# Atropine in BLS Protocols?



## Cup of Joe (Sep 4, 2011)

Was reading the NYC REMSCO BLS protocols which were revised in May.  I don't work in NYC EMS, but was reading it for kicks.  Anyone have training with Atropine auto-injectors (I'm assuming in practice it would be similar to an Epipen) and 2-PAM auto-injectors?  Its a nerve agent exposure kit.  Anyone ever heard of this before and/or have it in their protocols?  How would some of you feel about this addition if it became part of your protocols?

And to ALS guys: do you think its a good or bad move to put these kits on BLS ambulances?  Do you think the same auto injectors could be indicated in other situations as well?


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## Shishkabob (Sep 4, 2011)

We have Duo-dotes on our ambulances, but not for EMT usage, only Paramedic.  (Granted, if it was an organophosphate exposure we were afraid of, my partner is more than welcome to jab himself)


I can see it as a use in NYC for the fear of CNA (Central nerve agent, not the nurse assistants), but not for anything else at the BLS level.


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## DesertMedic66 (Sep 4, 2011)

We carry the duo-dotes/mark 4 (I think) kits on all of our units BLS and ALS. Each ambulance carries 3 per crew member (they are only for crew usage). EMTs can use them and so can medics. We have to get "retrained" every 6 months (all the training is, is just grab the pen and stab yourself in the mid thigh at a 90 degree angle).


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## Aidey (Sep 4, 2011)

It is part of our protocols, but the kits aren't stored on the ambulances. In the event there is a situation where they needed the supervisor will distribute them.


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## Cup of Joe (Sep 4, 2011)

firefite said:


> We carry the duo-dotes/mark 4 (I think) kits on all of our units BLS and ALS. Each ambulance carries 3 per crew member (they are only for crew usage). EMTs can use them and so can medics. We have to get "retrained" every 6 months (all the training is, is just grab the pen and stab yourself in the mid thigh at a 90 degree angle).



The intent for these would be for use on patients after decontamination (or during if they are flagged RED)


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## Anjel (Sep 4, 2011)

I know how to use them and what they are. We don't carry them. 

They are expensive. 

But if we only have 1 or 2 on the ambulance. Sorry those are gonna be for me and my partner. If it is a nerve agent exposure and there is a possibility i'm exposed. I am using it if things hit the fan.


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## DesertMedic66 (Sep 4, 2011)

Cup of Joe said:


> The intent for these would be for use on patients after decontamination (or during if they are flagged RED)



Ooh well then nope. we aren't allowed to give any med without it being prescribed to the patient aside from oral glucose (we don't carry aspirin or activated charcoal) at the EMT level.


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## Cup of Joe (Sep 4, 2011)

Anjel1030 said:


> But if we only have 1 or 2 on the ambulance. Sorry those are gonna be for me and my partner. If it is a nerve agent exposure and there is a possibility i'm exposed. I am using it if things hit the fan.



Agree with you 100%: if I need it and they need it, I'm getting it first. 

However, the protocols still dictate for regular EMS personnel to remain in the cold zone and administer the drugs there AFTER the patient has been decontaminated.  If the patient is given a RED triage tag, they are given the drugs during decon, I'm assuming by HAZMAT trained EMS personnel (which would be the HAZ-TAC FDNY trucks).


Question for medics: do you think Medical Control could tell a basic to give an auto-injector of Atropine in a case where it would be indicated at an ALS level? Lets assume medic are on the way, but are 15-20 minutes away...


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## STXmedic (Sep 5, 2011)

We carry 15 Duo-dotes on the fire apparatus, 9 on the ambulance. Dose is up to 3 injections, for use by any level EMT. Three are for patient use, the other 12/6 are for crew use ONLY. Our chief's trucks carry a large quantity of them as well for MCIs.


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## STXmedic (Sep 5, 2011)

Cup of Joe said:


> Question for medics: do you think Medical Control could tell a basic to give an auto-injector of Atropine in a case where it would be indicated at an ALS level? Lets assume medic are on the way, but are 15-20 minutes away...



Of course he could. Although, I am from Tx... Our medical directors can have our basics do surgical crics if he wanted  But yes, if the S/S are right and there is a high index of suspicion for Oranophosphate poisoning, there's no reason a basic couldn't. Administering a duodote is no different than administering an epi-pen


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## usafmedic45 (Sep 5, 2011)

> We have Duo-dotes on our ambulances, but not for EMT usage, only Paramedic. (Granted, if it was an organophosphate exposure we were afraid of, my partner is more than welcome to jab himself)



I would be doing it as I leave the scene.


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## MedicBender (Sep 5, 2011)

We had then on all of our units when I worked as a basic in MN. During the last republican national convention there were reports of medics stealing them and stocking up just in case


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## MonkeySquasher (Sep 5, 2011)

Linuss said:


> ...for the fear of CNA (Central nerve agent, not the nurse assistants)...



Yeah, those scare the hell out of me..  




Aidey said:


> In the event there is a situation where they needed the supervisor will distribute them.



So in the event YOU've been exposed, your supervisor is supposed to expose himself to give you the injectors?   :wacko:




Anjel1030 said:


> I know how to use them and what they are. We don't carry them.
> 
> They are expensive.
> 
> But if we only have 1 or 2 on the ambulance. Sorry those are gonna be for me and my partner. If it is a nerve agent exposure and there is a possibility i'm exposed. I am using it if things hit the fan.



+1 here.  Been trained on them, and see no difference from an EpiPen.  We have the only WMD/HAZMAT ambulance in our region, and we carry 10-15 2-PAM kits onboard.  But since my volly company will put 5 people on the ambulance, they'd probably use most the kits on themselves...  

And at my job, they'd either expect us to give ourselves lines/IV Atropine, or they'd say it's our fault for becoming contaminated and fire us to avoid paying Comp.  haha




Cup of Joe said:


> do you think Medical Control could tell a basic to give an auto-injector of Atropine in a case where it would be indicated at an ALS level? Lets assume medic are on the way, but are 15-20 minutes away...



I highly doubt it.  Atropine is given in an Organophosphate OD not because of bradycardia, but because of the secretions that overwhelm the airways.  In a medical case, giving Atropine is preferred IV at certain dosages... The IM route of the injector would be too slow-acting.  Same with an EpiPen..  You don't give it because of an allergic reaction, you give it because of airway constriction and hypotension, and would be near-useless in cardiac arrest.  They're auto-injectors designed for one purpose, and don't really work well otherwise.


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## Flight-LP (Sep 5, 2011)

PoeticInjustice said:


> Administering a duodote is no different than administering an epi-pen



And it's efficacy is about as low....................


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## usafmedic45 (Sep 5, 2011)

> And it's efficacy is about as low....................



Yeah....a couple of milligrams of atropine is not nearly enough.  The last symptomatic exposure I worked required over 30 mg just to get her to stop foaming.


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## systemet (Sep 7, 2011)

usafmedic45 said:


> Yeah....a couple of milligrams of atropine is not nearly enough.  The last symptomatic exposure I worked required over 30 mg just to get her to stop foaming.



It would be great to hear more about the call - what happened? How did the patient present? Do you feel like giving some more information, either here, or in another thread?

I've never seen one of these.


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