What medications are approved for use by Paramedics (Emergency Medical Technicians - EMTs) in North Carolina?

From the Guidelines

North Carolina paramedics should administer a comprehensive range of emergency medications, including epinephrine, naloxone, albuterol, aspirin, nitroglycerin, fentanyl, midazolam, and amiodarone, as well as atropine, dextrose 50%, diphenhydramine, and lidocaine, to stabilize patients during emergencies, with specific dosing and administration guidelines, such as aspirin (160 to 325 mg) for suspected cardiac events 1.

Medications for Cardiac Events

• Aspirin (160 to 325 mg) should be administered as soon as possible after symptom onset to patients with suspected acute coronary syndrome (ACS) 1.
• Nitroglycerin (0.4mg SL) may be considered for patients with chest discomfort and suspected ACS, but with caution in patients with initial systolic blood pressure <90 mm Hg or 30 mm Hg below baseline and in patients with right ventricular infarction 1.
• Morphine (intravenous) may be administered for persistent chest pain in patients diagnosed with ST-elevation myocardial infarction (STEMI) in the prehospital setting, but with caution in unstable angina (UA)/non-ST-elevation myocardial infarction (NSTEMI) due to an association with increased mortality 1.

Medications for Other Emergencies

• Epinephrine (1:1,000 at 0.3-0.5mg IM) should be administered for anaphylaxis, and atropine (0.5mg IV) for bradycardia 1.
• Naloxone (0.4-2mg IV/IM/IN) should be administered for opioid overdose, and albuterol (2.5mg nebulized) for bronchospasm 1.
• Fentanyl (25-100mcg IV/IM) may be administered for pain management, and midazolam (2-5mg IV/IM) for seizures or sedation 1.
• Amiodarone (300mg IV bolus) may be administered for cardiac arrhythmias, and lidocaine (1-1.5mg/kg IV) for ventricular arrhythmias 1.

Important Considerations

• Paramedics must follow specific protocols established by their medical director and the North Carolina Office of Emergency Medical Services, which may vary slightly between counties 1.
• These medications target specific physiological processes to stabilize patients during emergencies, such as improving cardiac output, reversing respiratory depression, reducing inflammation, or controlling seizures 1.
• Paramedics must maintain proficiency in medication administration techniques, dosing calculations, and recognition of adverse effects 1.

From the FDA Drug Label

5 mg should be given over a period of no less than 2 minutes. Wait an additional 2 or more minutes to fully evaluate the sedative effect. If additional titration is necessary, it should be given at a rate of no more than 1 mg over a period of 2 minutes, waiting an additional 2 or more minutes each time to fully evaluate the sedative effect. Total doses greater than 3. 5 mg are not usually necessary. For induction of general anesthesia, before administration of other anesthetic agents. Individual response to the drug is variable, particularly when a narcotic premedication is not used. The dosage should be titrated to the desired effect according to the patient’s age and clinical status Unpremedicated Patients: In the absence of premedication, an average adult under the age of 55 years will usually require an initial dose of 0.3 to 0. 35 mg/kg for induction, administered over 20 to 30 seconds and allowing 2 minutes for effect. Premedicated Patients: When the patient has received sedative or narcotic premedication, particularly narcotic premedication, the range of recommended doses is 0.15 to 0.35 mg/kg.

The recommended dose of midazolam (IV) for North Carolina Paramedic Drugs is:

• Initial dose: 0.3 to 0.35 mg/kg for unpremedicated patients under 55 years, administered over 20 to 30 seconds
• Initial dose: 0.15 to 0.35 mg/kg for premedicated patients
• Titration: additional doses should be given at a rate of no more than 1 mg over a period of 2 minutes, waiting an additional 2 or more minutes each time to fully evaluate the sedative effect
• Total dose: greater than 3.5 mg is not usually necessary 2

From the Research

North Carolina Paramedic Drugs

• The provided studies do not specifically address the topic of North Carolina paramedic drugs.
• However, the studies do discuss the use of epinephrine in the treatment of anaphylaxis, which may be relevant to paramedic drugs in general 3, 4, 5, 6, 7.
• According to the studies, epinephrine is the drug of choice for anaphylaxis and should be administered intramuscularly as soon as possible after the onset of symptoms 3, 4, 5.
• The studies also discuss the importance of proper dosing and administration of epinephrine, as well as the need for education and training on its use 6, 7.
• Additionally, the studies highlight the importance of recognizing the symptoms of anaphylaxis and administering epinephrine promptly, as delayed treatment can lead to severe consequences 3, 4, 5, 6, 7.