Originally posted by rescuecpt+Aug 10 2005, 08:46 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (rescuecpt @ Aug 10 2005, 08:46 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-asysin2leads@Aug 9 2005, 04:05 PM
As for the junkie part, I shake my head a little. Sure, the EMS system gets abused day in and day out, but just because something is in a protocol DOESN'T MEAN you have to give it.
If I have some skell come wandering up to the bus complaining of "severe pain in the leg", do you think he'd be getting morphine? Nope.
I realize that with the Republicans in power, getting loopy in any way, shape or form, is pretty much the worse sin you can commit, but as a medical care provider, I'm gonna stick to my commie feel good ways and say that if I have someone with multiple fractures entrapped in an MVA, I'd like to give them a little something to take the edge off before I move them, because I personally know how much it HURTS.
LOL, it's not about Republicans. It's about providers needing to make major decisions that we are not trained to make - who really needs it vs who doesnt, what it will do to the rest of the pt's injuries, etc. That's why around here (as they should be everywhere and I think they are) narcs are controlled substances only administered with medical control approval. That's also why I don't give narcs very much - because I don't get orders very often. They are very selective because in the long run, that is what is best for the most patients.
I ride in two departments. One has pain control meds (narcs & nitrous) and one does not. Why don't we have it at the 2nd place? Because it is too hard for us to secure it and train our personnel on security procedures. It brings too much risk to the department and the squad.
Lots of skells don't look like skells. Sometimes it's REALLY hard to tell which soccer mom is really a junkie, no matter how long you've been on the streets. [/b][/quote]
A couple things. If your 2nd department does not have people who can be trusted around narcotics and nitrous, they shouldn't be working EMS. Secutrity is no harder than a log book, a control number, and a count every tour. I'm not sure exactly what you mean by risk, but I know of ambulance services in East New York (bad area) that do just fine in keeping their narcotics where they should be.
As providers, we, in conjunction with the online medical control physician, are in fact qualified to decide who gets pain management and who does not. And countless of studies will show you, in hospital and out of hospital, that management of acute pain with opiates and other medications does NOT, by in large, create people addicted to pain medication. Recent theory holds that aggressive management of pain is the most beneficial to patient. As for the "soccer mom" thing, ummm, well, if Ms. McGuilicutty calls for the ambulance everyday (as a real junkie would need) for the same pain in the same area, well, we might catch on eventually. A junkie might get a free "high" once, might get it twice, but they're not gonna be feeding their habits on EMS narcotics. No way, no how. Pain is bad. We can treat it, and we should.
I completely agree with you. If you have it and the patient needs it, give it. We need to base our decision off of a sound assessment and the nature of illness / mechanism of injury. Pain is what the patient says it is. Acute illness and injuries that are indicitive of pain managment require it. It is absolutely cruel to withhold pain medication because of any additional paperwork required or because a medic thinks someone is an addict. Both examples open you wide up for litigation. In my mind there are three things that will ensure a happy patient. Respond promptly, be nice and professional, and take away their pain. I'm not saying to dope up your chronic back pain for 10 years patient, but the ones who have acute issues deserve pain management, plain and simple. Some doc's do not like medicated patients, thats fine, they will get over it. Do what you know is right for your patient and what your medical director dictates, remember, you are here for them, not the ER doc....