Paramedics in Temecula and across Riverside County will no longer carry atropine as a cardiac arrest drug under updated emergency protocols that took effect Thursday, Oct. 1.

The Riverside County EMS Agency (REMSA) issued a system advisory Wednesday, Sept. 30, announcing four policy changes approved by the county's Prehospital Medical Advisory Committee (PMAC). EMS Administrator Michael Moore signed the advisory.

The changes govern how paramedics treat cardiac arrest patients, administer a clotting drug during severe trauma and decide where to transport injured patients.

Atropine removed from cardiac arrest protocol

The biggest change drops atropine from the adult cardiac arrest medication list under Policy 4405. The American Heart Association removed atropine from its Advanced Cardiac Life Support guidelines in 2010. A 2019 peer-reviewed study published in the journal Resuscitation found the removal did not change survival rates for patients with non-shockable heart rhythms.

Riverside County's own data backed the move. A review of 2024 and 2025 records found no paramedic in the county system used atropine for a cardiac arrest call during that two-year span, according to the advisory.

Trauma drug guidance clarified

The advisory also updated Policy 4105, the county's drug index for advanced life support. The new language encourages paramedics to use Tranexamic Acid, or TXA, alongside tourniquet application when a patient has multiple traumatic injuries and vital signs are not improving.

Under the updated policy, medics should apply a tourniquet first when the patient's condition allows, then administer TXA if vital signs remain unstable or the injuries involve polytrauma.

Trauma triage consultations now optional

Under the previous version of Policy 5301, paramedics were required to contact a Level I or Level II trauma center before making certain transport decisions. That mandatory consultation has been removed.

Under the updated rule, if a medic is unsure whether a patient needs a trauma center or which level is appropriate, the closest base hospital may be consulted. The consultation is no longer required.

That same trauma triage policy, 5301, was referenced in a separate REMSA advisory issued Tuesday, Aug. 25, when Riverside University Health System lost its designation as a Pediatric Trauma Receiving Hospital.

A fourth update, to Policy 3301, refreshed the language and forms link for the county's drug and equipment noncompliance process.

Residents and providers with questions about the changes can contact REMSA's clinical team at [email protected] or 951-358-5029.