EMS Medications by Certification Level (EMR, EMT, AEMT, Paramedic)

This table is the national model. It is where you start, not where you finish. What you may actually give comes from your state and agency protocols, never from the table. Doses vary by protocol; follow local protocols and medical direction.

1. Find the level first. Confirm your certification level and what your state protocol lets your agency authorize. The national model is a baseline, not a legal scope.
2. Read the row, then your column. Yes: the national model lists the drug or route at that level, subject to medical direction. No: it is not listed at that level.
3. Confirm the order and stock. Several rows need medical director approval or agency-supplied product before use.
4. Document drug, dose, route, time and response. Doses here match the linked E3 medication page; protocol-dependent items are labeled.

Routes of administration by level

This comes from Section IV of the national model. Medical director approval limits these routes. The EMT intramuscular route also assumes medical direction for preparation training.

Hypoglycemia, antiemetic, nitrous oxide and antidotes

These are the rows the Pitfalls section points to, plus other items from the national model list. The route and the level set the scope. The dose is per protocol.

Tenecteplase STEMI dose by weight

Give it only after the indication and contraindication screen in Pitfalls, and per protocol. The volumes assume one 50 mg vial reconstituted with 10 mL, as the STEMI dosing table in the label lays out.

Worked example: a 15 kg child gets 0.01 × 15 = 0.15 mg IM (0.15 mL of 1 mg/mL). Auto-injectors skip the math. They come in fixed doses: 0.15 mg (about 15–30 kg) or 0.3 mg (30 kg or more). Pick the device that fits the weight band, then confirm against the agency protocol.

The arrest dose runs the same math: a 20 kg child gets 0.2 mg, or 2 mL of 0.1 mg/mL. Read the concentration on the vial before you draw it up.

• Pediatrics: The national model sets no age cutoff. Under 30 kg, epinephrine IM for anaphylaxis is 0.01 mg/kg, max 0.3 mg, when you draw it up. Fixed auto-injectors are 0.15 mg (about 15–30 kg) or 0.3 mg. Pediatric IV/IO arrest epinephrine is 0.01 mg/kg, max 1 mg, per AHA PALS. In children, aspirin for ACS is not established, and it carries a Reye syndrome risk. Naloxone IV/IO: the Hospira label starts at 0.01 mg/kg IV and moves to 0.1 mg/kg if there is no response. AHA PALS teaching uses 0.1 mg/kg (max 2 mg). Titrate to breathing. A full 0.1 mg/kg first dose can cause withdrawal in an opioid-dependent child. Intranasal pediatric dosing follows protocol. Oral glucose and nitroglycerin in children follow protocol. Nitrates need specialist input.
• Pregnancy: The national model does not establish a specific adjustment for the rows above. Treat by protocol and medical direction.
• Older Adults: Check blood pressure before every nitroglycerin dose. Withhold for hypotension per protocol. A common threshold is SBP under 90 mmHg or 30 mmHg below baseline. Recheck glucose after oral glucose. Older patients often have medication-related hypoglycemia and hypotension, which is why that recheck matters.

• Error: Reading this matrix as your state license. The national model is a baseline. States and agencies add, remove or restrict rows. Use the state protocol.
• Error: Reaching for a drug that is not listed at your level, even when the patient is unstable. The fix is medical control or a higher level of care.
• Error: Giving nitroglycerin before you screen. PDE-5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil) and riociguat rule it out. So do severe anemia, suspected raised intracranial pressure, circulatory failure or shock, and nitrate hypersensitivity. The label is clear that use within a few days of PDE-5 inhibitors or sGC stimulators is not recommended. The time course has not been studied. Protocols set the interval. Many use 24 hr for sildenafil or vardenafil and 48 hr for tadalafil. Withhold for hypotension (commonly SBP under 90 mmHg or 30 mmHg below baseline, per protocol). Withhold too for suspected right-ventricular or inferior MI.
• Error: Giving a thrombolytic before the screen is done. It is for STEMI with symptom onset within 12 hours, and only when PCI cannot be reached within 120 minutes. Then check for active internal bleeding, prior stroke, intracranial or spinal surgery or trauma within 2 months, intracranial neoplasm, AVM or aneurysm, bleeding diathesis, severe uncontrolled hypertension and suspected aortic dissection. Follow protocol and medical control.
• Error: Giving fentanyl with no monitoring plan. It is high-alert. Watch SpO2, waveform capnography and blood pressure. Keep naloxone and airway equipment ready, and hold for hypotension or altered mental status. Use the agency second-check policy.
• Error: Mixing up IV epinephrine (1 mg/10 mL, 0.1 mg/mL) with the 1 mg/mL vial you use IM. Read the concentration on the vial before you draw it up.
• Error: Stopping after one naloxone dose. The naloxone can wear off before the opioid does. Repeat per protocol and keep watching breathing until the transfer.
• Error: Giving oral glucose or aspirin to someone who cannot swallow safely. Aspirin is also out for aspirin or NSAID allergy or active GI bleeding. Under the national model, IV dextrose and glucagon belong to AEMT or paramedic (see Additional Tables). EMR and EMT call medical control.

• Carried products: Stock changes from agency to agency. Check the naloxone, epinephrine auto-injector, oral glucose, aspirin and nitroglycerin lots and expiry dates every shift.
• Medical direction: You cannot use a row that needs agency stock or a medical director order on your own initiative.
• Transport: Transport crews can carry IV drugs past these rows under their own protocol. Check the level and protocol before every drug.
• Handoff: Write down each drug, dose, route, time and response. Naloxone and nitrate doses especially.