# Pain free stick and shots



## mikeylikesit (Jun 26, 2008)

I was wondering if any of you who work either in the hospital or EMS field are proficient at pain free IV and Shots. i have gotten to a point in the ER that i can do blood draws without the patient saying they felt something. the IV's i have heard can be done without the patient enduring too much pain but i don't know how. Do any of you? now I'm not talking about the patient who has had soo many IV sticks that they don't feel them anymore like me, but the ones who are new to it.


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## Hastings (Jun 26, 2008)

mikeylikesit said:


> I was wondering if any of you who work either in the hospital or EMS field are proficient at pain free IV and Shots. i have gotten to a point in the ER that i can do blood draws without the patient saying they felt something. the IV's i have heard can be done without the patient enduring too much pain but i don't know how. Do any of you? now I'm not talking about the patient who has had soo many IV sticks that they don't feel them anymore like me, but the ones who are new to it.



Lol, that has entirely to do with the patient and not your skill. Everyone handles it differently, regardless of provider.


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## mikeylikesit (Jun 26, 2008)

i have yet to encounter a blood draw patient thus far who felt any pain. i have had a ton of blood draws done on me...sometime i feel them other time i don't. there is a guy in Minnesota who showed my how to do it without feeling it.


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## GonnaBeEMT (Jun 26, 2008)

mikeylikesit said:


> i have yet to encounter a blood draw patient thus far who felt any pain. i have had a ton of blood draws done on me...sometime i feel them other time i don't. there is a guy in Minnesota who showed my how to do it without feeling it.



I do not know how it is done, but when I was a child I had an appendectomy at a small county hospital, and the anesthesiologist started my IV and I never felt a thing.  I have no idea what size the needle was but I was amazed when he told me he was done because I was scared to death.


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## GonnaBeEMT (Jun 26, 2008)

I found a study about skin anaesthesia I copied and pasted part of it here.  You can google the cream and I am sure it will give you lots of info on it.

The effectiveness of skin anaesthesia after 5 minutes’ topical application of a lignocaine-prilocaine cream was evaluated. One hundred and twenty patients estimated the pain of antecubital venepuncture both on a linear scale and verbally after use of the cream for either 5 or 60 minutes, a placebo cream or no treatment. Reported pain was significantly less after only 5 minutes of the lignocaine-prilocaine cream (p = 0.002). The cream can be used to relieve the pain of all routine injections


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## akflightmedic (Jun 27, 2008)

I am soooo good at giving shots and starting IV's that I NEVER feel a thing. (At least thats what I tell all my patients). Seriously, I do use that line to insert a little humor and lessen tension.

Them not feeling anything has absolutely nothing to do with you. It is individual and unique to each person provided you are doing it right. Now if you are rooting around and digging, well yeh once you become better they may not feel it and that will be a result of your skill.

But if you are saying you are just so good they do not feel it, that is quite the statement.

Anyways, every patient is different. Before giving injections or IVs, I consider the age of my patient, their demeanor, their apprehension level and determine how I am going to approach them. Most respond well to humor. Some need detailed explanation of what you are doing. Some want to watch, some don't. And some, you just have to jump right in and do it unfortunately (mostly kids) while they kick, scream and resist. My oldest daughter is in that group and she is always amazed at how quickly it is over and how it did not hurt, yet each time she went, she was so wrought with fear and apprehension, she made the situation so much more worse.

Just remember, confidence is great but please do not confuse it with cockiness. Maintain some humility and humbleness and you will go far...because the one time you think you "got this", that will be the time the fecal matter hits the fan, and you will be standing there going WTF???


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## mikeylikesit (Jun 27, 2008)

I have used the xylocaine cream in the past and it works wonders on almost all my patients. i let it sit for 30 minutes if i have the time then i run the IV...(in the hospital not in the Ambo) But like AK said im usually not digging for a vein and get all my sticks the first time...usually.


