Date Published

April 6, 2021

Updated For

ALS PCS Version ALS PCS Version 5.2


I have two questions with regards to the Bronchoconstriction Medical Directive, under the current (February 22nd, 2021) Considerations for Paramedics Managing Patients during the COVID-19 Pandemic. 1) Are we still only administering IM epinephrine to patients who require BVM ventilations? 2) Are we only administering IM epinephrine under this medical directive to patients presenting with a cough? It was previously stated in the January 4th, 2021 update that: "Paramedics should consider administering IM epinephrine for severe respiratory distress with cough in known asthma patients..." I understand that the top of the new memo states: " This memo replaces both the May 6th, 2020 and the January 4th, 2021 considerations documents and memos." Just looking for some clarification on the current practice please. Thank you.


To answer both of your questions at once and clear up any confusion: IM Epinephrine should be considered for patients with severe respiratory distress with cough due to an acute asthma exacerbation.  IM Epinephrine for bronchoconstriction is restricted to patients < 50 years).  

The most recent Feb 22 Considerations Memo (here) describes the rationale behind restricting it to those <50 years.  But, as you point out, does not describe when to give it.  The most updated memo that describes when to consider IM epinephrine administration is from Jan 4th, 2021 (here).

The requirement for BVM ventilation was removed when the Considerations were formulated, in order to reduce potential aerosolization of the virus.  The thought is that IM epinephrine administration, in the appropriate patient population, may reduce the bronchoconstriction enough to negate the need for aerosol-producing BVM ventilations or aersolization.



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