What BLS Should Be Doing Now (Intro)

In the coming weeks I will be unveiling What BLS Should Be Doing Now. I am not talking about doing a better job of assessment, treatment and documentation. We all should be doing a better job of that, or most of us. I am talking about procedures or skills or medication administration that may not be in the BLS scope of practice in many states.

Now let me state, I am a firm believer in paramedics and believe all communities should have paramedic protection. What I will be proposing for BLS is not meant to give communities an excuse not to implement, upgrade or enhance their own paramedic coverage. I make these recommendations because I believe they will be better for patients, that they will do more good with minimal risk of harm. And again, while I am a firm supporter of paramedics, I do not believe, as a profession, we should act as doctors and nurses have sometimes acted in not allowing others to do skills that were previously only in their own domains. I like to think we should always put self-interest aside and put the patient first.

In the first part of the series, I will address Medications for BLS, before moving on to New Skills and Procedures for BLS. I have developed a list of medications that I believe are safe for BLS to give, and I have another list that I am on the fence about or am opposed to.

Now in Connecticut, there are already some medications BLS can administer, provided they have approval of their services medical director. These include ASA for suspected acute coronary syndrome, epinephrine in the form of an epi-pen for anaphylaxis, and they may also assist a patient with the patientís own nitro and inhaler.

I have no issues with ASA and the epi-pen, and find them reasonable, and in the case of anaphylaxis certainly, life-saving. I am on the fence about assisting them with their inhaler and nitro, leaning toward not objecting. In general, I think it is a good idea. The patients have been prescribed these meds by their physicians and are presumably taking them as directed for diagnosed conditions. I think assisting them is fine, and will mostly doing more benefit than harm. The danger of course is if the patient is having a right ventricle infarction or in the case of the treatment is not having asthma/COPD, but is in CHF.

I am not familiar with the training of the BLS in regards to this, but as long as they are cautioned to take a BP before allowing the patient to take the nitro or listen to the lungs before assisting them with the inhaler, I think this is okay. In our systems, paramedics can only give nitro after doing a 12-lead in cases of suspected ACS, and are forbidden to give nitro in cases of right ventricle infarct, but I have found that most patients who are already prescribed nitro and take it regularly are less affected than previously healthy people who have never taken nitro and are being given it for the first time.

Medication List for BLS
1. Epi-Pen (Yes)
2. ASA (Yes)
3. Inhaler (assist with patients) (A Conditional Yes)
4. NTG SL (assist with patients) (A conditional Yes)
5. To be continued

Here then are the meds, I will be discussing and voting either Yes-safe for BLS, Maybe – on the fence, or No -Not ready for it yet. And of course, any yes is conditional on the approval of the service’s medical director and the implementation of appropriate training, documentation and oversight.

Zofran ODT
Benadryl PO
Tylenol PO
Combivent
Glucagon IM
Versed IM (in autoinjector)
Fentanyl IN
NTG SL
Activated Charcoal (removed from our Regional BLS)

Stay tuned, and in the meantime, please feel free to comment with your thoughts on these drugs or drugs not on the list you think should be considered suitable for BLS administration.

2 Comments

  • Christopher says:

    Our Basics have had ASA, Albuterol, Benadryl PO, EpiPens, NTG SL, Naloxone IN, and Tylenol since ’09.

    I’d love to see Zofran ODT, ipratropium, Versed autoinjectors, Fentanyl IN or Morphine autoinjectors.

    Glucagon I’m not so sold on (you could do IN as well), not necessarily from a safety profile but from a cost/benefit and a What’s Next. Typically you’ll end up wanting ILS level Rx available (IV dextrose).

  • VinceD says:

    I’m on board with Christopher for adding ondansetron ODT and maybe a midazolam auto-injector. I’d also like our BLS units to be able to titrate oxygen to requirement, but they’re not supposed to be using pulse-oximetry so the protocols fall back on NRB’s for everyone.

1 Trackback

Leave a Reply

Your email address will not be published. Required fields are marked *

background image Blogger Img

Peter Canning

JEMS Talk: Google Hangout

Recent Posts
Thoughts on Ebola October 23, 2014
STEMI Call October 14, 2014
Ebola October 2, 2014
Breaker of Men September 25, 2014
Categories
  • ems-health-safety (7)
  • ems-topics (698)
  • hazmat (1)
  • Uncategorized (413)
  • Comments
    BH
    Thoughts on Ebola
    Kent, despite all those deaths, flu still doesn't have the mortality rate that Ebola does. I think concern is warranted.
    2014-11-21 06:05:35
    Jerrid Edgington
    Racing the Reaper: Book Review
    I was surfing the web and came across this page. I am humbled by the review and comments. I can't thank you all enough. The first two books that originally were self published, were re-edited by my publisher and re-released. The third book in the series, Reaper's Requiem, will be released on December 6, 2014.…
    2014-10-29 17:06:57
    Kent
    Thoughts on Ebola
    We are only talking about one airline and two weekly flights to Monrovia and Senagal because the plane lands in Dakkar. I can tell as I have been in both of these airports that prior to entry your temp is taken and a chlorine hand wash is required, this is also repeated before boarding. Again…
    2014-10-29 00:42:00
    Kent
    Thoughts on Ebola
    Every year 37000 people in the US die of the flu, for which we have a vaccine and OTC meds. 10000 Ebola cases and we loose our minds...why? Is this the CNN effect, whipping up hysteria ? Why do we not sequestering those with the flu? Quarantine is not the answer for non symptomatic people…
    2014-10-29 00:31:08
    RJ in florida
    Thoughts on Ebola
    this appears to becomming political. The lack of an african quarantine is because if the government orders it, the airlines can go back to the government for lost revinue when its over. If they do it on their own its a business descision and have to eat the loss. The appomtment of a non doctor…
    2014-10-24 19:36:32

    Now Available: Mortal Men

    Mortal Men is available as an electronic book for Kindle, Nook or any other e-reader. Here is a link to some of the places to buy it. The book sells for $3.99. Barnes and Noble Amazon Smashwords Scribd Also Available from iBooks

    Order My Books

    Support EMS Bloggers, Buy Their Books

    Google

    Order Books and Movies

    FireEMS Blogs eNewsletter

    Sign-up to receive our free monthly eNewsletter

    LATEST EMS NEWS

    HOT FORUM DISCUSSIONS