I think the BLS you are used to isn't quite the same as what my trauma center is doing on an EMT-A level.. Considering placement of an invasive airway is part of our protocols. Unless it's a ped requiring an ET, our BLS can do just fine with a King on an adult. Antihistamines are PO, up to 50 mg, BLS can do that too. Beta antagonists, you mean Ipratroprium.. Our BLS can do duo nebs, but I think I'd call med control, because it's not specifically in our protocols. I don't believe our ALS can administer steroids, I don't think we even have steroids on the truck, does yours? Help me understand why you think cardiac monitoring would be useful. Do you mean 4 or 12?
By beta agonists, I'm primarily referring to albuterol here. In cases of potential for increasing angioedema, I'd prefer an ETT to a supraglottic airway, though if they are already severely swollen at time of EMS contact either one may be out of the question.
Yes, we do carry steroids. We carry PO prednisone and Solu-Medrol for IV administration. I'd rather give IV Benadryl for anaphylaxis than PO, but if PO is all you have then that's appropriate. Aggressive fluid administration is important in cases of distributive shock, but if your AEMT scope can do that, fair enough.
IV epi drips are a huge consideration here. Not that I have vast experience in treating hundreds of severe allergic reactions or anything, but I've used an epinephrine drip on a teenager experiencing severe anaphylaxis that failed to respond to anything else. I mean, this guy was absolutely circling the drain with absolutely absent lung sounds, extreme hypoxia, and a systolic BP of ~70. No responses to 2x 0.5 mg IM Epi, but 10 minutes after the epinephrine drip he was talking, breathing, and pink.
Cardiac monitoring is more precautionary for any adult patient that's receiving epinephrine, particularly IV. I'm mostly referring to 4 lead monitoring, but I may do a 12 lead on an older patient if they develop any chest pain or increasing problems after the primary treatment for the reaction.
I'm with Tigger here. Just because the scope of a lower level provider may allow most of the interventions doesn't mean it's a substitute for higher levels of education and critical thinking. This is no different than Maryland's EMT-Cardiac or the way we've built paramedic education in the US. Simply adding more skills or medications to the drug box isn't a substitute for education or clinical competency. For critically ill patients, the provider with the highest level of training should be caring for the patient if they are available. I would never sit in an ED with a high priority patient and try to maintain patient care as an ER physician is trying to take over, and this would be a similar situation on a prehospital level.