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## Airwaygoddess (Jun 27, 2008)

Let everyone know that Airwaygoddess hates shots......... numbing medication or not!


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## Hastings (Jun 27, 2008)

mikeylikesit said:


> I have used the xylocaine cream in the past and it works wonders on almost all my patients. i let it sit for 30 minutes if i have the time then i run the IV...(in the hospital not in the Ambo) But like AK said im usually not digging for a vein and get all my sticks the first time...usually.



Using anything to numb the nerves for an injection or IV is absurd, whether in the hospital or out. Not worth it in ANY circumstance.


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## Ridryder911 (Jun 27, 2008)

Hastings said:


> Using anything to numb the nerves for an injection or IV is absurd, whether in the hospital or out. Not worth it in ANY circumstance.




WTF? Who are you Superman or just sadistic? Really, you must have never had many injections or transfusions! 

If my significant other/child was having her routine chemo or there was time allowed to place any anesthetic & you did not use such & proceeded to *attempt** to start an IV, (*that is attempt, because you will have to pick yourself up off the floor), I would see that there was a report placed in your permanent file !

Not doing so is absurd! Be a patient advocate!

I routine give Lido intradermal, Cetacaine, (viscous does not work except on mucosa membrane); I have even given Fentanyl lollipops. Needles hurt.. and if you can prevent pain do so!.. Not doing is unethical. 

R/r 911


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## Hastings (Jun 27, 2008)

Ridryder911 said:


> WTF? Who are you Superman or just sadistic? Really, you must have never had many injections or transfusions!
> 
> If my significant other/child was having her routine chemo or there was time allowed to place any anesthetic & you did not use such & proceeded to *attempt** to start an IV, (*that is attempt, because you will have to pick yourself up off the floor), I would see that there was a report placed in your permanent file !
> 
> ...



Yes, because paramedics often work in chemo departments. I assume the context of this thread, since being on EMTLife, is in regards to EMTs, whether in the hospital or in the ambulance. And I stand by my statement. Numbing agents aren't appropriate. 

I'll tell you what IS reasonable. My policy of only attempting an IV once before asking someone else to try. And if it's not a patient that absolutely requires IV/Drug intervention, I wont try again. THAT is reasonable in an EMS situation.


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## triemal04 (Jun 27, 2008)

Hastings said:


> Yes, because paramedics often work in chemo departments. I assume the context of this thread, since being on EMTLife, is in regards to EMTs, whether in the hospital or in the ambulance. And I stand by my statement. Numbing agents aren't appropriate.
> 
> I'll tell you what IS reasonable. My policy of only attempting an IV once before asking someone else to try. And if it's not a patient that absolutely requires IV/Drug intervention, I wont try again. THAT is reasonable in an EMS situation.


That's all well and good, but the point still remains that some (many in fact) people will require some type of topical anesthetic, or analgesic before they have an IV started.  That is, unless you like when the pt's anxiety level skyrockets, they begin to fight, scream, yell, cry, and stop allowing you to perform any of your other duties.  And yes, even people that "need" an IV will do this.  If you're preparing to start an IV on someone that starts getting worked up...why would you not use the adjuncts available to make it easier?  Why would you not treat your patient appropriately?  

I'm a big fan of nitrous oxide for this...short onset, short acting, and if they do manage to work themselves up, does wonders for calming them down.


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## Hastings (Jun 27, 2008)

triemal04 said:


> That's all well and good, but the point still remains that some (many in fact) people will require some type of topical anesthetic, or analgesic before they have an IV started.  That is, unless you like when the pt's anxiety level skyrockets, they begin to fight, scream, yell, cry, and stop allowing you to perform any of your other duties.  And yes, even people that "need" an IV will do this.  If you're preparing to start an IV on someone that starts getting worked up...why would you not use the adjuncts available to make it easier?  Why would you not treat your patient appropriately?
> 
> I'm a big fan of nitrous oxide for this...short onset, short acting, and if they do manage to work themselves up, does wonders for calming them down.



