Question: According to the PCP Dimenhydrinate Learner's Certification Package on the SWORBHP website under training materials, it says "It is also very important to note that Dimenhydrinate should not be administered to anyone with a recent history of closed head injury or medical history of a seizure disorder" (due to the decrease of seizure threshold) However, history of seizure disorders is not a contraindication in our medical directives. Does this mean we are able to treat patients presenting under the nausea and vomiting protocol with a history of seizure disorders with Dimenhydrinate?
Great question. As you may be aware, history of seizure disorder and recent history of closed head injury were relative contraindications in previous editions of the ALS PCS, however they were removed in the 2011 edition. Although these relative contraindications have been removed, they may be covered when assessing your patient's LOA. For example, a patient who recently seized or fell from a height sustaining a head injury is likely to have an altered LOA. With altered LOA, these patients would not be treated with Dimenhydrinate. We advocate for educated clinical judgment on the part of the paramedic in these types of cases.
As an aside, SWORBHP has recently purchased a new software program for delivering online education and we are currently updating all online training material. Keep an eye on our training site for the new version of the Dimenhydrinate package which will be released soon.