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Indications: Signs and symptoms of a severe allergic reaction (e.g. facial/neck/tongue swelling, wheezing, shortness of breath, hypotension, loss of consciousness)


Contraindications (Do Not Give): Chest pain of suspected cardiac origin


Procedure: ensure ALS unit is enroute

  • Examine pts own epinephrine auto-injector to ensure that is prescribed for pt, has not expired and visible medication is clear, auto-injector is correct dose for pt (Adult: 0.3 mg epi, Peds < 15 years:  0.15 mg Epi Pen Jr.)

  • Remove safety cap from auto-injector and place tip of auto-Injector on the mid-anterior lateral area of pts thigh, midway between groin area and knee (may place over clothing if necessary)

  • Push auto-injector against thigh until you hear an audible “click”, Hold auto-injector in place until all med is administered (about 10 seconds), dispose of auto-injector in sharps container

  • Reassess pt for improvement of symptoms, repeat vital signs 


Documentation:  Time of administration of auto-injector, dose given, response to treatment and repeat V/S, route (IM)


Indications: Possible or known exposure to a nerve agent

Signs/Symptoms: SLUDGEM - Salivation, Lacrimation, Urination, Defecation, GI Upset, Emesis, Miosis (pupil constriction)

Contraindications (Do Not Give): 

Pts > 65 yrs (must weigh at least 80 kg) - 1 Auto-Injector or 2-PAM

Pts < 12 yrs (must weigh at least 30 kg) - To receive auto-injector IM


Procedure: Use red instructions in Epi Auto-Injector procedure instructions above in Epi Auto-Injector

Mark 1: Grasp injector and hold it like a pen - do NOT handle or grasp GREEN tip. Repeat with both injectors.

Duodote: Grasp center of injector with green tip (needle end) pointing down. Do not handle GREEN tip.


Document: Time, Site, and Name of antidote kit administered (PCR, triage tag or on back of patient’s hand in MCI)

Dosing: Authorized to give to self or under ALS direction



Mark 1 Atropine Dose

Mark 1 2 Pam Dose

Severe respiratory distress, agitation, SLUDGEM

3 Auto-Injectors

3 Auto-Injectors

3 Auto-Injectors (6mg)

Respiratory distress, SLUDGEM

2 Auto-Injectors

2 Auto-Injectors

2 Auto-Injectors (4mg)


Monitor for respiratory distress/SLUDGEM every 15 minutes

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