I'm a big fan of Nitrous too. Unfortunately, very few EMS providers carry it.

Anyone that is bad enough to NEED an IV in the short period of time between the scene and the hospital that fights against it is not in their right mind. And in such a case, you find a way to do it through the fighting. Anyone else can wait until the hospital. And trust me, the hospitals around here wont give them anything for needle pain either. Mostly because the anxiety of getting a shot/IV is often not due to the pain at all.

But even beyond that, why won't I numb someone up for an IV? Besides time, that is? Because we don't carry anything that can.


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## So. IL Medic (Jun 28, 2008)

Ridryder911 said:


> WTF? Who are you Superman or just sadistic? Really, you must have never had many injections or transfusions!
> 
> If my significant other/child was having her routine chemo or there was time allowed to place any anesthetic & you did not use such & proceeded to *attempt** to start an IV, (*that is attempt, because you will have to pick yourself up off the floor), I would see that there was a report placed in your permanent file !
> 
> ...



Sorry. That goes over the line for pain control. Are you considering giving Lido or Fentanyl before an accucheck stick? Admin a little dermal LIdo before the IV in a suspected ACS?

I think we have other things to worry about out in the field than the stress of an IV in an AC. Pain considerations are fine in hospital procedures of chemo or frequent repeated sticks in other procedures.

But would you really lay someone out in the back of a truck before they could start an IV on a family member clutching theor chest in much worse pain?


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## Ridryder911 (Jun 28, 2008)

So. IL Medic said:


> Sorry. That goes over the line for pain control. Are you considering giving Lido or Fentanyl before an accucheck stick? Admin a little dermal LIdo before the IV in a suspected ACS?
> 
> I think we have other things to worry about out in the field than the stress of an IV in an AC. Pain considerations are fine in hospital procedures of chemo or frequent repeated sticks in other procedures.
> 
> But would you really lay someone out in the back of a truck before they could start an IV on a family member clutching theor chest in much worse pain?




C'mon use some common sense! Did you not read my posts? I said ..."_if there was time allowed to place any anesthetic"_ as well, do you know how long it takes for me to apply Ethyl Chloride? .. 1 second, is that too long? Ever even seen the stuff? It comes in a spray bottle and wears off in a few seconds..I can have the IV site numbed & started before you can expel the air in a IV tubing or even a saline lock, I do it for some patients. Patients appreciate the added measure. There is a lot of difference between a FSBS and a 18g Jelco. (BTW I sometimes use the ear lobe for finger sticks, not as painful/sensitive afterwards and a good is a well perfused area) Would you not use viscous Lidocaine for an NG tube or even nasal intubation? Why would one ever not be sensitive the patient needs? Is this really good patient care? 

Being ignorant about techniques just because one does not "carry or work" in a specific area is no longer tolerable. How do you think EJ's or any other procedure and treatment we use ever became popular in the field? It's called adaptation. Very few or any procedure was developed in the field for medical care. Medicine is medicine, no matter if it is in the truck, x-ray or CCU. The patient still has pain so does their pain threshold varies. As a healthcare professional you are responsible and held accountable for recognizing procedures that are painful & when possible eliminating the pain associated with these procedures.

If anyone considers nitronox or nitrous that maybe an overkill for just an IV. We are discussing simple local anesthetic for a simple procedure. Do I do it for all? ... no. Fortunately, I have mastered IV's that I can perform very fast, and successful usually without very much pain because the procedure is fast. However; there are patients and conditions that will allow me to perform the procedure. 

What I do NOT tolerate is seeing a Paramedic or EMT "digging" around searching for a vein. Patient complaining of pain, and the patient being ignored. Many times the IV is usually for "protocol tx." and very doubtful that the patient will require medication or fluids enroute. I will remind the patient they have the right to refuse the IV, this ironically irritates some medics. Again, you are there for the patient, the patient is not there for you. 

