Pharmaceutical Equipment

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Another area where practice is becoming blurred between BLS and ALS is in the realm of medications. The new basic EMT model curriculum has a module on certain classes of pharmaceuticals to prepare basic EMTs for helping the patient administer his or her medication in a limited fashion. This module includes nitroglycerin for chest pain, inhaled beta-adrenergic agonists for bronchospasm, glucagon for hypoglycemia, and epinephrine preloaded injections for anaphylaxis. The curriculum assumes that the patient already has the medication and the EMT is simply assisting; the drugs are not carried on the ambulance. Some states have gone beyond that and allowed limited carrying of medications on BLS ambulances.

Drugs carried by ALS services are more extensive, but it must be emphasized that out-of-hospital pharmaceutical interventions are limited to a few that will make a real difference before the patient gets to the hospital. The drugs that can make a real difference when administered by a paramedic include oxygen for hypoxia; glucose for hypoglycemia; nitroglycerin for chest pain and pulmonary edema; inhaled beta-adrenergic agonists for bronchospasm; naloxone for suspected narcotic overdose; morphine for pain; benzodiazepines for seizures, delirium, or intubation; furosemide for fluid overload; epinephrine for cardiac arrest and anaphylaxis; and lidocaine, magnesium, bretylium, and perhaps amiodarone for cardiac arrest. Adenosine and diltiazem are useful for rate control of tachycardia, but most patients would be able to wait until arrival in the emergency department for treatment. Sodium bicarbonate is helpful for suspected or known hyperkalemia but probably not for cardiac arrest. Calcium may also be of use in cardiac arrest, especially if hyperkalemia is suspected. In some systems, paralytic drugs (e.g., succinylcholine and vecuronium) are used along with the sedating agents for RSI. Out-of hospital care providers do not need the whole spectrum of drugs found in the emergency department; drugs carried by ALS services should be restricted to those that improve patients' outcomes.

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