Date Published

April 17, 2023

Updated For

ALS PCS Version ALS PCS Version 5.2


Would SWORBHP be ok with ACP paramedics utilizing the 4-2-1 rule for fluid maintenance rates in paediatrics. Especially, with the high incidence of RSV in the community compounded with sick kids who aren't taking in as much fluids and may be fluid depleted. Their fast respiratory rates and poor feedings, fever etc increases the insensible fluid loss. I can appreciate the current model, for fluid boluses utilizing the 70 mmHg + (2 x age in years). However, at this point they are decompensating rapidly with the hypotension and progressing to pre-arrest (with signs of delayed peripheral and central cap refill, looks sick as per PAT etc). Is the current protocol 15 ml/hr for


A patch to the BHP can be considered for treatment outside of the Medical Directives. If clinically the pediatric patient seems dehydrated, although not yet hypotensive, you can have a discussion with the BHP for consideration of fluids.  



IV fluid bolus, Pediatrics

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