R/r 911


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## mikeylikesit (Jun 28, 2008)

ah yes Ethyl Chloride...i use that when i do IV starts sometimes. The kids love it, it may give you a cold or slight stinging sensation but that IV won't make them cry.


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## Hastings (Jun 28, 2008)

mikeylikesit said:


> ah yes Ethyl Chloride...i use that when i do IV starts sometimes. The kids love it, it may give you a cold or slight stinging sensation but that IV won't make them cry.



Again, the best of patient care isn't doping up your patient (no matter how mild) for an IV start.

Good patient care includes not starting an IV just-because, telling the patient that you want to give them and IV and why, giving them an opportunity to refuse, and letting someone else try if you can't get it the first time.

I can't remember the last time I gave a child an IV. Mostly because I never do unless they are dehydrated or need intervention immediately. And again, if a kid is at the point of NEEDING an IV, they're often not going to care.


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## mikeylikesit (Jun 28, 2008)

Hastings said:


> Again, the best of patient care isn't doping up your patient (no matter how mild) for an IV start.
> 
> Good patient care includes not starting an IV just-because, telling the patient that you want to give them and IV and why, giving them an opportunity to refuse, and letting someone else try if you can't get it the first time.
> 
> I can't remember the last time I gave a child an IV. Mostly because I never do unless they are dehydrated or need intervention immediately. And again, if a kid is at the point of NEEDING an IV, they're often not going to care.


Depends on your setting i stated above that the question was posted to not only EMS but any hospital workers as well. i use anesthetics because if i have the time it makes the patient less afraid to come back to me when they're sick or hurt again. i do go thought the whole rigmarole of explaining things to the patient before i begin, but some people just plain are afraid sometimes and if i have to change my approach to help them feel better than so be it.


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## Ridryder911 (Jun 28, 2008)

Hastings said:


> Again, the best of patient care isn't doping up your patient (no matter how mild) for an IV start..




It is quite obvious, you don't know much about topical anesthetics. I don't know what you are referring to as "doping up" a patient? You mean a temporary 15 second numbing agent at the spot it is sprayed at?  Face it, you rather inflict pain. Sick kids (and adults) do care if they are even sick.. let's be realistic and humanistic. For those patients that don't care, chances are there is not much you are going to for them, and the IV will probably have to be an I/O. 

Before making such statements; Why don't you ask to try some ethyl chloride on yourself then .. comeback and tell me how it "dopes up" anyone.. It is a topical agent that cools the site to make it numb.

I don't do it every time but we carry many topical agents.. Why not? What's your hurry? Why not take an extra 5 seconds to make a painful procedure more tolerable? Be humanistic to patients. 

R/r 911


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## Hastings (Jun 28, 2008)

Ridryder911 said:


> It is quite obvious, you don't know much about topical anesthetics. I don't know what you are referring to as "doping up" a patient? You mean a temporary 15 second numbing agent at the spot it is sprayed at?  Face it, you rather inflict pain. Sick kids (and adults) do care if they are even sick.. let's be realistic and humanistic. For those patients that don't care, chances are there is not much you are going to for them, and the IV will probably have to be an I/O.
> 
> Before making such statements; Why don't you ask to try some ethyl chloride on yourself then .. comeback and tell me how it "dopes up" anyone.. It is a topical agent that cools the site to make it numb.
> 
> ...



Doping is phrasing I found most appropriate for the use of Nitrous discussed previously, as it has an affect of ALOC. As well, it's the only one that is even carried within the lower half of this state to my knowledge. There's a reason we don't carry the agents you're speaking of. Because they're 100% unnecessary. But then again, having only worked in cities with the hospital mere minutes away, if a patient doesn't need an IV immediately, I have the luxury of being able to wait.


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## skyemt (Jun 28, 2008)

without mentioning names, the nature of the disagreements is obvious...

Rid and others talk about what is best for the patient, and others, well, you seem to talk about what's best for you...

i continue to be surprised that so many think this job is about them.. it is all about the patient... and whatever makes the patient feel better, even for ten minutes,is good patient care.

maybe i am naive, but come on folks...


