Epinephrine Shortage
Midstate Regional Emergency Medical Advisory Committee
2521 Sunset Ave.
Utica NY 13512
TO: Midstate EMS ALS Agencies August 1, 2012
From: John DeTraglia MD, REMAC Chair
RE: Epinephrine Shortage
***EPINIEPHRINE 1:10,000 1 mg/ 10ml prefilled syringe:
Due to current and possible future shortages of Epinephrine 1:10,000 1mg/10ml prefilled syringes reported by the Food and Drug Administration (FDA), the following plan should be followed if your agency stock becomes low or exhausted.
Option 1: Utilizing Epinephrine 1:1,000 1mg/ml 30 ml vial
Make Epinephrine 1:10,000 1 mg/10 ml using
Epinephrine 1:1,000 1mg/ml 30 ml vial
ï‚· Step 1 Add 5 mg (5ml) Epinephrine 1:1,000 into a 50 ml bag of NS
ï‚· Step 2 Draw up 10 ml from the NS bag (that has been mixed with the 5 mg of Epinephrine 1:1,000) into a 10 cc syringe.
ï‚· Administer to patient
 After the 50 ml NS bag is mixed with the Epinephrine 1:1,000, you will have 5 doses of Epinephrine 1:10,000 available
 The actual concentration will be approximately 0.9 mg. The negligible difference is felt to be acceptable in this setting.
 Should personnel and resources be available, then certainly 5 mL of normal saline can be withdrawn from the 50 ml bag prior to instilling 5 mg (5mL) of Epinephrine 1:1000. This will result in a concentration of 1 mg.
Option 2: Utilizing Epinephrine 1:1,000 1 mg/ml ampule
Make Epinephrine 1:10,000 1mg/10ml using Epinephrine 1:1,000 1mg/ml ampule
ï‚· Step 1 Expel 1 ml of normal saline from a pre-filled syringe and instill 1 mg (1mL) of Epinephrine 1:1,000
EITHER OF THESE TWO ADDITIONAL OPTIONS IS ACCEPTABLE. REMEMBER TO DISCARD ANY UNUSED DOSES OF EPINEHRINE AFTER EACH PATIENT. THESE EXTRA STEPS AND ADDITOINAL AVENUES INCREASE THE POTENTIAL FOR ERRORS, ADDITONAL VIGILANCE WILL BE NECESSARY.
***Ondansetron (Zofran) 4mg/2ml vials:
Shortages have been reported and the Midstate REMAC approved the use of Ondansetron 4 mg Orally Disintegrating Tablets (ODT) if necessary.
