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.

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Peter Canning

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  • Comments
    Casey
    Intranasal Medication
    Agreed Steve. Love IN Versed for combative/ictal patients. Also IN versed is used in ED for kids. Helps with pain relief and as an amnesic and wears off fairly quick- not sure that directly applies to prehospital but food for thought nonetheless
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    Chris
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    Steve
    Intranasal Medication
    "either because they are seizing or are violent, then the better and quicker route would be IM. " I'm quite hesitant about bring a needle against someone fighting me or shaking... those are the perfect times to be needleless.
    2015-04-27 18:34:14
    bill
    The Ideal Medic
    very well put! aggression can be a good in moderation but over aggression can do harm. 1 year to 30 years no medic will know it all epically with our ever changing job description. thank you for your input!
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    Ben Leighton
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