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## Hastings (Jun 28, 2008)

skyemt said:


> without mentioning names, the nature of the disagreements is obvious...
> 
> Rid and others talk about what is best for the patient, and others, well, you seem to talk about what's best for you...
> 
> ...



It's unfair that I'm being portrayed in this pain-is-great way, because I strongly believe in pain relief when appropriate. I believe that patients should be made as comfortable as possible. Morphine before moving the old lady with a hip fracture and all. But come on, it's an IV. And more importantly, it's a procedure that often times is done "just because." And I believe that the steps I listed in my previous post is providing the most consideration to the patient in the situation. Especially when, as stated, we don't even have any drugs like Rid is referring to. And I'm certainly not going to be giving any narcotics for an IV start. 

So at the basic level, I don't have drugs to numb an area before an IV start. 

At the next level, I believe explaining why they need an IV, giving them the option to refuse, not attempting more than once, and not starting one if not absolutely necessary provides the best patient care to my patients.


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## triemal04 (Jun 28, 2008)

Hastings said:


> I'm a big fan of Nitrous too. Unfortunately, very few EMS providers carry it.
> 
> Anyone that is bad enough to NEED an IV in the short period of time between the scene and the hospital that fights against it is not in their right mind. And in such a case, you find a way to do it through the fighting. Anyone else can wait until the hospital. And trust me, the hospitals around here wont give them anything for needle pain either. Mostly because the anxiety of getting a shot/IV is often not due to the pain at all.
> 
> But even beyond that, why won't I numb someone up for an IV? Besides time, that is? Because we don't carry anything that can.


Unfortunately, even many people who "need" an IV will not just sit there and allow you to start it, as I've said before.  And no, doing it "through the fighting" isn't always the best choice; if the issue is due to anxiety, nitrous is great, if it is due to pain (when they rip their arm away from you as soon as you penetrate the skin) you use a numbing agent.  (many people we pick up are also not in their right mind...go figure)  Sometimes "doping up your patients" is the best course of action, the only course sometimes.  Physically restraining someone to start an IV if you have other more appropriate options...not a good idea.  Remember, this job is not about what is easiest for you, but what is best for you patient.  

As well, forget time...although there are exceptions to this, if the appropriate course of treatement means that you have to sit on scene for another minute, or your call lasts just a bit longer...do it.  Again, what is best for the patient is what we should be concerned with.


> Good patient care includes not starting an IV just-because, telling the patient that you want to give them and IV and why, giving them an opportunity to refuse, and letting someone else try if you can't get it the first time.


You do know that none of that matters, right?  If the patient loses it when you try and start a line, why would it be any different when the next person does?  And explaining a procedure, while damned important, won't fix that problem either.


> At the next level, I believe explaining why they need an IV, giving them the option to refuse, not attempting more than once, and not starting one if not absolutely necessary provides the best patient care to my patients.


Again, explanations are great, but don't expect them to always work; you need to have a plan for when, either because of anxiety/needle phobia, pain, or some other reason, the patient will not allow you to start an IV.

Saying that you don't do this because it's not an option is a lot different than saying that it's innapropriate.


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## Hastings (Jun 28, 2008)

> Again, explanations are great, but don't expect them to always work; you need to have a plan for when, either because of anxiety/needle phobia, pain, or some other reason, the patient will not allow you to start an IV.



Any patient that does not have an altered LOC has a right at all times to refuse treatment. That includes an IV. If, after I have explained why I want to start an IV, they say no, then I - as I legally and morally should - respect their wishes and do not start one.

That is my plan when a patient refuses treatment.


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## triemal04 (Jun 28, 2008)

Hastings said:


> Any patient that does not have an altered LOC has a right at all times to refuse treatment. That includes an IV. If, after I have explained why I want to start an IV, they say no, then I - as I legally and morally should - respect their wishes and do not start one.
> 
> That is my plan when a patient refuses treatment.





