EMS Drugs

As an exercise I rated the 33 drugs I carry in order of their essentialness.

In other words, if every day I had to take one drug off my rig until in the end I only had one left, which drug would I choose each day?

In writing the drug profiles, I tried to imagine I was telling a new preceptee my thoughts and experiences with the various drugs.

Here is the list from most essential to least:

1. Epinephrine
2. Morphine
3. Oxygen
4. Ativan
5. DuoNeb
6. Normal Saline
7. Dextrose
8. Nitroglycerin
9. Narcan
10. Aspirin
11. Amiodarone
12. Atropine
13. Dopamine
14. Zofran
15. Cardizem
16. Adenosine
17. Glucagon
18. Magnesium
19. Benadryl
20. Versed
21. Solu-Medrol
22. Sodium Bicarbonate
23. Calcium
24. Haldol
25. Metoprolol
26. Lidocaine
27. Toradol
28. Activated Charcoal
29. Tylenol
30. Tetracaine
31. Phenergan
32. Vasopressin
33. Lasix


  • Don says:

    Thanks for putting in the effort on this, much appreciated as I am always looking for more experience provider input.

  • mark says:

    Thanks for you work on this. I read this site many times at work just to quiz myself and learn from your experiences.

  • Christina says:

    This is good stuff! Thanks for writing it!

  • michelle says:

    I’m wondering if you’ve come across any reference that talk about the quantity of medications use? Say, are there any statistics on the average number of epinephrine 1:10,000 syringes used in a code situation? There are an increasing amount of drug shortages, mostly for our code tray items. We are looking to determine a minimum, safe quantity to include in the trays. We stock the code tray with 10 syringes. We would like to decrease this to 7 syringes. Do you have any thoughts? Any references you could point me to? Thanks.

  • Karin says:

    Thank you so much for writing this. I am studying to become a paramedic and your short ‘stories’ about the drugs make it so much easier for me to remember them all. Thank you!

  • raymond says:

    Thank you for the list, although I use Zofran and solu-medrol more so I think those would be higher on my list.

  • K says:

    Can you add RSI drugs (vec, roc, sucks, etomidate) these explanations really help me grasp the drugs.

  • Morgan says:

    I am 12 years young and I’m studying drugs for when I’m older I’m very smart and i love to learn new drugs so I study all my time into drugs this is a really good site thank you!!:)

  • Kayley says:

    I’m studying drugs for when I’m a CNA Nurse later in life. This is an awesome site thanks for this AMAZING SITE!!!!!!!!

  • Josh says:

    Great list. I was surprised to see Fentanyl left off the list since it seems to have become the go to prehospital analgesic over Morphine. I have been in EMS for 7 years and a medic for about a year and have seen/given Fentanyl far more often than Morphine for pain.

  • ryan says:

    Yes I think it has far less side effects and is also a better pain controller versus just doping up the patient. It is fully synthetic opioid while morphine is a true opiate, which means very many people are going to be allergic to the morphine and no the fentanyl, ranging from minor issues to anaphylactic responses. So basically porphine is just extracted from poppy plants and coverted into a hcl for administering it, while fentanyl is a chemical made in a lab and better designed to effect the opiate receptors to lessen pain. Still is a habit forming narcotic but its better than morphine in that sense.

  • EmG says:

    You guys all are right for morphine, and fentanyl too. But you are missing the other effects of morphine in pulmonary edema, for example. In our practice we use MONA (morphine, O2, nitroglycerine, aspirine) in MI. Then, bi-phasic effect of morphine (histamino-liberation and possible hypotension followed by vasoconstriction). This eternal analgesic still has it place in the tray.

  • Henrietta says:

    I am totally wowed and prrpeead to take the next step now.

  • Justin says:

    What about ketamine?

  • medicscribe says:

    Good question. It wasnt around when I made the list. We are expected to get it soon.

  • Justin says:

    This site is the best!

  • tyler says:

    I’m also shocked that fentanyl and ketamine is not on the list however this article was written in 2010. As rapidly as things are changing in EMS these medications may not have been common during this guys career pre-2010 to be seen on an ambulance.

  • Bryce says:

    I love, love, LOVE this list. The knowledge and perspective that you bring forth is amazing. However, it would be nice if possibly we could just see an updated list of your medications now and your perspective on them. (ie. fentanyl, ketamine, etc.)

  • Thanks for arranging such a essential medicine in in essential order…I appreciate for this..and I’m gona refer this list as I’m working in ER as both emt as well as paramedic…thanks..

  • Thanks for great…list of medicines

  • Harrison Okoth says:

    Thanks for this reasonable findings, for I am An EMT working with the leading EMS provider in my country.

  • Jani says:

    Hi! Do you have any national guidelines when it comes to what drugs to use in EMS? If no, do you think there would be any benefits with such guidelines? Is there any articles or papers done when it comes to + and – with national guidelines for drugs in EMS?

  • medicscribe says:


    You can reference the National Model Clinical Guidelines that can be found here.

    National Model EMS Clinical Guidelines

  • RscuNinja says:

    I would love to hear all of you EMT & Medics thoughts on Lidocaine…why is it still stocked on ambulances? I work in an ICU, it was removed from our code carts a long time ago. In an emergency, after all else has failed we have pharmacy bring us the drip. I can’t imagine a pre-hospital situation appropriate for a lido gtt. I’m also very concerned right now after receiving a patient s/p cardiac arrest because an EMT spiked & bloused the whole 2gm/500ml bag (thought it was NS)…TO A SIMPLE HYPOGLYCEMIC EPISODE patient, the glucagon & D50 had already worked it’s magic. Medication errors are real, in any setting, but if it’s not there to grab it can’t be given! Such a terrible story I know, but maybe this will shed light on the need for re-evaluation.

  • Janice L Cranmer says:

    Ok I would like to hear from you or anyone else on why morphine was pulled from our county. And the new pain killer is Ketamine????
    It may kill pain but its a sedative. Nearly killed me and I just can’t understand why its in the ambulance. It needs to go. Please if you have experienced good or bad I wanna here the experience please.

  • Janice L Cranmer says:

    That is a knock the patient out and make them unresponsive. Nearly killed me 5 days ago. It has
    No place in the ambulance. That’s some horrible

  • David Bowden says:


    I think O2 would by far be my number 1.
    Then ASA.

  • David Bowden says:

    Ketamine is not necessarily the cornicopia that we have been promised, but it is an amazing drug.

    That you had a bad experience with it doesn’t negate the fact that even at a 10x dosing error, it is generally safe in comparison to everything else we have at our disposal.

    If I even doubled the dosage of Fentanyl, likely respiratory compromise would occur. Ketamine has much less effect on respiratory drive than opioids, period.

  • Thomas Anthony Williams says:

    Now days Narcan is gonna be on the top

  • Maria says:

    What about normal saline?

  • Anvil Hawk says:

    This is a very great article even to this day however I wish that it could be updated and added too. It would be nice to bring it up to par with 2019-2020 protocols

  • medicscribe says:

    Thanks, I am thinking about updating them.



  • Kiki says:

    This was really helpful for my studies. I am aiming to become a paramedic i am 16 years old and have already started studying for when i go to uni and college.

  • Catherine Maher says:

    In the calls that I have seen Narcan, Oxygen, Nitro, Dextrose are the top 4.

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