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November 7, 2018 - Memorandum - National Medical Shortages


To: ALS / BLS / Air Providers

From: Eric M. Rudnick, FACEP, FAAEM
Nor-Cal EMS Medical Director

Date: November 7, 2018

Subject:      National Medical Shortages

The medication shortage crisis continues to disrupt the care of patients in both the hospital and prehospital areas. One of the most affected areas is emergency medicine and this places our high-risk patients at risk. Currently there are substitutions available for the medications that are in short supply.

We have begun to receive communication from various agencies within Nor-Cal EMS that certain Benzodiazepines can't be obtained. In particular Versed (Midazolam) is not available. Effectively immediately the use of any of the following medications are allowed to be substituted for Versed: Valium (Diazepam) and Ativan (Lorazepam) when being given intramuscular (IM), intravenous (IV) and intraosseous (IO) routes. Please don't administer Valium or Ativan via the intranasal (IN) route.

Adult Seizure


Maximum Total Adult Dose


Diazepam (Valium)

2 to 4 mg IV, IO initial dose

10 mg


Lorazepam (Ativan)

1 to 2 mg IV, IO, IM

6 mg


Pediatric Seizure


Maximum Total Pediatric Dose

Rectal Dosing

Diazepam (Valium)

1)Infants >30 days and Children <5 years: IV/IO: 0.2 to 0.5 mg slow IV every 2 to 5 minutes up to a maximum total dose of 5 mg.
2)Children >= 5 years and Adolescents: IV: 1 mg slow IV every 2 to 5 minutes up to a maximum of 10 mg.

1) Infants >30 days and Children <5 years;5 mg.
2) Children >= 5 years and Adolescents;10 mg.

0.5 mg/kg, may repeat X 1, then 0.2 mg/kg

Lorazepam (Ativan)

Dosing IV/IO: 0.05 to 0.1 mg/kg, maximum 4 mg/dose) may repeat in 5 to 15 minutes if needed.

2 to 4 mg Total maximum dose.


Obtaining Morphine has become problematic for multiple agencies. Fortunately, Fentanyl (Sublimaze) can still be obtained. You can substitute Fentanyl for any clinical indication that Morphine would be utilized in patient care.

These medications are back-ordered without a time frame for availability. Please let Nor-Cal EMS know when encountering these issues. Many times, there are substitutions available or other options.

Contact Nor-Cal EMS with any questions at 530-229-3979 or via email at: mail@norcalems.org

Please share this information with your staff and other interested parties.


Download the Memorandum PDF to post at your location and share with others.


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