Every Medication an EMT-B Can Administer (2025 Scope)

EMT-B medication scope is narrower than many students think, and that is a good thing for exam prep. You do not need to learn ALS drug boxes to pass an EMT-B exam. You need to know your approved medications, indications, contraindications, route, dose, and when local protocol or medical direction matters.

The core list is oxygen, aspirin, oral glucose, epinephrine auto-injector, albuterol metered-dose inhaler assistance, nitroglycerin assistance, naloxone in most states, and activated charcoal where authorized. Everything else is either an ALS medication or someone else's job.

Administer versus assist

The National EMS Scope of Practice Model separates medications an EMT administers from medications an EMT helps a patient take. That distinction is scored.

• Administer: oxygen, oral glucose, aspirin, epinephrine by auto-injector, naloxone where state-approved, and activated charcoal where authorized and typically with medical direction.
• Assist: the patient's own prescribed nitroglycerin and the patient's own prescribed metered-dose inhaler.

Assisted medications belong to the patient. That means the prescription must be the patient's own, current, and unexpired, and your protocol has to allow the assist. Practically, every state layers its own scope on top of the national model. Learn the national baseline for the exam and your local protocol for the street.

The quick reference list

Each line gives the medication, route, adult dose commonly taught, and the primary indication.

• Oxygen, inhalation, flow rate by device, for hypoxia and respiratory distress
• Aspirin, oral and chewed, 324 mg as four 81 mg chewable tablets, for suspected cardiac chest pain
• Oral glucose, oral and buccal, commonly one 15 g tube, for symptomatic hypoglycemia in a patient who can swallow
• Epinephrine auto-injector, intramuscular in the lateral thigh, 0.3 mg adult and 0.15 mg for pediatric patients under 30 kg, for anaphylaxis
• Albuterol, inhalation by the patient's prescribed MDI, per the prescription and protocol, for bronchospasm with wheezing
• Nitroglycerin, sublingual tablet or spray, 0.4 mg per dose up to three doses about five minutes apart, for cardiac chest pain
• Naloxone, intranasal or intramuscular by state protocol, dose device-specific, for suspected opioid overdose with respiratory depression
• Activated charcoal, oral, commonly taught as 1 gram per kilogram, for select ingestions with medical direction

Doses above are the ones most commonly taught in EMT programs. Your protocol is the authority on the street, and the NREMT expects you to check contraindications before any of them.

The six rights, every time

Before any medication, confirm the right patient, right medication, right dose, right route, right time, and right documentation. Then verify expiration and inspect the medication for discoloration or particulate matter. Exam questions frequently hide the failure in a skipped check rather than in a wrong drug.

Oxygen

Oxygen is used for hypoxia, respiratory distress, shock, altered mental status, chest pain, and other situations where oxygenation is a concern. Choose delivery based on how much support the patient needs.

• Nasal cannula: commonly 1-6 liters per minute for mild need in a patient breathing adequately.
• Nonrebreather mask: commonly 10-15 liters per minute for a patient with adequate respiratory effort who needs high-concentration oxygen.
• Bag-valve mask with reservoir at 15 liters per minute: for inadequate ventilation. This is a ventilation device, not just an oxygen device.

Target saturation for most adults is at least 94%. Many protocols use a lower target, commonly 88-92%, for known COPD patients. Never withhold oxygen from a severely hypoxic patient out of fear of hypoxic drive. Titrate and reassess.

The most common oxygen error is device mismatch. If rate and depth are inadequate, the answer is assisted ventilation. A mask on a patient who is not moving air does nothing.

Aspirin

Aspirin is given for suspected cardiac chest pain in the absence of contraindications. It reduces platelet aggregation.

• Dose: commonly 324 mg, given as four 81 mg chewable tablets. Chewed, not swallowed whole, for faster absorption.
• Contraindications: known aspirin allergy, active gastrointestinal bleeding, known bleeding disorder, suspected stroke or head injury with bleeding risk, and inability to swallow or protect the airway.
• Pediatric patients do not receive aspirin, because of Reye's syndrome risk.
• Ask whether the patient already took aspirin today and how much, then follow protocol.

Aspirin is the exam's favorite chest pain question because it is easy to give too early. Airway, breathing, circulation, and vital signs come first. Contraindication screening comes before the tablets.

Oral glucose

Oral glucose is for a hypoglycemic patient who is conscious, able to swallow, and has an intact gag reflex. It is placed between the cheek and gum for buccal absorption.

• Dose: commonly one 15 g tube, repeated per protocol.
• Threshold: many protocols treat below 60 mg/dL, some use 70 mg/dL. Treat the patient and the protocol, not just the meter.
• Absolute contraindications: unresponsiveness, inability to swallow, and absent gag reflex.
• Reassess mental status and repeat a glucose check after administration where your service carries a glucometer.

If the patient cannot swallow or has severe altered mental status, the answer is airway support, positioning, ALS request, and transport. Intravenous dextrose and intramuscular glucagon are ALS interventions, not EMT-B options.

Epinephrine auto-injector

Epinephrine by auto-injector is indicated for anaphylaxis per protocol. It causes vasoconstriction, bronchodilation, and increased heart rate and contractility.

• Adult dose: 0.3 mg intramuscularly, into the anterolateral thigh, and it may be given through clothing.
• Pediatric dose: 0.15 mg for children under 30 kg, per protocol and device availability.
• Indications the exam looks for: respiratory compromise such as stridor or severe wheezing, or signs of shock, following a likely exposure. Hives alone without airway or circulatory involvement is not anaphylaxis.
• Expected effects: tachycardia, tremor, anxiety, pallor, headache. These are side effects, not reasons to withhold the drug in true anaphylaxis.
• Repeat dosing requires protocol authorization or medical direction.

