There's a few cases where treat and release after albuterol may be appropriate (the healthy teen who forget their inhaler), but most asthma and COPD exacerbations that the patient can't control with their home medications need to be transported to evaluate the need for admission.
I absolutely agree. I work on a college campus (for a BLS service), and we do a about a neb a month on an otherwise healthy college-aged patient who has run out of their albuterol MDI. Our protocol requires we roll an ALS ambulance when we start the neb, but unfortunately, the medics would rather transport than get a refusal from many of these patients. For most, it's a straightforward asthma attack (determined by history, we even have some frequent fliers), with no other symptoms or conditions. The patients rarely get any treatment in the truck (or ED), symptoms have completely subsided by the time we transfer care, and the patients are often discharged from the ED within 45 minutes.
Unfortunately, for the private service that transports our patients, from a billing (and paperwork) perspective, it's easier just to do the transport then try to get a refusal (per company protocol, all need to be medical-control approved), and the paperwork is more complicated than that of a transport.
From my perspective, I can't justify giving what is otherwise ALS medication without calling for an ALS truck, and my medical director would prefer medics get the medical control refusal.
Side question: For a respiratory arrest that we know to be induced by broncospasm/asthma, is there a way to connect a SVN to a BVM, or otherwise provide positive pressure ventilation with albuterol? Are we better off just ventilating with oxygen?
