Had an IFT the other day where an elderly pt. was being transported due to a fractured hip. Patient was having considerable pain and had received initial dose of 100mcg Fentanyl on arrival at the ED and then subsequent doses of Demerol 25mg... I wasn't real impressed with the pain management... I mean 25mg of Demerol is a very low dose for pain of this magnitude let alone using Demerol at all. I haven't seen or heard of Demerol being administered in ages so was surprised to see that the CRNP decided to use Demerol when there are much better analgesics available. Patient did well for most of the transport up until about 15mins out he experienced increased pain... I noticed he stopped having conversation, was moving around on the stretcher trying to ease the pain, and had a noted grimace and complaint of increased pain from level 5 to a level 8 pain. He stated, "the last dose definitely wore off". At this point the Demerol was onboard for about an hour. Prior to departing I had talked to the CRNP about orders for Fentanyl she said if at all possible to hold off due to the recent admin of the Demerol. Patient was obviously in pain which was also being exacerbated from ambulance transport. I gave fentanyl 100mcg. Within a minute, the patients pain response was gone, pt. was conversing again, and no longer moving around. Pt. stated much relief with pain rating back down to the tolerable level 5. I have read that quite a few hospitals have really gotten away from Demerol due to the side effects and much better alternatives. Are there any hospitals or EMS systems still routinely giving Demerol?