Goodbye to Confusing Drug Ratios

By Mike McEvoy
FireEMS Editor

Effective May 1, 2016, manufacturers will no longer be able to use ratios on medication vials. The confusing epinephrine 1:1,000 and 1:10,000 will be replaced with the actual number of milligrams in each mL. The US Pharmacopia (USP) and the National Formulary (NF) ordered the change to alleviate persistent errors resulting from different ratio expressions being confused with one another. EMS, for example, has seen repeated incidences of patients administered a full milligram of 1:1,000 epinephrine IV when the provider intended to give only 0.1 mg. A case report resulting in the death of a 16-year old was published several years ago by the Institute for Safe Medication Practices (ISMP):

Let your medics and purchasing folks know that after May, epinephrine 1:1,000 can only be labeled at epinephrine 1 mg/mL and epinephrine 1:10,000 will read epinephrine 0.1 mg/mL. If your reference charts and protocols use drug ratios, you might want to review and update them to the new nomenclature so you’re on the same page with how medications will be packaged and labeled.

Mike McEvoyMIKE McEVOY is the EMS coordinator for Saratoga County, New York, and the EMS editor for Fire Engineering magazine. He is a nurse clinician in the cardiac surgical ICU at Albany Medical Center, where he also chairs the resuscitation committee and teaches critical care courses. He is the chief medical officer and a paramedic/firefighter for West Crescent Fire Department and a paramedic supervisor for the Clifton Park & Halfmoon Ambulance. He serves on the EMS Section board of directors of the International Association of Fire Chiefs and speaks at nursing, critical care, fire, and EMS conferences worldwide.

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