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Analgesia on Offload

Question# 622

I was wondering about the ability to utilize a mix of narcotics for our patients in light of the long offload delays that we are all now facing. In discussion with my fellow ACP's there have been many of us that have called to be allowed to switch to the longer acting Morphine after beginning with Fentanyl. Multiple medics I have spoken to have been given this to best help their patients. One medic was calling for an order for more Fentanyl as he was maxed out and the offload delay was significant and his Pt required more and the BHP gave him an order for Morphine without a question. I also know some have been denied despite their patients being nearly identical. Continuity and the ability to provide the proper care for our patients using clinical judgement in this area would be amazing.

With safety measures in place of course and parameters, can we get this in our directives so that we can help with initial acute pain with Fentanyl and then switch to a longer acting Morphine?


Thanks for the inquiry. We applaud your compassionate patient advocacy.

Over the past few years, there have been numerous changes to the Base Hospital Physicians group and processes.

We have moved away from a "calling for permission" model to a consultative discussion forum.

During this transition, there may be perceived inconsistencies in BHP guidance as we get everyone up to speed. We are excited about this evolution and the positive changes for both paramedics and the patients that they care for.

While there are no proposed changes pending to the Medical Directives regarding mixing of narcotic therapies, the current online medical consultation group is happy to discuss individual cases via the patching system. We recognize that patient responsibility while on (often lengthy) offload delays is shared, and the BHPs are eager to support your treatment plan.

Thanks for your great patient care.

Medical Directive Category



29 September 2022



Please reference the MOST RECENT ALS PCS for updates and changes to these directives.