Due to current emergency medication shortages of varying scope affecting the US and Kentucky, KBEMS will be following the recommendations of the FDA Drug Shortage List. Please note that if you are using a medication past its expiration date (if recommended by the FDA), you will need to maintain documentation to support the extended use with the medication on each ambulance.

If a replacement medication is not available, or does not exist please submit a letter, through the Medical Protocol Application in KEMSIS, signed by your medical director indicating that you will be temporarily removing that particular medication from your protocol, and will resume regular operation once that medication becomes available again. You can follow this same guidance if a replacement medication exists, however you will indicate appropriate dosages and guidelines for administering the replacement.

FDA Drug Shortages

The FDA has further extended the expiration dates of DuoDote to 2 years beyond the manufacturer s expiration date. For more information: http://www.fda.gov/drugs/drugsafety/ucm376367.htm .

The Kentucky Board of EMS is currently aware of the drug shortage of D50. The following substitutions may be used.

The typical adult dose is 25 grams of glucose, given as 50 ml. of 50% dextrose solution (500 mg. of dextrose per ml.).

In any situation where D50 would be used, as specified in the Statewide Treatment Protocols, ambulance services may use any of the following acceptable substitutions:

1. An equal-dose amount of D25. Since this is packaged in 10 ml. syringes, the usual adult dose would be 10 syringes of 10 ml. each of D25, or 100 ml. of D25.
2. A sterile IV bag containing 250 ml of D10W, delivering 25 grams of glucose.

Printable Statement on Dextrose

Click on the documents below for guidance regarding the national shortage of IV Normal Saline, and alternatives.

• Normal Saline Alternatives
• Lactated Ringers
• Nitroglycerine
• Lactated Ringer's and Blood Transfusions

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