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Newfoundland and Labrador paramedics' ability to administer hydrocortisone a life saver, says patient

Paula Courage, who has been diagnosed with Addison’s disease, says it is “incredibly comforting” to know that paramedics in Newfoundland and Labrador are now able to administer hydrocortisone at the scene.
Paula Courage, who has been diagnosed with Addison’s disease, says it is “incredibly comforting” to know that paramedics in Newfoundland and Labrador are now able to administer hydrocortisone at the scene. - Glen Whiffen

It may be a play on her last name, but Paula Courage has bravely dealt the effects of Addison’s disease since being diagnosed about nine months ago.

Addison’s disease is a medical disorder in which the body produces insufficient amounts of certain hormones produced by the adrenal glands. The condition puts her at risk of an adrenal crisis that could make her really ill, possibly unconscious, and can even become fatal if she is not administered hydrocortisone in short time.

An announcement Tuesday by Eastern Health that paramedics in Newfoundland and Labrador are now able to administer hydrocortisone at the scene brings a high level of comfort to Courage and others in her situation.

The province is the first jurisdiction in Canada to bring in the new protocol.


Courage enjoys hiking and travelling and says though she carries an injection of hydrocortisone with her, it’s reassuring to know that paramedics are able to administer hydrocortisone on the spot instead of her having to wait to be transported to a medical facility.

“It’s is incredibly comforting. It’s actually quite exciting. The way the injection works, it’s not like an EpiPen, so I carry an injection with me when I hike or if I go on the highway, and my husband and I watch the video every week just so we remember what to do in a situation,” she said.

“But my husband is not medically trained, so he would be in an heightened sense of anxiety in the situation if I were left unconscious and he had to do this, so to know that help is coming and it was someone who could administer the medication and have it with them if something were to happen to mine, or if it happened to be a time I forgot (my medication), it’s just a life-and-death situation for me, so it’s incredibly exciting and comforting to know that (initiative) is out there.”

The new protocol will be used by all paramedics, both primary care and advanced care within all regional health authorities, who have recently completed the required training offered by the office of Provincial Medical Oversight (PMO).

Dr. Brian Metcalfe, provincial medical director of PMO, said while adrenal crisis is uncommon, it is not rare. There are about 3,000 or more people in the province who can be affected.

“We want to ensure that we can either prevent it or treat it when it happens so people get the right care at the right time,” he said.

“It’s estimated that thousands of Newfoundlanders and Labradorians have medical conditions that put them at risk of an adrenal crisis and paramedics are ideally positioned to act swiftly to prevent and treat this serious complication.

“An adrenal crisis happens when people have a low level of steroids in their body and are unable to respond to medical emergencies, whether it be a trauma or medical illness. So, our paramedics are now able to treat that provincewide using several things, including hydrocortisone.”

Dr. Carol Joyce, a physician and endocrinologist, and associate professor of medicine at Memorial University, was involved in outlining the reasons this protocol was needed in the province. She said it is an issue that hasn’t received enough attention.

“We have quite a few people with adrenal insufficiency in Newfoundland and Labrador, like there is everywhere, and there were often inordinate delays in them getting necessary medication because they had to wait to be transported to a medical care facility before their adrenal crisis could be treated. This is often a fatal condition and delays of 20 minutes or more can make the difference between a life and death situation.

“Being able to do a simple thing, like giving a shot of hydrocortisone right in the field, right at the site where the person is, at the site of a car accident, that’s going to save their lives. I have patients who’ve have been in bad situations and they are very excited to know that this safety net is now out there for them.”

Examples of medical conditions that may cause adrenal insufficiency, whose patients may benefit from the new protocol include: Addison’s disease; chronic adrenal hyperplasia; cancer; bilateral adrenalectomy; pituitary conditions; autoimmune disorders; tuberculosis; and patients on chronic glucocorticoid steroids.

The Canadian Addison Society, which has advocated throughout Canada for greater recognition and rapid management of adrenal crisis, provided the supply of hydrocortisone training vials for the education of paramedics in Newfoundland and Labrador.

“This is truly a milestone for Canadian paramedicine and for patients with adrenal insufficiency,” said Harold Smith, president of the Canadian Addison Society. “Our society is pleased to have been instrumental in raising awareness of the prevalence and risks of adrenal insufficiency. We extend sincere thanks to the Provincial Medical Oversight clinical team, for their tireless efforts in protocol development and paramedic education.”

As of Sept. 1 there were 553 registered primary care paramedics and 67 registered advanced care paramedics in Newfoundland and Labrador. There are 179 active ambulances across the province.

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