LOC for BLS meds

[Brandon O]

Basics -- in your area, what are the LOC requirements for administering nitro, aspirin, metered-dose or nebulized albuterol, and epi?

Obviously this only applies for those who can administer these at all, whether they carry their own or can use/assist the patient's meds.

And we can probably assume that no protocol lets you give oral glucose or charcoal without a conscious and somewhat oriented patient who can guard their airway.

 

[emp430]

For LOC, PT has to be alert and able to swallow. Can't put oral glucose in their mouth if they can't swallow. If they're unconscious putting anything in their mouth could become an airway problem. In my area basics can only assist, so that would mean the PT is A&O.

 

[Lifeguards For Life]

For LOC, PT has to be alert and able to swallow. Can't put oral glucose in their mouth if they can't swallow. If they're unconscious putting anything in their mouth could become an airway problem. In my area basics can only assist, so that would mean the PT is A&O.

I was just about to say. i think most areas (mine included) operate under protocols saying basics can not administer any meds but can "help" a patient with the patient's medcations or the medications authorized for use to the EMT-B in that area

 

[emp430]

I was just about to say. i think most areas (mine included) operate under protocols saying basics can not administer any meds but can "help" a patient with the patient's medcations or the medications authorized for use to the EMT-B in that area

Also in my area basics can only assist with the PTs meds. Basics can't go into the ALS bag and grab Nitro to give, even if the PT is prescribed nitro. Has to be out of their bottle

 

[emtfarva]

Basics -- in your area, what are the LOC requirements for administering nitro, aspirin, metered-dose or nebulized albuterol, and epi?

Obviously this only applies for those who can administer these at all, whether they carry their own or can use/assist the patient's meds.

And we can probably assume that no protocol lets you give oral glucose or charcoal without a conscious and somewhat oriented patient who can guard their airway.

I can give Epi only in cases of anaphlasis. So, a Pt doesn't really have to be A+Ox3. Everything else, they have to A+Ox3.

 

[Brandon O]

Is that your company policy, farva, or is that how you read the MA protocols? From what I can see the protocols are ambiguous for ASA and nitro at the very least, and probably inhalers as well.

Obviously you have to be able to chew the aspirin, and you have to be breathing to receive the inhaler. But that doesn't say much. And you have to be able to complain of ACS symptoms to get nitro, but it seems like you could c/o chest pain and then promptly deteriorate, so technically it appears that you could get nitro even if you're unresponsive. Unclear stuff.

Noticing these ambiguities made me realize that these meds often seem to be indicated in this way, so I thought it was a worthwhile topic to look at.

 

[boingo]

I think a little common sense is needed. Example, tight asthmatic, loses consciousness in front of BLS crew, they assist ventilation w/BVM with in-line nebulizer. Pt wasn't alert however the PMH was known and the actions were appropriate. I think protocols are guidelines, they are not engraved in stone without room for clinical judgement. I know we can argue all day what degree of experience and education are needed to have clinical judgement, however thats for another thread.

 

[Seaglass]

For LOC, PT has to be alert and able to swallow. Can't put oral glucose in their mouth if they can't swallow. If they're unconscious putting anything in their mouth could become an airway problem. In my area basics can only assist, so that would mean the PT is A&O.

This, pretty much.

 

[firecoins]

If ALS is on scene, it a Contradiction for BLS to give meds.

 

[Tincanfireman]

I think protocols are guidelines, they are not engraved in stone without room for clinical judgement.

Can't speak for everyone, but our standing orders are broken down into ALS, ILS, and BLS. It doesn't matter if I've responded to the same patient 20 times for CP with a PMHx, there's no way in the world I'm reaching for that bag if I'm working without a Medic partner. He'll have an INT in place, and the bag might be out and sitting on the bench, but we can't even give ASA as Intermediates in my service, so they stay in the bag. It's frustrating, but it's the rules of the game.

 

[Dominion]

Where I work I can assist with Nitro if alert and able to swallow. This must be the patients prescribed, non-expired nitro. I can administer ASA from our truck, again if alert and can swallow.

Epi I can give in case of severe anaphylaxis and a medic must be in route or on scene (but I do not have to wait to give the epi SQ).

If a patient has wheezes + severe respiratory distress I can give up to 5 albuterol treatments as long as the HR remains below 110. If the HR is above 110 I must wait for a medic to arrive on scene and they have to give it. If a patient has a MDI then I can assist them taking it, if it's albuterol MDI though I'll probably just start my own.

I can check sugar with a glucometer and give oral glucose if alert and able to swallow.

I don't even think we carry Charcoal, I've never seen it atleast.

If ALS is on scene already I can do all of the above without issue, many times if it requires it, I'll do the above while the medic does something else to get the patient ready to go.

All of our protocols are standing orders, the only time a medic at my service has to call for orders is something either A. Not in protocols or B. to ask to admin a controlled substance

 

[dave3189]

In my area (Washington State) Basics can administer Sub-Q Epi, ASA, O2, Oral Glucose, Activated Char and assist with Nitro and MDIs. It amazes me that some states still don't allow all EMTs to administer Epi? Look up the "The Kristin Kastner Act" if you want to see the reasoning and justification for it.

 

[ceej]

At the BLS level in central Indiana:

Nitro as long as it is the patients RX and bottle, MDI, ASA. Obviously there is an LOC requirement on these patients.

Charcoal is not on our trucks nor in our protocols.

Glucose is a call-for-order at the BLS level. Glucose may be administered rectally in this system, so no LOC indicated.

 

[technocardy]

At the BLS level in BC:

Nitro - as long as the patient is alert, able to maintain their own airway, and are prescribed nitro.

ASA - as long as the patient is alert, and able to maintain their own airway.

Entonox - it's used as long as the patient is alert at time of administration. If the patient becomes drowsy and drops the mouth piece we simply provide O2 until they wake up, at that point they can either choose to take more Entonox if the pain isn't relieved, or they can simply stay on the O2, or just RA.

Oral Glucose - as long as the patient is alert, and able to maintain their own airway.

Obviously the patients can't meet any of the contraindication requirements (eg. p/t may possibly have 'the bends', therefor, no Entonox for them).