Intranasal Narcan for BLS

[Brandon O]

Oxygen reverses hypoxia. Not Narcan.

The only situation I can think of naloxone being useful is a pseudo-PEA secondary to opioid induced hypotension (i.e. never).

Random anecdote, but I have seen more or less exactly this... the exact sequence wasn't clear, but it was a near-total PEA, textbook sinus on the monitor, nobody had any answers, until someone throw some naloxone down the IV on a whim and she started to come around. Odd one.

 

[downunderwunda]

That's fine in the abstract. But this is a volunteer fire department, with about 10 EMTs, almost all of whom are doing something else full time. Recruiting and retaining members is a big issue. It's hard enough to get people to go through a 120 hour class, having everyone take the EMT B and a EMT I as well isn't going to happen, and I'm not sure it is worth it for a place where they run 30 calls a year.

As to making everyone an EMT-I, I think there are plenty of people who I don't think should be doing drug calculations and starting IVs but who I would trust to stick tube up someone's nose and give 0.2mg of Narcan when their friend says they did heroin.

Sure it would be great if everyone was an EMT-I, but I don't see it happening in the current funding situation.

You need to read all my posts in relation to this but I will make it easy.

1. Fire is a profession. Ems is a profession. They should be separate.

2. There are areas that taxpayers should fund. Healthcare, ems are part of that. They shod not be a for profit setup.

3. There is no place for fully volunteer ems in today's world in first world countries. I wouldn't do that much study & time for no gain. As I said, ems is a profession. There is some justification for some billy services as a secondary adjunct to the professional service.

4. With this said, you can run a retained service with a nominal retainer & payment for each call in quieter areas. There is then financial incentive to train & up skill.

Sorry I'd I upset any volleys out there but it happens. For ems to progress it needs to be said. Mentalities need to change.

 

[m0nster986]

Why would you give narcan in arrest? What are you trying to accomplish?

He may have been taught the "Coma Cocktail.":glare:

 

[Tigger]

4. With this said, you can run a retained service with a nominal retainer & payment for each call in quieter areas. There is then financial incentive to train & up skill.

Could you shed some light on how this works? Obviously I'd love to have full-time ALS coverage for all, but how exactly do you provide this for a community that has 30 runs a year, surrounded by similar places? If you spread the units out enough to make the call volume cost effective you'd be looking at some pretty long scene times it seems?

It's getting better to be sure, I was recently transported by an agency that serves a town of less than 5000 (and are the biggest for many miles) that had ILS on board for most calls, but only one member was paid and the other two were volunteer. One of the volunteers was an intermediate, but I cannot imagine most volunteers are.

 

[Handsome Robb]

It's getting better to be sure, I was recently transported by an agency that serves a town of less than 5000 (and are the biggest for many miles) that had ILS on board for most calls, but only one member was paid and the other two were volunteer. One of the volunteers was an intermediate, but I cannot imagine most volunteers are.

Eh the town I grew up in was less than 5000 and we had a dedicated ALS fire department. We did see a big influx of tourists in the summer though so that probably had something to do with it.

 

[Tigger]

Eh the town I grew up in was less than 5000 and we had a dedicated ALS fire department. We did see a big influx of tourists in the summer though so that probably had something to do with it.

This town has a large ski area (hence the reason for my ride), but I was still surprised. The ski area also has medics that will ride in with their own equipment should the patient be serious.

As a rule though most small towns in New England lack full time fire and EMS it seems. I am presently living in one of the more wealthy towns in MA yet we have POC BLS ambulance and fire. The cops have a maximum two cars on the road for the overnight, three at other times. The money is there, but the want is not which sucks. Medics can be 20 minutes away, which is too long half the time.

 

[downunderwunda]

Could you shed some light on how this works? Obviously I'd love to have full-time ALS coverage for all, but how exactly do you provide this for a community that has 30 runs a year, surrounded by similar places? If you spread the units out enough to make the call volume cost effective you'd be looking at some pretty long scene times it seems?

