View Administrative Bulletin: No. 23 - BUL - 008 Medication Shortages
TO: ALL EMS Providers
FROM: Dr. Greg Kann
DATE: April 11, 2023
BULLETIN: No. 23 – BUL – 008 Medication Shortages - Update
Medication backorders from manufacturers have become an increasing concern and are now posing a threat to patient treatment within the established Agency policies and protocols. (Updates in RED).
Authorization for the following is given, until further notice:
1. Substitute Levalbuterol (0.63mg/3ml) for Albuterol (2.5mg/3ml)
a. Substitute on a 1:1 basis (1 vial of Levalbuterol for 1 vial of Albuterol).
b. Providers SHALL NOT mix Levalbuterol with Albuterol.
c. Levalbuterol may be used in place of albuterol in all applicable protocols.
2. Extension of existing expiration dates on Epinephrine 1:10,000 concentration.
a. Up to 6 months past their manufacturer printed expiration date. This is only for Epinephrine that was set to expire prior to 9/30/2022.
b. Providers should continue to make every effort to provide non-expired Epinephrine and may do so by diluting, when available, Epinephrine 1:1,000 to the 1:10,000 concentration with Normal Saline.
3. Dose changes for Epinephrine 1:10,000 administration pertaining to Stanislaus County EMS Agency Policy 554.11 Cardiac Arrest Algorithms.
a. Change from the current 1mg 1:10,000 Epinephrine administration, to 0.5mg 1:10,000 Epinephrine administration with a maximum of 3mg 1:10,000 total administration per adult cardiac arrest.
4. Dilution of Atropine Multi-Dose Vials (20ml vial of 0.4mg/ml) to create Atropine 1mg/10ml concentration, may be used to supplement shortages in Atropine pre-load availability.
5. Tranexamic Acid (TXA) can be mixed with 250ml Normal Saline bags IF 100ml Normal Saline bags are unobtainable. TXA will continue to be administered as 1 gram over 10 minutes.
Please contact the EMS Agency office if you have any questions related to this temporary approval.
Please select the link for official administrative bulletin and details*