Today in EMS and public safety, not enough emphasis is placed on how to teach and develop problem-solving skills when a rule for a particular scenario doesn’t exist or apply, or when rules compete or conflict with each other. For example, most protocols treat hypovolemia and severe dehydration via replenishment of blood volume with a fluid bolus of a balanced salt solution, such as normal saline. For symptomatic heart failure, most protocols would restrict fluids and salt by using a dextrose solution and may also use a diuretic. In hot regions, it’s quite common to find a patient in symptomatic heart failure and with symptomatic hypovolemia and dehydration. Does your system have a protocol for administration of fluids to a fluid-restricted patient?
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