BHP Webinar

Submission ID: 16



On a recent webinar Dr. Exley cited two examples of orders a BHP might give that should not be followed because they are out of the scope of practice. One was an ACP getting an order for Atropine for a cholinergic overdose.

My question is just to clarify this point...

Am I to conclude that if I have a patient exposed to Organophosphates or Carbamate or Herbicides who is experiencing severe S&S of a cholinergic OD (Hypotension, Bradycardia, SLUDGE), that I CANNOT contact a BHP and ask for Atropine or carry out the order if a BHP orders Atropine?

My confusion stems from a belief that I have always been able to perform this procedure and because the Medical Directive for Adult and Paediatric Nerve Agent Exposure calls for the administration of Atropine at given doses based on whether the patient's condition is moderate or severe:

Adult 2 - 6 mg

Ped. 0.5 - 1 mg/kg

I appreciate the time taken in providing me with an answer, and look forward to hearing from you.

Thanks for your question, we are happy to provide clarification.

You are correct, you cannot contact a BHP and ask for Atropine for a cholinergic overdose, as referenced by Dr. Exley in his webinar. ACP's are not authorized/certified or trained to administer Atropine for this patient condition & presentation. The Medical Directive for Adult and Pediatric Nerve Agent Exposure is a Chemical Exposure Medical Directive that requires specialized training, and ACP's in Thunder Bay have not received this training or authorization.
Therefore, Atropine can only be administered by an ACP for the current indications/conditions specific to the Symptomatic Bradycardia Medical Directive.