Date Published

October 22, 2020

Updated For

ALS PCS Version ALS PCS Version 5.2


If you arrive to a patient who is circling the drain very low heart rate respirations are almost none due to opioid overdose and you take a bgl and it comes back no hypoglycemia would you be wrong to administer naloxone before obtaining a full set of vitals and hooking up the cardiac monitor due to the condition of the patient. (covid times so it meets an inability to adequately ventilate).


According to the latest OBHG Considerations for Paramedics Managing Patients During the COVID-19 Pandemic (here, link to be added) Part A, #7. states, "Opioid Toxicity Medical Directive: In all cases of patients with opioid toxicity and inadequate spontaneous respirations, Paramedics should consider administering naloxone, without the requirement of an inability to adequately ventilate.  Given the scenario, it appears that there is a strong suspicion for opioid toxicity, the patient is not ventilating due to this and is pre-arrest. Therefore, the decision to provide naloxone seems reasonable.

With regards to giving treatment before a full set of vitals, it should also be noted that care is not provided in a linear fashion when you are responding as a crew.  Assessments and interventions are occurring concurrently.  As such, your partner can obtain an SpO2 and provide oxygen or BVM if required as per the OBHG Treatment Considerations Memo Part B,#2. (please see full details within the memo) until the naloxone has been delivered and begins to take effect.  The purpose of Part A, #7. is to alleviate the need to provide prolonged BVM, thus reducing exposure risk. Its intention is not to say that you cannot provide BVM if the requirements are met as per Part B, #2.

We believe that paramedics should assess patients as per the BLS-PCS, make a treatment decision, follow their Medical Directives where appropriate, and make a transport decision.  The SWORBHP Medical Council does not support micro-managing paramedic scene management as long as patient care remains priority based and timely.



COVID-19, naloxone

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