Document Type



Rappahannock Community College

Publication Date

Fall 2015


Normal Saline (NS) (0.9% Sodium Chloride Solution) and Ringer’s Lactate (RL) also known as lactated Ringers (LR) (Propanoic acid, 2-hydroxy-, calcium potassium sodium salt, hydrochloride (1:1:1:2:4)) (ChemSpider, 2015) are the two primary fluids used in resuscitation in the pre-hospital environment. In generally established protocols, these two rarely exist together in the same protocol for use by EMS personnel. In theory, NS is the primary fluid used in much of the Eastern United States (US), while Ringer’s Lactate is generally relied upon in the Western United States. The primary goal of this study is to examine resuscitative fluids as well as the others discussed in our course textbook. Three questions are to be addressed: When are these fluids used, why is one Isotonic Crystalloid Solution better than another for a given resuscitative purpose? Why is there a difference not only in our text, but also in the common usage for these fluids? Where are these fluids commonly used within the US, (i.e. where based on prehospital protocol guidance are these used)? Other Isotonic, Hypotonic, Hypertonic, Colloidal, and Electrolytic fluids will be examined under similar context. Peer Reviewed Authoritative Studies, if possible, interview with Medical Directors and EMS Council representatives setting locality based Protocols, and cursory web survey/review of available online EMS protocols will be used to answer these questions.

Due to uncontrollable circumstances, interviews were not possible. Electrolyte administration discussed in Guy is a special condition of hypertonic solutions. Electrolytes will not be specifically discussed in this paper. This study found many study authors acknowledge the long time debate along the same lines, which is best, NS or RL. Based on the research, this author would lean toward use of Ringer’s Lactate except in the case of pediatric patients where Ringer’s Acetate might be a better fluid. Which ever the fluid, the paramedic is advised based on this study to become educated in the various types of fluids, when and where they are to be used, their protocols, and most importantly study the acid-base balance impact of the various types of fluid.


Robert Brandel received the 1st place Fall 2015 Student Research Paper Award from Rappahannock Community College Library for this paper.



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