Date Published

November 22, 2012

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: After 3 treatments of Ventolin be it MDI or NB i was understanding that we could patch for another 3 treatments if needed. I have spoke with other medics and some say yes and some say no could you please verify.


 Thanks for this terrific question. The key to this answer is the word "treatment". The Bronchoconstriction Medical Directive defines a "dose" as 8 puffs via MDI for a patient who is greater or equal to 25kg. The directive allows for up to three "doses". Therefore, a paramedic could administer up to 3 X 8 = 24 "puffs" of Ventolin via MDI without a patch.

The rationale for patching if further Ventolin administration is required rather than repeating the directive three times is that medical directors were uncomfortable in advocating for paramedics to administer 3 X 24 = 72 "puffs" of Ventolin without speaking to a BHP.

Now, when looking at the same dosing chart on the medical directive, if utilizing the NEB route for a patient greater or equal to 25kg, the "dose" is 5mg and the max number of doses by the directive is 3. Thus, a patch would be required to a BHP in order for a paramedic to administer greater than 3 nebulized Ventolin treatments.



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