It's getting better to be sure, I was recently transported by an agency that serves a town of less than 5000 (and are the biggest for many miles) that had ILS on board for most calls, but only one member was paid and the other two were volunteer. One of the volunteers was an intermediate, but I cannot imagine most volunteers are.

I love the way people only read what they want to see. Tigger this is point 2.

2. There are areas that taxpayers should fund. Healthcare, ems are part of that. They shod not be a for profit setup.

 

[Tigger]

I love the way people only read what they want to see. Tigger this is point 2.

2. There are areas that taxpayers should fund. Healthcare, ems are part of that. They shod not be a for profit setup.

Relax, lay off the attitude.

All I wanted was a little bit more of an explanation of how this works.

4. With this said, you can run a retained service with a nominal retainer & payment for each call in quieter areas. There is then financial incentive to train & up skill.

It's not a system I am familiar with.

 

[paradoqs]

Emt iv's can give iv and in narcan in my area and there are no contraindications. Indications are respiratory depression due to opiate od or unresponsive with unknown etiology. However, either of those chiefs are going to get an als response so its kind of pointless for us. The md's in my area are apparently not worried about any complications or side effects from narcan. I saw somewhere that they are giving it out to junkies for when their junky buddies od, so letting emt's give it doesnt seem like too bad of an idea. And get off the high horse about upping your skills. Emt's have a place in medicine and it isnt stopping ems from becoming a profession. Cna's are an integral part of hospital medicine and they arent keeping nurses from being recognized as health professionals. Being a cna is required for entry to a lot of nursing schools just like emt exp is and should be a prereq for medic school

 

[downunderwunda]

I would have thought it self explanatory.

Pay people to get their qualifications. Once qualified & registered they are paid a nominal allowance to be on call. Then when they are called they get paid for each call at a set rate for up to a certain period of time.

This will then give an incentive for people to be involved & stay involved as well as maintaining their qualifications.

 

[Handsome Robb]

I would have thought it self explanatory.

Pay people to get their qualifications. Once qualified & registered they are paid a nominal allowance to be on call. Then when they are called they get paid for each call at a set rate for up to a certain period of time.

This will then give an incentive for people to be involved & stay involved as well as maintaining their qualifications.

So where is all this money coming from, champ?

 

[Medic Tim]

So where is all this money coming from, champ?

He has already answered this question.

 

[Handsome Robb]

He has already answered this question.

You can say taxes as an answer to pretty much every funding problem.

It's not a plausible answer. In a perfect world, yea sounds great. In the current economy, not the case.

 

[ffemt8978]

You can say taxes as an answer to pretty much every funding problem.

It's not a plausible answer. In a perfect world, yea sounds great. In the current economy, not the case.

And what happens when the taxpayers reject an increase in their taxes, despite being educated on the benefit it could bring?

 

[Tigger]

I would have thought it self explanatory.

Pay people to get their qualifications. Once qualified & registered they are paid a nominal allowance to be on call. Then when they are called they get paid for each call at a set rate for up to a certain period of time.

This will then give an incentive for people to be involved & stay involved as well as maintaining their qualifications.

Ah, a retainer system is just like paid on call. Just wanted to be sure. But to place someone on call you have to pay them a fair amount to make it worth their while to alter their life. No alcohol use, etc, while on call. Considering that there are many, many towns in this country that average an EMS call every two weeks, that's a lot of time on call. I can't imagine it's a desirable assignment, and to combat boredom one would need to hire more crews, making it more expensive.

For me, it comes down to getting what you pay for. If you live in the middle of nowhere and pay tiny taxes, then you shouldn't expect excellent public services. If you want better service, move to where the tax base exists to support it.

 

[Tigger]

You can say taxes as an answer to pretty much every funding problem.

It's not a plausible answer. In a perfect world, yea sounds great. In the current economy, not the case.

Many states could raise the their taxes despite the economy, and I'm not sure it would be the worst thing to ever happen. It might just create jobs, but I don't want to get into that argument here.

What is more troubling is the states that demand a popular vote on tax hikes, like Colorado. There is simply no way to generate new funding, because residents flat out refuse to ever pay more taxes if given the choice unless it can be shown that they will receive a direct benefit. Much of the tax increases will only assist the smaller portions of the population, those living in poorer areas (both rural and urban) are simply outnumbered by those who are receiving more than adequate state and city services.

