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Blueridge EMS Council
Protocols & Pharmacy Information

BREMS Protocols 

icon BREMS Protocols as of June 2019


Medication Shortage Notifications & Directives

icon BREMS Medication Directive for Epi & Bicarb - Feb 2019 

icon BREMS Dobutamine Infusion Directive 8-29-18

icon BREMS Diphenhydramine Directive 11-14-18

icon BREMS Lidocaine Infusion Directive 12-20-17


BREMS Drug Box Drawer Map

Providers will no longer see a laminated drawer map in the top of the BREMS drug box lid. The configuration will be here, on the BREMS mobile protocol app, and it will be placed on the LGH requsition sheet.

Screen Shot 2017-06-05 at 12.36.47 PM

icon New BREMS Drug Replacement Requisition Sheet

 icon Acudose Supply Tower Form - Updated June 2019



BREMS Protocol Update Training for June 2017


Below you will find training material for the next BREMS Protocol Update which will go live on June 1, 2017. 
Included in this update are:
  • DDNR/DNR & Palliative Care
  • How to properly restrain a patient and dealing with a combative patient
  • Changes to the concentration of Levophed (Drip rate changes)
    • Please note: There will now be (2) 4mg vials of Levophed in the BREMS Drug Box. 
  • Narcan administration for EMTs and Intranasal Administration training


While most of these will be updates to our actual policies, the Levophed concentration change and the administration of Narcan for EMTs will be reflected in the protocols as of June 1, 2017. This gives your departments and providers ample time to train and to read the documents. As of June 1, 2017, all EMTs in the BREMS Region should be utilizing the administration of Intranasal Narcan as needed, based on response level.
The members of the OMD Committee, comprised of your local OMDs as well as Dr. Marilyn McLeod being the Regional OMD, have approved these changes and updates to the policy. 
Please contact our office (434) 947-5934, with any questions you may have. And please ensure that all of your agencies and providers receive this notification.


icon Narcan & Opioid Abuse

icon Intranasal Administration

icon DDNR & Palliative Care

icon Restraints & Dealing with Combative Patients

icon Levophed Concentration Change

icon BREMS Box Configuration- Feb. 2017


Apps for Android and IOS software:  




 Older Documents

icon BREMS Protocol Changes Directive - March 2017 

icon BREMS Protocol Update as of March 2017

icon D10% Administrative Directive Sept. 2016

Regional Competency Review

icon BREMS Competency Review - 2019





Advanced Paramedic Program


icon Updated APP Protocols - August 2017

icon Updated APP Medication Index - Feb 2019


QA Forms:

icon New BREMS Agitated Chaotic Event/Behavioral Emergency Conscious Sedation QC Form

icon New BREMS AP Misc Use Form

icon DAI/ROSC Form




iGel Airway Release

As of June 1st, 2019 the BREMS Region will begin using the iGel Airway in place of the KING LTD Airway. 

The i-gel® is the innovative second generation supraglottic airway device

from Intersurgical. The first major development since the laryngeal mask

airway, i-gel has changed the face of airway management and is now widely

used in anesthesia and resuscitation across the globe.

Made from a medical grade thermoplastic elastomer, i-gel has been designed

to create a non-inflatable, anatomical seal of the pharyngeal, laryngeal

and perilaryngeal structures whilst avoiding compression trauma. Launched

in 2007 after years of extensive research and development, i-gel now has

an established reputation in anesthesia with three adult and four

pediatric sizes in the range, ideal for use with patient weights between

2-90+kg. In 2012, the indications for use were expanded to include use as

a conduit for intubation (with fiberoptic guidance).

Training & Procedure Information:

icon iGel Training Powerpoint

icon iGel Procedure Protocol

icon iGel Trainer Kit

General Classes/Continuing Education