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

If a patient is in pain and states they don’t like taking Advil or can’t take Advil (but no allergy), would it be appropriate to administer Tylenol and Toradol? They are not contraindications of each other.

Question: In the 2015 ALS Companion Document Version 3.3 pg 13, it states this: “A clinical consideration states “Suspected renal colic patients should routinely be considered for Ketorolac”. More correctly, this statement should include NSAIDS like Ibuprofen. Ketorolac is preferred when the patient is unable to tolerate oral medication.

There is some confusion over the interpretation of this. I read this statement as suspected renal colic patients should be routinely screened for an NSAID (not just Ketorolac), and therefore should be given ibuprofen first instead, unless the patient cannot tolerate oral medication. My PPC is saying differently that you should be considering Ketorolac first, since the companion document cannot overrule the ALS Directives. What is the true purpose of this statement then?