As a PCP I am trying to get a better understanding of what orders a BHP can give and when certain orders may be considered outside our scope of practice. My understanding has always been that deviations can be made to most areas of a protocol like age, RR, SBP, LOA, contraindications, dosing levels, # of doses etc., but what about treating conditions or diseases that are not written into the protocol? ex. Tylenol for fever, Glucagon for beta blocker toxicity, energy for SVT or Ventolin for hyperkalemia? Although we are trained in how to use these drugs are we expected to give them for conditions not listed in our protocol, if ordered by a BHP? Thanks 

In general, we would not suggest a PCP patch to use medications for reasons outside of the Medical Directives.

Regarding electricity for SVT: Cardioversion is a different procedure than defibrillation. There are some important nuances and education that is required prior to providing this treatment. This is not within PCP education. Therefore, SWORBHP Medical Council would not suggest patching to the BHP for any procedures that are outside of PCP scope, including cardioversion for an arrythmia.

For glucagon in beta blocker toxicity, the most important thing for this patient is transport to hospital. The amount of glucagon needed to manage the toxicity is far higher than what is carried in the ambulance. Any delay in transport to initiate an IV and draw up this medication should be avoided.

Ventolin for hyperkalemia: This can be considered within the ACP scope because they can also give calcium gluconate first, which can stabilize the cardiac membrane. Without this medication, rapid transport is the most efficacious treatment.

Regarding Tylenol for fever, please see a previous Ask MAC on this topic (March 28, 2019)

Analgesia,Cardiac/Circulation,Hyperkalemia,Pain/Sedation/Nausea,Tachydysrhythmia

acetaminophen, Beta Blocker, BHP Patch, Cardioversion, defibrillation, Fever, glucagon, Hyperkalemia, Medical Directive, PCP scope, salbutamol, Toxicity

https://sworbhp.ca/sworbhp-ask-mac/ask-mac-522/ 

https://sworbhp.ca/sworbhp-ask-mac/ask-mac-64/