Palliative Care Medications
With palliative care directives now becoming a core directive, what is the RPPEOs stance on using these medications for general practice. Examples include: using hydromorphone for pain management for someone who has previous hx of hydromorphone use, ondansetron IV as opposed to SL (we still are on back order for ondansetron at our service and have none in the wafer form as of yet), haldol for sedation in a PCP scope of practice setting.
As it currently stands, the palliative care directives do not live within the ALS PCS, and while there is ongoing work to embed them, they will ultimately become auxiliary directives. You’ve highlighted that paramedics have a working knowledge, and given that, should be able to use these medications for their patients - a position we agree with. As a result, we have been advocating at the provincial level to amend the nausea/vomiting medical directive to include additional therapies/routes, as well as developing an acute behavioural disturbance medical directive (partnered with additional education) to allow our paramedics, regardless of scope practice, the opportunity to safely treat patients. When it comes to opiate therapy, there is a body of evidence that has shown that morphine and hydromorphone at equianalgesic doses are very similar in an acute setting, and there is no difference in side effect profile. We’re hoping these new changes will be approved and make it into upcoming iterations of the ALS PCS, but in the current climate, these medications aren’t available for use in general practice.
Medical Directive Category
Please reference the MOST RECENT ALS PCS for updates and changes to these directives.