 

[downunderwunda]

And what happens when the taxpayers reject an increase in their taxes, despite being educated on the benefit it could bring?

Interestingly enough there are many ambulance services worldwide who operate on this basis. The mentality of pay for everything is what holds people back. As I have stated previously, some things should be controlled by government to ensure quality & availability of supply. Healthcare, education, law enforcement gas & electricity supply. Essentials of life. They can still be run to attain profit but those profits ate used to provide better services.

The more people use a service, the more viable it becomes.

I encourage you to think outside square. Think outside what you consider "normal" & open your eyes & mind to other possibilities.

 

[ffemt8978]

I encourage you to think outside square. Think outside what you consider "normal" & open your eyes & mind to other possibilities.

We have...and our voters (i.e. the people that pay for the taxes that support us) have rejected it on more than one occasion.

 

[downunderwunda]

I ask why is that? Answer: because it is not explained properly to them in a language they understand. Put simply a nominal increase in taxes that most people wouldn't notice, would fund all services.

Many people pay for health insurance, Australians pay a 2.75% tax for free healthcare, they can also elect to have private, more extensive healthcare, of they are pensioners, free healthcare, prescriptions for $5.40 each.

Gee I think if it is explained properly, I a language people can understand, then the vast majority would be accepting of it.

The simple truth is, in my humble opinion, that the US governments, at all levels, has convinced the vast majority that the systems in place should be there as a profit making venture. That governments should be entitled to take & waste money. They justify this through declaring war on terror, then carrying it on for over 10 years, incurring trillions, yes trillions of dollars debt. Spending billions every year on drug detection with no real success. The conspiracy theorists might blame the CIA got that one.

When was the last time one of these politicians, a so called elected representative of the people, had to really think about how much a loaf of bread cost? Or how much gas costs? Or maybe how much an ambulance costs & the subsequent hospital bills cost?

Let me answer. Never. Do they want a change? No because while they keep the majority in the dark, they keep pocketing all their money, allowances etc.

Maybe they need to live on struggle street like most of us do. Not in their ivory towers barking at us what's best for us, but learning to listen to the majority of voters, then they might learn.

If you don't believe we are told what to be scared of consider this from recent history.

From the end of WWII, we were told to be fearful of the commies, be scared if reds under the bed, so we had the Korean conflict, a police action, this continued through to Vietnam in the 60's & 70's as well as the early 80's. The came the end of the cold war. That didn't last long though. The early 90's had operation desert storm. We were told how scared we had to be of saddam & his weapons of mass destruction.

We then had tragedy in 2001 in new York , 2002 in Bali, & again in 2005 in London. So now we have to have a war on terror.

How about instead if all of these distractions & having to go to war, we look at what we can do to benefit our own people. Spend their tax dollars more wisely & offer the services they need, without looking for profit.

 

[ffemt8978]

I ask why is that? Answer: because it is not explained properly to them in a language they understand. Put simply a nominal increase in taxes that most people wouldn't notice, would fund all services.

That's an easy assumption to make, and you're wrong. It's been explained to them in a language they understood, but they chose to not support it. It is not an end sum game of "do this because you're wrong if you don't" (at least not in this country.)

Also, when you are dealing with a tax base of 1500 people, how much of a non-noticable tax increase would actually effectively fund a full time EMS service?

Many people pay for health insurance, Australians pay a 2.75% tax for free healthcare, they can also elect to have private, more extensive healthcare, of they are pensioners, free healthcare, prescriptions for $5.40 each.

Actually, the majority of people around here don't have health insurance. Your 2.75% tax increase would almost double our current sales tax rate of 7%, taking sales taxes as an example.

Gee I think if it is explained properly, I a language people can understand, then the vast majority would be accepting of it.

Then you don't understand how America works. People are free to make their own choices, even if you believe it is the wrong one. No amount of explaining it will change everyone's mind.

As to the rest or your post, I'm not even going to bother addressing it.