Question: On our ROSC protocol, the ONLY route that we are allowed to give a fluid bolus/dopamine is via an IV. Please confirm that we are NOT allowed to do so via IO or CVAD? This does vary from the IV and Fluid Therapy protocol which allows us to do so.
This is an excellent question and really made us take another hard look at the directives!
You are correct, there is not an allowance for dopamine to be given IO in the directives. This is by design out of concern for tissue destruction from extravasation and for logistical concerns in titrating dosages and infusion rates for dopamine while using a pressure infuser. The IO route is designed for fluid boluses or IV "pushes" of medications, and that is why the various directives read as they do.
Now, as for CVAD and dopamine, this is an excellent point and truly we think is an oversight.
We have added this to the list of edits the Ontario MAC should consider when the directives are "re-opened" for discussion. Until then, patching for dopamine via a CVAD is an option for properly trained Advanced Care Paramedics.