EMS Protocols

Immediate Treatment for those suffering from an Adrenal Crisis

“A simple act of having a protocol in place to allow EMS personnel to treat an adrenal crisis can mean the difference between life, disability, and death. Rare diseases are often overlooked by drug development and by advocacy groups. Bringing a voice to an underserved community is needed now more than ever. Together we can make a difference and save lives.” 

~ Ian

What is Adrenal Insufficiency

When someone with adrenal insufficiency experiences illness or injury and does not receive the required steroid coverage to treat the stress on the body, an adrenal crisis can occur. The administration of a steroid injection or IV can mean the difference between life, disability, and death.

An adrenal crisis is a serious, potentially life-threatening emergency, that can occur during times of illness, injury, or extreme stress. An adrenal crisis can occur suddenly and must be treated immediately.

What is an Adrenal Crisis

Adrenal Insufficiency occurs when the adrenal glands no longer produce a sufficient amount of cortisol, and sometimes aldosterone.  Cortisol is a hormone that regulates changes that occur in the body including  immune responses, blood pressure, cardiovascular function, body fluid volume, and blood sugar levels. Aldosterone is a hormone that regulates the balance of water and electrolytes in the body. Failure to maintain this balance can result in critically low blood pressure, rapid heart rate, seizures, and mental disorientation.

Individuals with Adrenal Insufficiency run the risk of suffering an adrenal crisis. According to Adrenal Insufficiency United, there are over 60 known causes of Adrenal Insufficiency, which include:  Addison’s disease, Congenital Adrenal Hyperplasia, sudden cessation of long term steroid use, HIV, and cancer.

Signs and Symptoms of an Adrenal Crisis
  • Abdominal / leg pain
  • Chills
  • Clammy skin
  • Confusion
  • Low blood sugar
  • Seizure
  • Low back pain
  • Neurological deficits
  • Despondent
  • Fatigue
  • Headache / dizziness
  • Joint pain
  • Weakness
  • Shock-like symptoms
  • Low blood pressure
  • Loss of appetite
  • Cardiovascular Collapse
  • Listlessness / lethargy
  • Vomiting / diarrhea
  • Slow eye movement
Adrenal Crisis Pathway of Events

Impaired cortisol production   →   Decreased liver function   →   Low blood glucose   →   Seizures, convulsions, loss of consciousness   →    Shock    →   Brain coma, organ failure   →   Death

Protocols

Establishing EMS protocols for an adrenal crisis can mean the difference between life, disability, and death. An adrenal crisis can occur suddenly and must be treated immediately.

Many emergency services are unaware of the signs and symptoms of an adrenal crisis and how to treat it.

Some counties and states across the country have established, or are in the process of establishing protocols that allow emergency services to treat an adrenal crisis. This lifesaving treatment necessitates protocols in place in every state.

Florida EMS Protocols
  • The Adrenal Insufficiency United website has a great deal of information, resources, and educational resources for those affected by adrenal insufficiency (http://aiunited.org).