What is your opinion of pain management?
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H33
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Paramedic, ALS service, and our only option for pain meds is the whirly bird.
NomadicMedic
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Really? Where is this?
H33
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I don't disagree.. but true it is.. south alabama 12 trucks 5 counties. 10 of which ALS
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There are several Albany area services that do the same. It's not a required medication, so they don't carry it and therefore avoid "regulatory" issues.
CentralCalEMT
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To me, pain management is an essential part of being a paramedic. It blows me away how many "old school" paramedics believe that pain medication should only be used in the most extreme cases. In my area, all we have is Fentanyl. When we switched from morphine we also got a "severe pain management" protocol which gives us the right to give pain medications as standing orders in any situation where there is significant pain and the patient has a stable BP, and no ALOC. Still some paramedics say they are not "the candy man" and still do not give pain medication when it is warranted. It embarrasses me as a paramedic, when I see another medic bring a patient in who is writing in pain and is telling them "there is nothing they can do for them until the doctor sees them that they do not carry pain medications". Now that I am a field preceptor, I try and instill in the paramedic student that as paramedics we will not save many lives at all, but we can relieve human suffering and that is extremely important. There is NO reason to withhold pain medication or any medication that relieves suffering (Zofran, etc.) to any patient who needs it based on the paramedic's personal opinion.
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Us old school guys were trained that way.
Not that that's an excuse for poor care, but the attitude towards prehospital analgesia has changed dramatically in just the past 5-10 years.
CentralCalEMT
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That does make sense. Unfortunately, many people who are in this field, just get their 48 or 72 hours of CE every two years and do not actually keep up with recent trends and ideas.
Heck, during my recent internship I'm glad my got my preceptor and I agreed on many things and treating our patients pain was ne of them. I belive we filled out almost a whole narc log sheet in a little more than 500hrs. Many compliments were received and happier more pleasant patient transports followed 
..it kills me to see a pt suffering in pain and the medic just ignoring it because "i only give meds to obvious fractures" . It's embarrassing to watch. Unfortunately, I believe alot of it also has to do with more paperwork being required when narcs are used.
Needless to say, I'm glad we have a new progressive and involved medical director which allows to have a agressive pain management protocol.
..it kills me to see a pt suffering in pain and the medic just ignoring it because "i only give meds to obvious fractures" . It's embarrassing to watch. Unfortunately, I believe alot of it also has to do with more paperwork being required when narcs are used.Needless to say, I'm glad we have a new progressive and involved medical director which allows to have a agressive pain management protocol.
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CALEMT
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Thats what it boils down to most of the time it seems. Now granted I'm not the one writing the PCR and pushing the narcs, but not to give pain meds just because it takes longer to finish your PCR is total bull **** in my book.
DesertMedic66
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It's not a whole lot more paperwork in all honestly.
Per protocol we are only able to give pain meds for extremity trauma. If it's anything aside from that we have to contact base to get an order. One of our hospitals is famous for not giving us orders (that may change due to their new EMS medical director) so our way around this is we contact another hospital who will give us orders and then have the hospital contact the hospital we are transporting to haha
CALEMT
The Other Guy/ Paramaybe?
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In all reality no its not that much more paperwork. Not saying anyone I've worked with does it, but you do hear of people doing it.
I think I know which hospital you're talking about. Its been awhile since I've seen fent pushed and don't exactly remember which hospital it is haha. But thats clever clever calling another hospital to get orders. Kinda like going to mom when dad says no haha.
MonkeyArrow
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If you contact a hospital for base orders, don't you have to transport to that hospital?
