Within their standing protocols, EMTs may administer a limited set of medications directly. Oral glucose, supplied as a gel such as Glutose or Insta-Glucose, is indicated for suspected hypoglycemia in a conscious patient who can swallow and protect the airway. The typical adult dose is one tube containing roughly 15 to 25 g of glucose, administered buccally between the cheek and gum for rapid mucosal absorption and reduced aspiration risk. A blood glucose level below approximately 60 to 70 mg/dL generally defines hypoglycemia in adults, and EMTs should look for altered mental status, diaphoresis, tachycardia, weakness, and confusion. Oral glucose must never be given to an unconscious patient or to anyone who cannot protect the airway; instead, the EMT should secure the airway and arrange transport, with intravenous dextrose provided by ALS if available.
Activated charcoal is used for certain oral poisonings and overdoses, although it has become less common in modern protocols because of limited prehospital benefit. The standard adult dose is approximately 25 to 50 g, around 1 g/kg, mixed as a black, gritty slurry and given by mouth. Its mechanism of action is adsorption of certain toxins in the gastrointestinal tract, preventing their systemic absorption. Activated charcoal is most effective when given within about an hour of ingestion and only when the patient is awake, alert, and able to protect the airway. It is contraindicated in patients with altered mental status, in those who have ingested acids, alkalis, or hydrocarbons, and for substances it does not bind well, such as iron, lithium, and alcohols. Aspiration of the slurry can cause aspiration pneumonitis, and medical direction is typically required before administration.
Aspirin, generically acetylsalicylic acid (ASA), is administered for suspected acute coronary syndrome (ACS) and cardiac chest pain. The standard adult dose is 160 to 325 mg given as chewable, non-enteric-coated tablets, commonly four 81 mg baby aspirins, because chewing increases surface area and accelerates absorption. Aspirin is an NSAID with antiplatelet properties; by inhibiting platelet aggregation, it limits clot propagation in coronary arteries and reduces mortality when given early in suspected myocardial infarction. Contraindications include a known aspirin allergy and active gastrointestinal bleeding or a bleeding disorder. Aspirin is not given by EMTs for suspected stroke because of the risk of hemorrhage, and it is generally avoided in children because of the risk of Reye's syndrome. Aspirin fits into the traditional MONA mnemonic, Morphine, Oxygen, Nitroglycerin, Aspirin, used for early cardiac chest pain care, though morphine administration falls outside the EMT scope.