Date Published

January 19, 2012

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: For combative patient, preference for route choice from left to right is IV then IM. Shouldn't it be IM first? It is kind of hard to get an IV on a combative patient. Why no IN anymore?


 It is perfectly acceptable and in fact advised that if a patient is so combative that beginning an IV poses a risk to the paramedic, then the IM route is ideal. If an IV can be safely established for whatever the reason, the IV route allows for titration of dosage and speed of onset that is superior to the IM route. The IN route was removed out of concern by one of the RBH to due a risk of a paramedic being bitten. Multiple RBH have asked the IN route to be re-instituted (including SWORBHP) and this is on the list of suggested edits for the coming year.



Intravenous Therapy (IV)

Additional Resources

No additional resources are available for this SWORBHP Tip.