If we have an asthmatic patient that is refusing transport to the hospital after administering salbutamol, should we still proceed with dexamethasone administration? 

If a capable patient decides that they do not want to be transported to hospital, then further treatment by paramedics should not be continued.  

The reason for this is two-fold: 

1) Further assessments, diagnostics and treatment provided in hospital can help ensure comprehensive care is provided and alternate differential diagnoses are considered and treated. Additionally, the patient may feel falsely reassured that they have received all the medical care that they need if care is provided by paramedics after the patient decides not to be transported to hospital. It should be made clear to patients after they decide to refuse service that a comprehensive and complete work up has not yet been completed.  

2) The Medical Directive treatment is written with the intent that the patient be transported to hospital for further diagnostic and therapeutic treatment. Providing care outside of this model can cause false reassurance for patients and not allow for a comprehensive diagnostic work up (see point 1) and is not following the delegation of the Medical Directive.  

Airway/Breathing,Bronchoconstriction,Cardiac/Circulation,Trauma Cardiac Arrest

Asthma, Bronchoconstriction, Dispensing a Medication, Refusal of Service, ROS, salbutamol, Scope of Practice

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