Coastal Valleys EMS Agency has released an updated version of earlier guidance for provider agencies experiencing medication shortages due to supply chain disruptions. EMS Special Memo 22-002 Drug Shortages and Substitutions includes direction for the substitution of Lactated Ringer's Solution in place of Normal Saline with some important exceptions. The Memo outlines procedures to be put in place if a provider agency is unable to obtain required medications after exhausting usual and alternate vendors. This guidance will allow for the use of expired medications in extremis when no other options remain.