Why do the pandemic guidelines allow for the administration of 2 doses of epinephrine (<50y) in bronchoconstriction (asthma exacerbation) vs the ALS PCS allowing only a single dose (without age guideline)?
The OBHG COVID-19 Conisderations document was an evolving framework that was based on best evidence/information at the time. As most are aware, the document has evolved as we have learned more about COVID-19, its transmission, as well as access to approrpriate PPE which was lacking at the onset of this pandemic.
In the first iteration of the document, a patient with severe bronchoconstriction and cough was left with very few treatment options given the concern about viral transmission through inducing cough with ventolin, aerosolizing the virus with BVM etc. As such, the decision was to allow for 2 doses of epinephrine in this patient population. The decision was based off of expert opinion as there is little to no evidence of epinephrine benefit in this patient population to begin off with. There was some discussion utilzing 2 doses as this was in keeping with the Moderate to Severe Allergic Reaction Medical Directive, thus potential reducing human factor errors that may have arisen.
As the document evolved and treatment strategies for severe bronchoconstriction changed, the 2 doses of IM epi remained. The change back to one dose was probably more of an oversight.
Please note that a revised OBHG COVID-19 Conisderations document will be distributed shortly. In this version of the document more emphasis is placed on paramedics using clinical judgement as to when to treat patients with these considerations versus employing the directives as per the ALS PCS in patients with a very low likelihood of having COVID-19.