Question: There was a discussion among crews surrounding DNRs and our permitted treatment such as epi can be given for anaphylaxis or silent chest, but not as a pressor as listed on the DNR. That being said, I found a previous Ask MAC question where you addressed isolated epi administration as not very effective (where the BVM is contraindicated due to a valid DNR) in the situation of severe bronchoconstriction. Wondering if the same logic applies to the setting of anaphylactic VSA patients? If we cannot begin CPR or utilize a BVM, should we give isolated epi to that patient, as it is not being given as a pressor? (I’m of the opinion that a VSA patient gets no treatment in the presence of a DNR).

Question: I have a question regarding the administration of narcan. Narcan seems to be given more often now that there is no patch point. The wording of the medical directive hasn’t changed though so just to confirm, are we still just to be giving it when we cannot adequately ventilate the patient? Example, if they are GCS of 3 and breathing inadequately but we are getting good compliance on the BVM and the patients vitals are otherwise stable, are we ok to not give it? If we do go ahead and give narcan to a patient who is NOT breathing and they start breathing on their own but are still GCS of 3 are we to stop there since we can now manage their airway or do we continue up to our maximum of 3 doses or until they become GCS of 15?

Question: In a setting where you arrive on scene and you are presented with a patient who is unconscious and is hypotensive, the patient has a valid DNR. Can you still administer fluids to this patient or does that fall under the same category as inserting an OPA/NPA and BVM to a patient with a DNR?

Question: In a setting where you arrive on scene and you are presented with a patient who is unconscious and is hypotensive, the patient has a valid DNR. Can you still administer fluids to this patient or does that fall under the same category as inserting an OPA/NPA and BVM to a patient with a DNR?

Question: I would like to know the actual medical directive and/or guidelines regarding PCP’s transporting trach patients with no nurse, doctor or RT escort.

Additionally, what the medical directive is if staff is sending the patient to the ER without their vent, therefore, the paramedic is required to bag the patient via BVM for the duration of transport and until there is transfer of care at the ER?

Is this in the BLS scope of practice?