Question: This question may be a very rare situation but I have not been able to get an answer from any paramedics I have asked. As per the “Patching” section in the introduction of the ALS PCS the literature states “BHP cannot be reached despite reasonable attempts by the paramedic to establish contact, a paramedic may initiate the required treatment without the requisite online authorization if the patient is in severe distress and, in the paramedics opinion, the medical directive would otherwise apply”. In a situation where a cardioversion is required and the unstable patient is still conscious, it is fairly common practice to ask for sedation and pain control (i.e. Morphine/Midazolam) along with orders for cardioversion. If multiple BH patches cannot be completed and in the paramedics opinion cardioversion is required for the unstable but conscious patient, are we able to administer sedation and pain control? I ask this because there is not a directive that directly deals with pain and sedation prior to delivering the cardioversion, but is common to ask for such direction.

Question: The IV Therapy Medical Directive lists hypotension as a required indication for a fluid bolus. In pediatric medicine, blood pressure is rarely used alone as an indication of perfusion and tends more to rely on looking at the overall presentation including: level of awareness/activity, heart rate, capillary refill etc.

If presented with a child who is: irritable, tachycardic (or bradycardic for that matter), with delayed cap refill, and decreased urine output, but is not hypotensive (<5th percentile), is it permissible to administer a fluid bolus?

Question: My question is in regards to abdominal pain and analgesia. I was always under the understanding that as ACP’s we should not be patching to a BHP for analgesia when a patient is experiencing severe abdominal pain. I have come into discussion with other ACP’s where some have and some have not patched for analgesia in severe abdominal pain. I am a bit confused about this particular situation. Should I be patching a BHP for analgesia orders for a patient experiencing severe abdominal pain?