Gravol for patients ≥65

We can understand that there is some confusion about dimenHYDRINATE use in the elderly (≥ 65 years of age) population and the intent of the ALS PCS was to outline that Ondansetron is still the recommended medication for them. However, if it is unavailable or the paramedic determines that dimenHYDRINATE is the better medication for their patient (ie: vertigo, motion sickness, hyperemesis gravidarum, etc.), they can go ahead and give it after having completed a risk-benefit assessment as well as giving a lower dose of 25mg. No patch is required. If the paramedic is unsure if dimenHYDRINATE is appropriate for their patient, a patch to a BHP is always recommended.

Additionally, we would really like to stress the risk-benefit analysis. Some specific questions to consider asking include:

1. Have you taken any dimenHYDRINATE or diphenHYDRAMINE today?
2. Have you taken dimenHYDRINATE previously? (Any reaction?)
3. What medications are you currently on?
4. What medications have you taken today?

While this is not an exhaustive list, they can help determine if dimenHYDRINATE is in fact the best medication for this patient. This patient population is at significant risk of anticholinergic effects and delirium with ongoing use and large doses.

Lastly, you are correct in noticing that the Companion Document does not specifically address the "if Ondansetron is unavailable" piece, but it does state: The addition of Ondansetron allows the Paramedics to use their clinical judgment in their selection of medication based on the suspected underlying cause of nausea or vomiting. Therefore, as mentioned, utilizing that risk-benefit analysis and giving a lower dose for this patient population is considered patient-centered, safe care.