Severe allergic reactions deteriorate fast. Epinephrine early, then oxygen, positioning, ALS request, and transport. Do not delay epinephrine to collect more history.

Albuterol MDI assistance

At EMT-B level, albuterol is usually assistance with the patient's own prescribed metered-dose inhaler, depending on protocol. Some systems authorize a small-volume nebulizer for EMTs. Check yours.

• Indication: bronchospasm with wheezing or known reactive airway disease in distress.
• Requirements: the medication is prescribed to this patient, is not expired, and the assist is protocol-approved. Confirm the patient has not already exceeded the prescribed dosing.
• Technique: shake the inhaler, use a spacer when available, coordinate actuation with a slow deep inspiration, then have the patient hold their breath briefly.
• Side effects: tachycardia, tremor, nervousness. Expect them and reassess anyway.
• Reassess lung sounds, respiratory effort, and saturation after administration and document the change.

A patient who is too altered or too weak to use an inhaler effectively needs ventilatory support and ALS, not another puff.

Nitroglycerin assistance

Nitroglycerin is typically assistance with the patient's own prescribed medication for cardiac chest pain. It dilates vessels, reduces cardiac workload, and can drop blood pressure sharply.

• Dose: 0.4 mg sublingual tablet or spray, up to three doses about five minutes apart, per protocol.
• Blood pressure requirement: many protocols require a systolic above 100 mmHg, and some use different thresholds. Take a blood pressure before every dose, not just the first one.
• Hard contraindication: recent use of a phosphodiesterase-5 inhibitor. Commonly taught windows are within 24 hours for sildenafil or vardenafil and within 48 hours for tadalafil. The combination can cause profound hypotension. Ask directly and privately.
• Other cautions: hypotension, suspected head injury, and any protocol-specific restriction such as suspected right ventricular involvement. Follow medical direction.
• Side effects: headache, dizziness, hypotension, burning under the tongue.

Reassess blood pressure and pain after each dose and document both. A patient whose pressure drops after nitroglycerin gets positioning, oxygen, and a fast reassessment, not a third dose.

Naloxone

Naloxone is authorized for EMT use in many states for suspected opioid overdose with respiratory depression. It is an opioid antagonist.

• Routes at EMT level: commonly intranasal or intramuscular, depending on state scope and the device your service carries.
• Dose: device-specific and protocol-specific. Prefilled intranasal devices and intramuscular presentations differ, so learn the device you carry.
• Goal: adequate ventilation, not perfect alertness. Titration matters where protocol allows it.
• Support ventilation first. Bag-valve-mask ventilation with oxygen treats the hypoventilation that is actually killing the patient. Naloxone does not replace it.
• Watch for re-sedation. Naloxone can wear off before the opioid does. Transport, and monitor breathing continuously.
• Expect possible agitation or acute withdrawal. Scene safety applies.

Activated charcoal

Activated charcoal is state-variable and usually requires medical direction. It adsorbs certain ingested substances in the gastrointestinal tract.

• Dose: commonly taught as 1 gram per kilogram of body weight, per protocol.
• Timing: most useful soon after ingestion, generally within about an hour, and the decision belongs to medical direction.
• Contraindications: altered mental status, absent gag reflex, inability to swallow, ingestion of corrosives or caustics, ingestion of petroleum products, and any patient at risk of aspiration.
• Contact poison control and medical direction where your protocol requires it.

Many services no longer carry it. Know whether yours does, and know the contraindications either way, because the exam still asks.

What is not EMT-B medication scope

Adenosine, amiodarone, atropine, dopamine, epinephrine drawn from a vial or ampule for intravenous use, intravenous dextrose, glucagon, intravenous fluids, sedatives, and paralytics are not EMT-B medications. Intravenous and intraosseous access, endotracheal intubation, needle decompression, and cardiac monitoring interpretation are not EMT-B skills in the national scope.

On the exam, the EMT-B response to a patient who needs any of those is the same: recognize the need, deliver the basic interventions that are within your scope, request an ALS intercept early, transport, and document.

Common NREMT traps

• Giving aspirin before completing the primary assessment and vital signs. The medication is correct and the sequence is wrong, so the answer is wrong.
• Giving nitroglycerin without asking about erectile dysfunction medications. This is the single most tested nitroglycerin contraindication, and students skip it because the question feels awkward.
• Giving a second or third nitroglycerin dose without rechecking blood pressure. A pressure taken once at the start does not authorize the next dose.
• Giving oral glucose to an unresponsive or non-swallowing hypoglycemic patient. The glucose reading does not override the airway.
• Withholding epinephrine in anaphylaxis because the patient has a cardiac history or because tachycardia worries you. Untreated anaphylaxis is the greater threat.
• Calling isolated hives anaphylaxis and reaching for the auto-injector. Anaphylaxis requires airway or circulatory involvement.
• Choosing naloxone as the first action for an apneic overdose patient. Ventilate first. Naloxone is the second answer, and ventilation is the one that keeps the patient alive.
• Assisting with a medication that belongs to a family member rather than the patient. Assisted medications must be the patient's own prescription.
• Selecting an ALS intervention as the EMT-B action. If the option involves an IV, an advanced airway, or a cardiac drug, it is not your answer.
• Forgetting the reassessment. A medication question is often really a reassessment question, and the missing step is what gets scored.

Practice this next

Read once, then drill. Contraindication checks only stick under time pressure.

• Pharmacology — indications, contraindications, dose, and route checks.
• Cardiology — chest pain sequencing, aspirin and nitroglycerin decisions.
• Respiratory Emergencies — albuterol assistance and oxygen versus ventilation calls.
• Free NREMT practice test — full mixed-domain set.