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WREMAC Normal Saline Shortage Guidance

The WREMAC Adult and Pediatric Advanced Life Support Protocols require the use of Normal
Saline (.9% Sodium Chloride) when establishing any IV (trap, KVO, or volume replacement).
Currently, Normal Saline packaging is available as a flush (10cc bolus for IV trap) but not in a form
sufficient for volume replacement (500cc/1000cc bags).

Agencies without Normal Saline should review the guidance below and address specific concerns
with their Medical Director.

The WREMAC has provided guidance to assist agencies and Medical Directors during the Normal
Saline shortage, as follows:

1. There is no change concerning the use of IV traps with a Normal Saline flush.
2. An IV typically established “TKO” or “KVO” should, instead, be established utilizing an IV
trap flushed with Normal Saline.
3. Children and Adults (all patients > 1 year old) who may require volume replacement
during EMS transport should receive Lactated Ringers as prescribed for Normal Saline in
the WREMAC Protocols.
4. EMS should contact medical direction for Infants (patients < 1 year old) who may require
volume replacement during EMS transport.
Once Normal Saline becomes available in either a 500cc or 1000cc package, agencies shall
immediately remove any Lactated Ringers supply and replace with Normal Saline.