> Anyone that is bad enough to NEED an IV in the short period of time between the scene and the hospital that fights against it is not in their right mind.


Completely understood.  If they aren't altered then they can refuse.  But if they really need one and aren't altered and still refuse, then they really are altered, so you'll just go back to having to...what?  Restrain them?  Not start it?  What?

There is a need for topical anesthetics or analgesics prior to starting an IV pre-hospital.  Just because you have not been able to use them, did not realize how they could have been used, or are not willing to admit that these things have a role in the field does not change that need.


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## Hastings (Jun 28, 2008)

Even if a patient needs IV intervention to save their life, they still have the right to refuse if they don't have an altered level of consciousness. I'll explain the risks over and over again, and my reason for needing to start an IV, but in the end, if they refuse for ANY reason, then I cannot start that IV. If a patient is so scared that they'd rather die than get an IV, then the fear goes far beyond a simple dislike of pain, and it's not a fear that can be worked around with numbing agents.  Most fear of IVs isn't pain based.


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## Ridryder911 (Jun 28, 2008)

Like I described, 95% or more of the time I never use analgesics for an IV. I do though like to have an option. It is not hard to obtain. Do like I did and write a protocol and then purchase it, just like any other medication. Most Doc's are very understanding and usually assume you have it. 

Ethyl Chloride is about $26 a bottle that will usually last a year or more, if the medics does not play or waste it. Lidocaine 1% is real cheap in multi-dose vials, usually the ER may even give you some discount or even give you a small multi-dose vial. Again, just an option for your patient. 

I ask do you not place viscous Lidocaine for gastric tubes or nasal intubations as well? Remember studies and now even successful litigation's against health care providers for not providing pain control. Many are ignorant at the fact that unresponsive patients have pain as well. Be forewarned if you mark grimacing as r/t fracture, chest pain and do not treat the pain (when it could be treated) you may be held accountable. 

Treating pain has been one of the forefront of things to change in medicine. If the patient (truly) hurts treat it, that is really what you are there for. Again, the justification should be why not; instead of why? 

R/r 911


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## Hastings (Jun 28, 2008)

Ridryder911 said:


> Like I described, 95% or more of the time I never use analgesics for an IV. I do though like to have an option. It is not hard to obtain. Do like I did and write a protocol and then purchase it, just like any other medication. Most Doc's are very understanding and usually assume you have it.
> 
> Ethyl Chloride is about $26 a bottle that will usually last a year or more, if the medics does not play or waste it. Lidocaine 1% is real cheap in multi-dose vials, usually the ER may even give you some discount or even give you a small multi-dose vial. Again, just an option for your patient.
> 
> ...



Write a protocol and then buy the drug? I'm not sure what awesome fantasy world you're living in, but things don't work that way around here. The drugs we're allowed to carry and the protocols related to them are created by the medical director and whoever else, and only they have the ability to change them. And trust me, they're not getting changed.


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## skyemt (Jun 28, 2008)

is this really that different from someone wanting to refuse treatment?  if you think they really need to go, and they are not AMS and want to refuse, do you actually say, "well, ok, they are allowed... not gonna force ya... bye"...


COME ON....  you know there is more to it than just giving an explanation...
there is compassion, and understanding the patients fears and needs, and relating to them on their level, not trying to get them to relate to YOU on YOURS..  see the pattern here???

i have seen many patients who wanted to refuse both treatment and IV's talked into it, not just because they were given "explanations", but because the  EMT's and Medics related to them on their level.

not sure you are seeing the big picture here...


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## Ridryder911 (Jun 28, 2008)

Hastings said:


> Write a protocol and then buy the drug? I'm not sure what awesome fantasy world you're living in, but things don't work that way around here. The drugs we're allowed to carry and the protocols related to them are created by the medical director and whoever else, and only they have the ability to change them. And trust me, they're not getting changed.



