EMT Standing Orders

Routine Patient Care:

• For anaphylaxis, administer: (anterolateral thigh preferred administration site)
  • Epinephrine (1:1,000) (1 mg/mL): Administer 0.15 mg (0.15 mL) IM for patients less than 25 kg, 0.3 mg (0.3 mL) IM for patients greater than 25 kg.
• Contact Medical Direction for additional dosing.
• Do not delay transport. (Patients who receive epinephrine must be transported.)
• Call for AEMT/Paramedic intercept & assist them in patient care.

AEMT/Paramedic Standing Order:

Epinephrine (1:1,000) (1 mg/mL): Administer 0.01 mg/kg (0.01 mL/kg) IM (max single dose 0.3 mg).

• May repeat epinephrine every 5 – 15 min as needed for continued symptoms.
• (Maximum 3 doses.) Contact Medical Direction for additional dosing.
• For bronchospasm, consider administration of albuterol 2.5 mg via nebulizer x 1 dose OR ipratropium 0.5 mg and albuterol 2.5 mg via nebulizer (DuoNeb). May repeat every 5 – 15 minutes (maximum 3 doses). Contact Medical Direction for additional dosing.
• Establish IV access. Administer 20 mL/kg bolus 0.9% NaCl if hypotension. May repeat x 2 as needed.
• For anaphylaxis refractory to IM epinephrine, consider epinephrine infusion. Infuse 0.1 – 1 micrograms/kg/minute via pump until symptoms resolve.
• Diphenhydramine 1 mg/kg PO/IV/IM/IO to treat pruritis (maximum dose 50 mg).
• Methylprednisolone 1 mg/kg IV (max 125 mg) every 6 hours if symptomatic OR
• Dexamethasone 0.6 mg/kg IV/IO/IM/PO (maximum dose 10 mg).