Should I85s be allowed to help with pain managment?

[Veneficus]

He said cardiac related chest pain. Whats wrong with that as a basic indication?

when I read it, I was thinking about the mechanism.

It is not for pain it is for platelet inhibition.

perhaps I erroneously concluded the mechanism from the indication.

 

[Melclin]

when I read it, I was thinking about the mechanism.

It is not for pain it is for platelet inhibition.

perhaps I erroneously concluded the mechanism from the indication.

Ohhhh I see where I got my wires cross.

I hope you you won't mind me saying that I hope you're wrong. I'd hate to think that there are providers out there that think we give aspirin for pain relief in acute coronary syndromes.

 

[Dwindlin]

Ohhhh I see where I got my wires cross.

I hope you you won't mind me saying that I hope you're wrong. I'd hate to think that there are providers out there that think we give aspirin for pain relief in acute coronary syndromes.

I can assure you there are, work with them frequently.

 

[Melclin]

I can assure you there are, work with them frequently.

Ohhhhhhh.

I'd better get another drink.

 

[Veneficus]

I hope you you won't mind me saying that I hope you're wrong. I'd hate to think that there are providers out there that think we give aspirin for pain relief in acute coronary syndromes.

I hope I was wrong too, but apparently not.

 

[EMT91]

...but you don't give ASA for pain management.

...I know. Its for cardiac a d may relieve associated pain.

 

[EMT91]

when I read it, I was thinking about the mechanism.

It is not for pain it is for platelet inhibition.

perhaps I erroneously concluded the mechanism from the indication.

You did. I was speaking simplisticly; it has to do with the enzymes and making them non sticky. However in the end the patient may tell you his pain is reduced. I should have been more clear. Its hard to give a lot of detail when typing a reply from a tablet ^_^ I was merely thinking that pain relief may be a possible by action or result. For instance viagra is used for ED but it can also be used to treat pulmonary hypertension.

 

[Veneficus]

You did. I was speaking simplisticly; it has to do with the enzymes and making them non sticky. However in the end the patient may tell you his pain is reduced. I should have been more clear. Its hard to give a lot of detail when typing a reply from a tablet ^_^ I was merely thinking that pain relief may be a possible by action or result. For instance viagra is used for ED but it can also be used to treat pulmonary hypertension.

No medication for EMT-Is

the prosecution rests.

 

[Tigger]

No medication for EMT-Is

the prosecution rests.

Right, because the words of forum member should decide how we go about things. I get that this is all probably somewhat in jest, but you yourself (rightly) call for studies to back up a so-called "n=1" conclusion. So how is it fair to judge in reverse, you cannot say that one person's postings accurately reflect a group as a whole.

 

[Medic2409]

In other countries that require more education it is not an issue. In countries where the provider signs the chart and is held accountable to those decisions without pointing the finger at the doctor when something goes wrong, that is not an issue.

The flip side to this is when something does happen, the doctor can lay all the blame on the Medic, with no recourse for the Medic to pursue.

But the US is the most simplistic of protocol medicine in EMS. It is one size fits nearly all with just a few sizes in stock.

It would benefit not only the patients, but the economics for US providers to be at the same level as their counterparts in other modern nations.

But it is not a popular view on EMTlife, in the real world even less.

Popular view from where I stand, although, sadly, we are in the minority.

 

[JakeEMTP]

The flip side to this is when something does happen, the doctor can lay all the blame on the Medic, with no recourse for the Medic to pursue.

In the US the Paramedic has become reliant on their Medical Directors and other doctors to make their decisions. In other countries the Paramedic has achieved the privilege of being able to make the necessary medical decisions through education and extensive internships. They are accountable for their actions and must come up with reasons beyond that's what the protocols say or the state says I can because it is in my scope of practice. They must be able to differentiate the difference between can do something and should do something.

 

[Veneficus]

Right, because the words of forum member should decide how we go about things. I get that this is all probably somewhat in jest, but you yourself (rightly) call for studies to back up a so-called "n=1" conclusion. So how is it fair to judge in reverse, you cannot say that one person's postings accurately reflect a group as a whole.

I would say it is partly in jest. But not all.

(Next part no jest)

I have no doubt there are many exceptionally knowledgable, skilled, and experienced EMS providers of all levels.

But when I was actively a medic (I am still a medic on paper and still teach medics), these providers were few and far between.

I have not noticed a significant population level change in the quality of EMS providers.

Actually, over the years it has become more skills focused and the clinical accumen of providers has by in large appeared to go down.

If you don't want to be judged by the lowest common denominator of EMS provider, it is your responsibility as one to raise the lowest standard.

It is not about 1 poster. It is about 1 poster who happens to represent what in my experience seems to be the vast majority of EMS providers.

I think it is surely possible to train EMT-Is to administer pain meds, both narcotic and otherwise, but we simply are not there yet.

 

[EMT91]

Then please, explain how I was wrong and teach me what is proper.
This is @ ven.

