Date Published

February 11, 2020

Updated For

ALS PCS Version ALS PCS 5.2


Case: A 39 year old male is found unresponsive. A bystander states they were going to try a new drug; his buddy went first. He presents with the classic signs and symptoms of opioid toxicity and his ventilation hasn™t improved following 3 doses of naloxone and ongoing assisted ventilation with a BVM. You™re still 20 minutes from the ED. You patch to the Base Hospital Physician (BHP), who orders 2mg of naloxone IN (provided you have it in stock).

What do you do? Consider this: Written medical directives are considered offline medical control, and BHP patch orders are considered online medical control. BHPs can give orders that fall outside of the medical directives (online trumps offline) provided the intervention is within the paramedic™s scope of practice.

Now what do you do? Yes, administer the 2mg of naloxone IN. Consider this a similar example to requesting additional nitroglycerin from a BHP for a patient who has ongoing ischemic chest discomfort following the administration of 6 doses. A higher dose in this case, is still within the paramedic™s scope of practice.

Keep in mind, however, that if a BHP directs a paramedic to perform an assessment or intervention that exceeds the paramedic™s scope of practice (for example, asking a PCP to administer epinephrine to a VSA patient), the paramedic must advise the BHP of such and notify the physician that he or she cannot comply with the direction as it exceeds his or her scope of practice.


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