Question: My question is in regards to abdominal pain and analgesia. I was always under the understanding that as ACP's we should not be patching to a BHP for analgesia when a patient is experiencing severe abdominal pain. I have come into discussion with other ACP's where some have and some have not patched for analgesia in severe abdominal pain. I am a bit confused about this particular situation. Should I be patching a BHP for analgesia orders for a patient experiencing severe abdominal pain?

 This is a complicated question.  The short answer is that the new ACP Adult Analgesia Medical Directive allows for paramedics to administer morphine for patients in moderate to severe pain with trauma, burns, renal colic with prior history OR acute MSK back strain OR current history of cancer related pain without a patch to the BHP.  If no contraindications exist, paramedics may administer morphine as directed in the medical directive.

In the setting of non-traumatic isolated abdominal pain, apart from renal colic with a prior history, paramedics would require authorization from a BHP patch to administer morphine.

The main complicated issue to address is the concept of when should paramedics patch to the BHP for medications/interventions not covered by medical directives?  The frequency of BHP patches could increase dramatically across the system overwhelming our patch sites as well as the variability of patient care could increase exponentially if paramedics continually patched for BHP orders for a wide variety of clinical conditions not covered by their medical directives (pediatric Ketorolac, acetaminophen for fever, fluid boluses for normotensive patients etc€¦).   That being said, the option to patch to the BHP exists for paramedics should they feel their patient would benefit from a therapy paramedics are able to provide.

It must be a balance of clinical judgment, transport time, patient condition including stability and level of discomfort.  If a patient is in excruciating pain with a relatively longer transport time and hemodynamically stable as your case presentation outlines, then it may be reasonable to patch to the BHP for direction.  As you know, the BHP are variable in their clinical practice however they may choose to order narcotic analgesic for these and other patients not initially covered by the medical directive.

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Advanced Care Paramedic (ACP), Base Hospital Patch (BHP)

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