Sorry, I will never work in such a system that medical control does not work and participate with the medics. Yes, I write the protocols (as well as a committee) and then the physician reviews and alters them as he/she seems fit. Otherwise protocols become stagnant overtime and should be reviewed yearly as needed for change. Emergency medicine changes to often to have orders stay the same. 

R/r 911


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## skyemt (Jun 28, 2008)

Ridryder911 said:


> Sorry, I will never work in such a system that medical control does not work and participate with the medics. Yes, I write the protocols (as well as a committee) and then the physician reviews and alters them as he/she seems fit. Otherwise protocols become stagnant overtime and should be reviewed yearly as needed for change. Emergency medicine changes to often to have orders stay the same.
> 
> R/r 911



We just had a meeting with head of our ER and member of the local REMAC...
met with agencies in the area, which he does periodically, to ask for input into new protocols to be written.. they are always changing, and they value the EMT and Medic input to make these changes... at JEMS conference, had a conference with Medical Directors from many states, who do the same...

i'm not really sure why so many seem it is something done behind closed doors and only at the whim of the Medical Director?  I suppose it many be that way in some states, but clearly it is not the norm.


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## Hastings (Jun 28, 2008)

Ridryder911 said:


> Sorry, I will never work in such a system that medical control does not work and participate with the medics. Yes, I write the protocols (as well as a committee) and then the physician reviews and alters them as he/she seems fit. Otherwise protocols become stagnant overtime and should be reviewed yearly as needed for change. Emergency medicine changes to often to have orders stay the same.
> 
> R/r 911



Sounds like a great, progressive system. Just one we don't have.



> is this really that different from someone wanting to refuse treatment? if you think they really need to go, and they are not AMS and want to refuse, do you actually say, "well, ok, they are allowed... not gonna force ya... bye"...
> 
> 
> COME ON.... you know there is more to it than just giving an explanation...
> ...



The compassion and empathy come in when I explain why I want to start an IV, and the risk, etc, etc. I relate to them while explaining everything. The point is that if they can't be talked into it after I've done my best, I'm not going to push it.


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## Flight-LP (Jun 28, 2008)

Hastings said:


> Sounds like a great, progressive system. Just one we don't have.
> 
> 
> 
> The compassion and empathy come in when I explain why I want to start an IV, and the risk, etc, etc. I relate to them while explaining everything. The point is that if they can't be talked into it after I've done my best, I'm not going to push it.



Personally, I think this is a deeper issue for you than you describe based in your postings, however I rarely ever have a patient remotely question, much less refuse an IV. Without re-hashing all of the other logical responses, I too agree with their postings. Any available resource to ease a patient's anxiety or pain tolerance should be employed. Your "one stick" idea is great and all, but what happens when you are the only ALS provider available? Sorry, but again your logic falls short........................


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## mikeylikesit (Jun 29, 2008)

Hastings, like you stated you only have a few minute transport time for patients so you have the luxury to wait for IV starts. Most however can't allow 30+ minutes for a dehydrated patient to refuse fluids. i like anesthetics because i have them and i know that i will never ever have a patient refuse an IV if i can promise them that it wont hurt. It then becomes as much of a decision for the patient as "can i check your pulse?"


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## Hastings (Jun 29, 2008)

mikeylikesit said:


> Hastings, like you stated you only have a few minute transport time for patients so you have the luxury to wait for IV starts. Most however can't allow 30+ minutes for a dehydrated patient to refuse fluids. i like anesthetics because i have them and i know that i will never ever have a patient refuse an IV if i can promise them that it wont hurt. It then becomes as much of a decision for the patient as "can i check your pulse?"



And that's all well and good. That's probably why some have the ability to numb while I don't. Because it is recognized here that it is *not necessary*. And that is it, right there. Short transport times.


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## MasterIntubator (Jun 30, 2008)

There is a product called "shotblocker" which has been used for years and years and is based on pain diversion.  Works very well.  There is also a 'U' shaped version for IV's that I have used.  

