Date Published

March 30, 2021

Updated For

ALS PCS Version ALS PCS Version 5.2


With the new bronchoconstriction update, saying you cant give Epi to pts unless theyre <50, does this apply only to the covid guidelines where you can administer it up to 2x if conditions met (asthma, cough, severe respiratory distress) or does the age now apply to the normal bronchoconstriction directive for Epi where you can give up to 0.5mg once too?


The modification to not administer IM epinephrine to patients equal to or greater than 50 years of age was specific to the Bronchoconstriction Medical Directive within the Paramedic Considerations during the COVID-19 pandemic (here).  These considerations should be utilized during the COVID-19 pandemic.

OBHG MAC is always looking for ways to improve prehospital care. During the pandemic, there was good reason to make changes to the Bronchoconstriction Medical Directive (see our Podcast and Ask MAC COVID-19 on this subject). It was recognized that there was increased used of IM epinephrine in patients that did not meet indications for its use. As such, the OBHG MAC is reviewing the ALS PCS Bronchoconstriction Medical Directive to ensure the correct patients with acute bronchoconstriction (acute asthma exacerbation) that could benefit from IM epinephrine are properly identified and those that would not benefit from IM epinephrine (or in those that it could cause potential harm €“ e.g. COPD, CHF etc), are also identified.



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