What is your system doing for the saline shortage?
Wake County EMS Directive
Situation: We have a critical shortage of normal saline.
Background: The multi-factorial national drug shortage continues and has now affected normal saline. We now have a very limited supply of normal saline and it is unclear when more may become available.
Assessment: We must immediately take action to limit the administration of normal saline to patients with specific illness or injury. This change in practice, since prescribed by the Wake EMS System Medical Director, does not increase the liability for responders who are no longer administering IV fluids to patients for whom they historically would have.
1. It is important to clearly document in ESO which IV therapy you use.
a. If you start a saline lock, please use the procedure “IV Therapy – Saline Lock”
b. If you are starting a 500cc, 1000cc or larger bag of fluid and/or cold fluid, please use the procedure “IV Therapy – Normal Saline or Cold Saline”
2. IV fluids of 500cc, 1000cc or larger may be initiated on patients who are symptomatic from their injury or illness and have a systolic blood pressure of less than 90. This includes, but is not limited to, patients with the following conditions:
a. Cardiac arrest
b. Heat emergency with corresponding body temperature >101 F
d. Blunt or penetrating trauma
e. Blood glucose reading of “High”. If a numeric value is present, the patient should not receive IV fluids
f. Inferior MI
g. All burn patients being transported to a burn center regardless of their blood pressure
3. If you are treating a cardiac arrest patient, please follow these guidelines. Once access has been obtained, attach only a saline lock until the 500cc, 1000cc or larger bag of cold fluid arrives, unless the cardiac arrest is clearly related to hypovolemia (e.g. you are immediately on the scene of a penetrating trauma arrest). DO NOT administer a bag of non-cold 500cc, 1000cc or larger bag of Normal Saline for most medical arrests.
a. Administer COLD Saline to medical arrests once cold saline arrives on scene. Only use a single bag of 500cc, 1000cc or larger bag of cold saline on cardiac arrest patients, unless:
i. The patient regains ROSC and is transported. In this case, go ahead and hang a second 500cc, 1000cc or larger bag of cold saline
ii. If the first bag is empty and the resuscitation is going to continue then you may hang another 500cc, 1000cc or larger bag of cold saline
4. We have traditionally treated intoxicated patients at special events with a normal saline bolus. However, given the shortage, we will not be able to continue this practice. These patients should not receive fluid bolus unless they meet one of the above criteria listed in bullet #2 to receive IV fluid.
5. Medication drips utilizing 250cc or other prescribed size bags are not affected by this directive. These bags are for medication administration only and NOT for volume bolus. Continue to utilize the medication label for proper mixing and administration.
a. Patients who receive IV drip medication often require IV fluids as well. However, you may attach the medication drip directly to a saline lock. If you feel the patient would benefit from additional IV fluids of 500cc, 1000cc or larger you may administer IV fluid regardless of whether they meet one of the indication(s) listed in bullet #2.
6. As always, if you feel a patient has a particular need for IV fluid that is not addressed in this list, you should contact medical control for further guidance. DO NOT administer IV fluid outside of these guidelines without contacting medical control.