Holistic, kids love it.  Tried it many times on myself with folks giving me IM saline shots.... it is quite fascinating


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## So. IL Medic (Jun 30, 2008)

So laying someone out for starting an IV was hyperbole?


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## So. IL Medic (Jun 30, 2008)

Ridryder911 said:


> Like I described, 95% or more of the time I never use analgesics for an IV. I do though like to have an option.
> 
> R/r 911



Now that makes more sense.


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## So. IL Medic (Jul 1, 2008)

Hastings said:


> Write a protocol and then buy the drug? I'm not sure what awesome fantasy world you're living in, but things don't work that way around here. The drugs we're allowed to carry and the protocols related to them are created by the medical director and whoever else, and only they have the ability to change them. And trust me, they're not getting changed.



Hastings, something to ask your med director and ems coordinator about: 

Our system has a simple committee comprising of one medic from each service in the system, the EMS coordinator, and the Med Director sits in as time permits. We meet every four months. Primary purpose is protocol review, secondary is any other system issues, such as a continuing education schedule was set in the last meeting. Our Med Director was actually very pleased for the opportunity for two-way feedback when the committee was formed - at the request of the medics no less.

It's worth a shot to do something similar.


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## triemal04 (Jul 7, 2008)

Better late than never.  

Hastings, you seem to have the attitude that, just because your service doesn't carry it, it's not neccasary.  As well, that because you have short transport times proper patient care isn't neccasary.  This is a horrible stance to take, and will only cause you grief in the future.  Not to mention (this may be wrong, if it is then ignore it, or just consider it a blanket statement for anyone new to the field) that some of your posts seem to indicate that you are new, like maybe a year new, to the field.  If this is the case then your attitude is doubly bad; now is when you should be rounding out what you learned in school and learning all the things that you didn't pick up.  This is the time when you should be learning all you can, not getting dead-set in your ways.

Medicine changes, almost on a daily basis.  And many services will carry equipment or do things that yours does not.  To discount these things because you don't do them, or don't think they are neccasary is setting yourself up for failure, both as a paramedic, and as a person.


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## Hastings (Jul 7, 2008)

triemal04 said:


> Better late than never.
> 
> Hastings, you seem to have the attitude that, just because your service doesn't carry it, it's not neccasary.  As well, that because you have short transport times proper patient care isn't neccasary.  This is a horrible stance to take, and will only cause you grief in the future.  Not to mention (this may be wrong, if it is then ignore it, or just consider it a blanket statement for anyone new to the field) that some of your posts seem to indicate that you are new, like maybe a year new, to the field.  If this is the case then your attitude is doubly bad; now is when you should be rounding out what you learned in school and learning all the things that you didn't pick up.  This is the time when you should be learning all you can, not getting dead-set in your ways.
> 
> Medicine changes, almost on a daily basis.  And many services will carry equipment or do things that yours does not.  To discount these things because you don't do them, or don't think they are neccasary is setting yourself up for failure, both as a paramedic, and as a person.



I'm not refusing to use a tool that is available to me because I'm a sadist or stubborn. We don't have it. I'm simply justifying not having it, and explaining what I believe is the best patient care techniques in the absence of what I believe to be unnecessary tools (unnecessary, because I've had no situations where my a patient has been unhappy with my method). 

Great, they work for other people. And if they were available to me, I'm sure I'd put them to good use. But since I don't have them, I've adapted and developed ways of minimizing the pain in other, non-chemical ways. They're listed in previous posts.



> As well, that because you have short transport times proper patient care isn't neccasary.



Proper patient care in the absence of the drugs you're talking about and short transport times has been mentioned enough times by me. It includes only attempting once, attempting only if necessary, and giving the patient an opportunity to understand the reason for starting an IV and to refuse. That is EXCELLENT patient care, and I believe that 100%. I give my patients the best quality of care, and I don't need these extra drugs for that.


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