I have been writing about medications or interventions I believe BLS could be doing safely with approval of their medical oversight. To date, in the approve category, I have Epi-pen, ASA, Zofran ODT, and IN Narcan.
Today, I am adding Benadryl and Tylenol PO. These are over the counter meds that unfortunately many people don’t have access to either because of money or circumstance and having an EMT there to start making a kid with a fever or someone with a rash start to feel better on their way to a likely hospital waiting room, I think it is a good thing. These are low risk medications with the reward of making people feel better. It doesn’t take a lot of training to be able to understand when to give these meds. Many of us give them to our kids at home.
I am also adding to the list Glucagon IM in the form of a preloaded syringe. I would make the indication for confirmed hypoglycemia with inability to protect the airway. There has been talk recently of IN glucagon, but I do not favor this favor. IN absorption is not as reliable as IM, and it requires double the dose. At $80-$100 a pop, I don’t see the utility of IN glucagon. If someone is in insulin shock, they need as reliable a method of administration as there is. Absent an IV for Dextrose administration, that would be IM Glucagon.
Now some say EMTs should not be doing invasive procedures, and an IM med is invasive. I think the invasive procedure distinction is artificial. The sole distinction should be risk versus benefit. If the risk is minimal and benefit is large, then I am for it. I think that is true in this case. The fact of the matter is whether in a big city or a rural township, unless there is a paramedic in every ambulance, BLS is going to walk into calls where patients are in insulin shock, and without glucagon, they have little choice but to bag and drag and call for a medic who may not be available.
BLS in many areas can give Epi-pens. Epi-pens are invasive, but they are also life-saving. Preloaded Glucagon syringes may not be as dramatic as Epi-pens when it comes to saving less, but they are also considerably less harmful if given to the wrong patient.
Writing this series is helping me shape my thinking on this issue of “What BLS Should Be Doing Now.” In one of my next posts I will address an interesting conversation I had about the unintended consequences of enhancing BLS. Other posts will address the remaining medication options – pain and anti-seizure meds, breathing treatments, and NTG SL for BLS, and I will also later be addressing interventions for BLS. I will wrap it up with an EMS vision for the future.