Aside from that, I feel like especially in an urban environment, and working in an ED where I can see the other side of the coin, I don't see the need for aggressive pain management with 10-15 minute transports. Likely by the time the med actually starts making a difference, you're pretty close to the hospital and giving things pre-hospitally messes up the ED "flow" if you will. For example, we do not give narcotics in the ED unless you are either getting admitted or have a ride home. If you are driving home, no candy for you. Most medics don't really think about that. Also, having the advantage of seeing a lot of our patient's EMR, you feel a lot more jaded when you see someone with 10/10 pain acute onset lower back pain, but they've been at the ED every month and have had 30 of hydrocodone filled a week ago.
DesertMedic66
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EMC and thats exactly what its like. Only if you get denied orders from one hospital it's going to be a huge problem if you call other one. So to avoid that we just skip mom and go directly to dad.
Nope. We can transport to whatever hospital we want to. The base hospital we contacted will make contact with the hospital we are transporting to and let them know whats going on.
Fentanyl has almost an immediate onset time when given IV and is at full strength within minutes of giving it, so it does help in the short transport times. Our EDs work a little differently here. Our EDs give out narcotics almost immediately after an IV is started for patients in pain. During my clinical time for medic school the process in the ED was: Vitals, Doc assessment, IV, bloods, pain management, CT scans (or other scans and treatments). It makes no difference if the patient is going to be admitted or not (Kidney stones are very painful and hardly any of these patients are admitted). Our hospitals and EMS agency views pain as an additional vital sign. The goal is to bring the patients pain down to a bearable limit or better yet to have the patient in zero pain.
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The 90s called and they would like their ED back.
But actually. Did you ever work on an ambulance? The transport is often not the issue, getting the patient from where they lie to the cot is. We aren't going to not medicate someone just because we're only 10 minutes from the hospital. There are so many more considerations than that. Also, IV fentanyl has reasonably quick onset time and Ketamine is nearly instantaneous.
We also get our orders from one hospital network but transport to others as our medical control comes out of that network.
NomadicMedic
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Well, I guess it depends on where you are. At the service I'm working at PRN, giving ANY medication is a huge pain in the balls. Any Med, not just narcs. Even zofran.
If you open a message bag for anything, you break the numbered seal which then requires a full replacement bag at the ED.
SO... Before you can swap your med bag, you have to fully complete a PCR, print a copy, drive to the local base hospital, which is usually NOT where you've brought the patient, go to the pharmacy, (or find the night nursing supervisor if it's after hours) sign in your old drug bag, fill out a narc/med use form, waste any leftovers in front of the pharm (or RN if the pharmacy is closed), tape your now empty vial or carpo to the PCR and seal that in the OLD bag, get a new bag, break the pharmacy seal, count the contents, re-seal with a new numbered seal, sign a med bag form and then you're able to go run another call.
Biggest pain ever.
When I asked why we don't refill our bag from the Pyxis, they looked at me like I had two heads. "What? Give a paramedic access to the Pyxis? Never!!!"
Have I given fewer meds than I have in the past? Yep. You betcha.
If you open a message bag for anything, you break the numbered seal which then requires a full replacement bag at the ED.
SO... Before you can swap your med bag, you have to fully complete a PCR, print a copy, drive to the local base hospital, which is usually NOT where you've brought the patient, go to the pharmacy, (or find the night nursing supervisor if it's after hours) sign in your old drug bag, fill out a narc/med use form, waste any leftovers in front of the pharm (or RN if the pharmacy is closed), tape your now empty vial or carpo to the PCR and seal that in the OLD bag, get a new bag, break the pharmacy seal, count the contents, re-seal with a new numbered seal, sign a med bag form and then you're able to go run another call.
Biggest pain ever.
When I asked why we don't refill our bag from the Pyxis, they looked at me like I had two heads. "What? Give a paramedic access to the Pyxis? Never!!!"
Have I given fewer meds than I have in the past? Yep. You betcha.
DesertMedic66
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We don't restock a single item from the hospital and for our narcotics we use an in house system so we don't have RNs witness our wasted drugs nor do we have to keep the vial. Our partner for the day EMT or Medic witnesses the drug waste.
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God that sounds terrible.