salt solutions may be carried as an option by an EMS agency if approved by the agency medical director, but it is up to the agency medical director to educate providers when another isotonic fluid is preferred by the medical director over NSS. The EMS agency medical director must develop a written policy that identifies which fluid is preferred in specific patient conditions, with specific attention to compatibility of other isotonic solutions with medications administered by EMS providers. When compliant with these requirements, EMS providers may substitute these other isotonic solutions where the protocol states NSS, without contact with a medical command physician. Solutions with hypertonic concentrations of any electrolyte or other solvent that exceed physiologic concentration, are not acceptable as substitutions for NSS.”
“(4) Infusion mixtures – EMS regions or agencies may set standards for the mixture of medications that are to be given by infusion. When such standard concentrations are established, it is recommended that the region or agency also provide ALS providers with a table to assist in administering the correct infusion dosage.”
As always, on behalf of the residents and visitors to our Commonwealth, we appreciate your continued dedication to prehospital clinical excellence.