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This group is often affected by metabolic derangements that alter rhythms, in addition to having high rates of underlying heart disease. Hyperkalemia is a common complication of renal failure that can cause a bradycardia or a wide‐complex rhythm, although the latter is usually not above a rate of 100 to 120/minute and often much slower. Treatment should include IV calcium, high‐dose nebulized albuterol, and insulin plus glucose. Albuterol rapidly (but temporarily) shifts potassium into the cells and should be part of protocols for any renal failure patient with new‐onset symptomatic bradycardia or a wide‐complex rhythm. Insulin and glucose also work quickly, but insulin is rarely available in the field. If used, however, insulin and glucose infusions are best done with direct medical oversight supervision due to the risk of hypoglycemia.

Mode	Planning factor	Distance	Limiting factor	Notes
Ambulances (ground) Type I – ALS non‐HAZMAT Type II – BLS non‐HAZMAT Type III – Bariatric ALS, non‐ HAZMAT Type IV – ALS/critical care transport, non‐HAZMAT	One critical or two stable patients per ambulance	Good for short or intermediate distances no more than 250 miles.	Oxygen Road conditions	Evacuation of hospital patients may require care that exceeds most paramedic training
Paratransit vehicles Type I – Sedan/minivan (1‐7 seats) Type II – Minibus (8‐26 seats) Type III – transit bus (>26 seats) Type IV – Wheelchair van (1‐9 seats with wheelchair lift) Type V – ADA minibus (10‐26 seats with wheelchair lift) Type VI – ADA transit bus	Determine the seat requirement. The contractor determines the number of vehicles required based on seat requirements.	Good for short or intermediate distances for wheelchair patients	Road conditions IAW FEMA contract, the one‐way distance to transport paratransit passengers shall not exceed 250 miles	Paratransit transportation means comparable transportation services required by the Americans with Disabilities Act A for people with disabilities who are unable to use fixed route transportation systems.
Commercial air ambulances (rotary) Type 1 – Critical care and ALS, 2 or more litter patients Type 2 – Critical care and ALS, 1 litter patient Type 3 – Neonatal specific	Depends on the model of aircraft, but assume one litter for planning purposes.	Rotor‐wing for medical facilities to medical facilities or from medical facility to airport of embarkation (APOE) Good for short and intermediate distances but for planning purposes no more than 150 miles. The goal is to be able to deliver the patients quickly and return to provide additional lifts as needed	Experience and qualification of medical crew. Equipment onboard Oxygen Weather conditions Crew rest: Usually 10 hours in a 24‐hour period.	All air ambulances will have at least three crewmembers (pilot and two medical attendants)
Commercial air ambulances (fixed wing) Type 1 – Critical care and ALS, 2 or more litter patients Type 2 – Critical care and ALS, 1 litter patient Type 3 – Neonatal specific	Depends on the model of aircraft, but assume no more than two litters for planning purposes.	Good for intermediate and long distances, but for planning purposes no more than 150 miles. The goal is to be able and deliver the patients quickly and return to provide additional lifts as needed	Experience and qualification of medical crew. Equipment onboard Oxygen Weather conditions Crew rest: Usually 10 hours in a 24‐hour period.	All air ambulances will have at least three crewmembers (pilot and two medical attendants)

NOTE: Type refers to FEMA’s methods for the categorization and description of resources that are commonly exchanged in disasters via mutual aid, by capacity and/or capability.

Source: Based on FEMA Resource Typing Library Tool v1.5.3. Available at: https://rtlt.preptoolkit.fema.gov/Public/Combined

Lidocaine can cause asystole in the presence of hyperkalemia. The role of other agents, including amiodarone, is unknown in the rare event of hyperkalemia and new‐onset wide‐complex tachydysrhythmia [14]. If a rhythm‐specific intervention is needed in unstable patients with suspected hyperkalemia, electricity (pacing for slow, countershock for fast rates) is a safe choice.