Question: I have been talking with my paramedic colleagues and I am wondering about the role of CPAP and aspiration. My understanding of the Medical Directive is that CPAP is not indicated for pneumonia or aspiration but rather severe SOB from either COPD or pulmonary edema. Can you please clarify the role of CPAP for respiratory distress patients with either pneumonia or aspiration as the underlying precipitating factor for their SOB?
Thanks for the question! It is difficult to differentiate the cause of shortness of breath among the clinical presentations of COPD, CHF, aspiration, and pneumonia. It is likely that patients with shortness of breath from causes other than COPD/CHF, receive CPAP in the pre-hospital environment and sometimes benefit from it. However, the provincial medical directive clearly limits the indication for paramedic administered CPAP to respiratory distress caused by COPD or pulmonary edema. The SWORBHP Medical Council does not want to make exceptions to the provincial medical directive and therefore recommends the provincial directive be followed.