 

[Veneficus]

The flip side to this is when something does happen, the doctor can lay all the blame on the Medic, with no recourse for the Medic to pursue..

I find such behavior not only revolting, but completely unacceptable of somebody calling themself "doctor" without exception.

When a doctor or anyone else is in charge, they are responsible. That includes accepting blame and responsibility for the faults of those who work under them.

A doctor should never be blaming a provider who that same doctor signed off on as qualified and fit to practice under them.

They deserve to be sued for all they have and lose, including their license for such behavior.

Nobody forces a doctor to be a medical director. They accept the position, they accept the responsibility. Whether they are paid or not.

 

[JakeEMTP]

I find such behavior not only revolting, but completely unacceptable of somebody calling themself "doctor" without exception.

When a doctor or anyone else is in charge, they are responsible. That includes accepting blame and responsibility for the faults of those who work under them.

A doctor should never be blaming a provider who that same doctor signed off on as qualified and fit to practice under them.

They deserve to be sued for all they have and lose, including their license for such behavior.

Nobody forces a doctor to be a medical director. They accept the position, they accept the responsibility. Whether they are paid or not.

Originally Posted by Veneficus
In other countries that require more education it is not an issue. In countries where the provider signs the chart and is held accountable to those decisions without pointing the finger at the doctor when something goes wrong, that is not an issue.


I thought your previous post was about other countries with Paramedics having a more independent practice. I don't believe other countries are reliant of a Medical Director.

In the US the Medical Director provides the protocols and should see that the Paramedics have a measureable amount of competency by some means. But, if a Paramedic defies protocols or acts negligently, that Medical Director is not solely responsible for the actions of the Paramedic. That is where licensure comes in that the Paramedic has a share of the responsibility. You can not put your incompetency or screwups solely on the back of your Medical Director. That is just an excuse for you to have some of the fun but none of the accountability

 

[NYMedic828]

Then please, explain how I was wrong and teach me what is proper.
This is @ ven.

That's the problem. You can't leave something open to teaching it after the fact. Your educational program did not fully address pharmacology as in depth as would need to be done for informed administration of medications. Yes there are people more than capable at the EMT and EMT-I level but you cannot do something based on the few when the many are not ready or capable.

Unfortunately there are also paramedics who don't know any better either. But it is assumed that the scale is the opposite and most are educated "enough" and will make decisions in their scope for the right reasons.

As far as aspirin goes, we don't give aspirin for analgesia. Ever. Yes ASA can relieve pain and inflammation, yes it reduces fever, But that isn't what we have it for.

As you already stated it inhibits platelet aggregation. The whole purpose of this is to distupt the clotting cascade to either reduce the chance of coronary blockage in those taking daily aspirin, or in our case to reduce further blockage. Aspirin does not break up already formed clots but it will help prevent them from enlarging worsening the condition.

We only give aspirin for suspected MI. If the patient simply has chest pain, and the suspect is not infarction 2nd to blockage than aspirin is no longer in play.

 

[EMT91]

I know all of that its writtten off to the side in my basic book. I was merely using asa as an example of a medication we give po. I was not saying we use it for pain. I know we use it for the anti coagulant properties. I think a great misunderstanding took place here. I apologize for that.

 

[Veneficus]

Then please, explain how I was wrong and teach me what is proper.
This is @ ven.

The answers you seek can be found here:


http://www.amazon.com/Guyton-Hall-T...2&sr=8-1&keywords=Guyton's+medical+physiology

and here:

http://www.amazon.com/Robbins-Cotra...=1-1&keywords=Robins+and+Coltran+Pathological

 

[Veneficus]

Originally Posted by Veneficus
In other countries that require more education it is not an issue. In countries where the provider signs the chart and is held accountable to those decisions without pointing the finger at the doctor when something goes wrong, that is not an issue.


I thought your previous post was about other countries with Paramedics having a more independent practice. I don't believe other countries are reliant of a Medical Director.

In the US the Medical Director provides the protocols and should see that the Paramedics have a measureable amount of competency by some means. But, if a Paramedic defies protocols or acts negligently, that Medical Director is not solely responsible for the actions of the Paramedic. That is where licensure comes in that the Paramedic has a share of the responsibility. You can not put your incompetency or screwups solely on the back of your Medical Director. That is just an excuse for you to have some of the fun but none of the accountability

In the previous post, I was pointing out that the medics in other countries do not rely on protocols from medical direction.

By default, that makes them both the in charge and responsible party. (as anyone in charge must be responsible, there can be no authority without responsibility)

Those medics do not follow protocols and then point the finger at the doctor or protocol when things go wrong.

If something were to go wrong where I work, then I am responsible. It doesn't matter what nonmedical provider made the mistake or why. It is still unquestionably my fault and my responsibility.

 

[Handsome Robb]

What about just giving them nitronox?

Intermediates can give nitronox. Well at least here they can :unsure: