First Due Academy MedicalEMREMTAEMTParamedic

Anaphylaxis / Allergic Reaction — Utah 2025 Protocol

Epinephrine is FIRST LINE — Benadryl does not treat anaphylaxis, it treats hives.

Steps by Cert Level

ALL: Epinephrine 1:1000 0.3mg IM anterolateral thigh — IMMEDIATELY. O2 high flow. Supine with legs elevated (unless respiratory distress).
EMT: EpiPen 0.3mg IM. Repeat in 5–15min if no improvement.
AEMT: Epi 1:1000 0.3mg IM, repeat q5–15min. IV/IO + NS 500mL–1L for hypotension. Diphenhydramine 25–50mg IV/IM. Albuterol nebulizer for bronchospasm.
PARAMEDIC: Methylprednisolone 125mg IV — prevents biphasic reaction. Glucagon 1mg IV/IM if patient on beta-blockers and unresponsive to epi.