Narcan Use Survey

[Andrew Nelson]

Remi's point stands. You don't offer an option of zero- only 1-10. Your selections imply that using Narcan just because is something that everybody does, and you just want to know how often that is. The fact is, many (possibly even most) don't do that anymore. Opiates have a fairly specific presentation. If they meet that presentation and suspicion, they get Narcan. They don't get narcan just because they're unconscious/unresponsive/altered.

And in regards to cardiac arrest, that's also old practice. What role does Narcan play in cardiac arrest? What is the indication for Narcan during a standard opiate overdose prior to arrest? Narcan is intended to restore respiratory effort. Do you know what else fixes the hypoxia and hypoventilation? A BVM. Thus Narcan is not needed at any point during a cardiac arrest.

What people are trying to point out is that your survey is worded poorly, thus skewing the results and altering the productive discussion you're hoping for. That's not going to "improve our profession" in any way. All it's doing is propagating old, outdated dogma that many are trying to fight.

I've already stated why I chose the topic so if you know more than the ER doctors I observed then good on you bud.

I've already stated it was my error I left out a zero option.

I've already stated the questions meet the requirements for the assignment. My teacher who has completed his doctorate in health sciences and has worked in EMS for many years appreciated the topic and found value in gathering others opinions. I don't know you from Adam so I appreciate your opinion but I'll continue with the paper as is.

Also the responses collected so far have been split. It seems people have given it diagnostically and they have had positive outcomes. You choose not to and that is your prerogative.

 

[Andrew Nelson]

Exactly what unsubstantiated claim did I make?

You are the one who tried to justify this practice by pointing out that "the ED physicians have a lot more training than we do", as though that means that everything you see done by every EM should be mimicked by every paramedic. I simply took your (true) statement in a slightly different direction and pointed out that, because they have much more training than you do, maybe they have reasons for doing things that you aren't aware of. You don't know what you don't know.

You can't hide behind the "but the docs do it and they know more than us" deal when it works in your favor and then run from it when someone suggests that maybe they are more qualified to make a certain decision than you are.



Because it is just sloppy medicine.

The "coma cocktail" used to be common, but fell out of favor when we learned that it doesn't work. We also used to inject epi into the heart, compressed the lower torso to increase to BP, and strapped people's entire bodies to hard boards in case their neck was injured. Before that we drained "bad humors" from sick people and literally blew smoke up people's butts in an attempt to regain a pulse. We stopped doing those things, too, when we realized that they didn't work.

Instead of using a poorly worded survey to fish for opinions that support your beliefs, try reading the actual clinical research on the topic.



You'r words: "I just have to put some numbers on a paper with some words". Forgive me if I misinterpreted that as meaning you were trying hard to to a good job.

I apologize for using jovial language. I thought this would be a light hearted forum where I could gather some data for a paper. I was unaware I would receive such a lambasting from the worlds smartest medics. Glad I don't have to work with folks like you.

My topic and questions were approved my teacher who has completed his doctorate and worked in EMS for many years and he found value in researching further so I'll stick with what I have. The responses have been varied already anyways so clearly not everyone is onboard with your train of thought. I'm not going to go back and forth with you because I clearly will not be changing any minds. I value your opinion and thanks for sharing it.

 

[SomeGuy9005]

50% of people surveyed say they use naloxone as a diagnostic agent ... does that mean they're right? Not very high quality data. Medical practice shouldn't be guided by popular opinion.

How about doing some reading into what naloxone actually does ... like going deeper than 'competitively antagonizes opioid receptors.' Any other actions? Yes it is a "safe drug," but what are the risks and possible complications of giving naloxone to a polypharm OD? Can naloxone have an effect on people with no opioid in their body, but suffering the effects of another toxidrome? Is an increase in LOC following naloxone administration pathognomonic for opioid overdose?

 

[Andrew Nelson]

50% of people surveyed say they use naloxone as a diagnostic agent ... does that mean they're right? Not very high quality data. Medical practice shouldn't be guided by popular opinion.

How about doing some reading into what naloxone actually does ... like going deeper than 'competitively antagonizes opioid receptors.' Any other actions? Yes it is a "safe drug," but what are the risks and possible complications of giving naloxone to a polypharm OD? Can naloxone have an effect on people with no opioid in their body, but suffering the effects of another toxidrome? Is an increase in LOC following naloxone administration pathognomonic for opioid overdose?

Those are all fantastic questions to raise. They would probably be the follow up questions to the survey I presented. The survey was an initial gauge of current use and successes. The data is available so why not consider it and then determine if we need to further look into the medications actions and interactions to see if it actually a "safe drug" like we are told.

 

[WolfmanHarris]

I can't help but get a kick out of this. My Advanced Care Paramedic course coming up this fall has a full course devoted to research methods.

My employer has an entire unit devoted to research. One of our Paramedics has a PhD earned doing research in Paramedic education. A few of our medics also have or are working on Msc's doing clinical research.

By 2025 it's expected that entry to practice for Paramedics will be a four year Bachelor's in Canada.

Research is vital to advancing this profession and Paramedic lead research is key to having control over the direction this profession takes in the future. Paramedicine isn't an extra cert for an FF to toss on their resume along with rope rescue and hazmat ops and shouldn't be treated as such.

 

[Carlos Danger]

Those are all fantastic questions to raise. They would probably be the follow up questions to the survey I presented. The survey was an initial gauge of current use and successes. The data is available so why not consider it and then determine if we need to further look into the medications actions and interactions to see if it actually a "safe drug" like we are told.

That's right, the data is already available. Everything you could ever want to know about narcan is right there for the reading. Including whether it's a good practice to give it indiscriminately.

P.S., I think it is fascinating that you still think this survey is a "gauge" of anything.

 

[Andrew Nelson]

I can't help but get a kick out of this. My Advanced Care Paramedic course coming up this fall has a full course devoted to research methods.

My employer has an entire unit devoted to research. One of our Paramedics has a PhD earned doing research in Paramedic education. A few of our medics also have or are working on Msc's doing clinical research.

By 2025 it's expected that entry to practice for Paramedics will be a four year Bachelor's in Canada.

Research is vital to advancing this profession and Paramedic lead research is key to having control over the direction this profession takes in the future. Paramedicine isn't an extra cert for an FF to toss on their resume along with rope rescue and hazmat ops and shouldn't be treated as such.

That's right, the data is already available. Everything you could ever want to know about narcan is right there for the reading. Including whether it's a good practice to give it indiscriminately.

P.S., I think it is fascinating that you still think this survey is a "gauge" of anything.

Link to the studies then please. Don't just claim they are out there and that they support your position so you can make slighted comments.

 

[SomeGuy9005]

https://scholar.google.ca/scholar?as_ylo=2016&q=naloxone&hl=en&as_sdt=0,5

3,480 articles published since the beginning of 2016 ...

 

[Andrew Nelson]

https://scholar.google.ca/scholar?as_ylo=2016&q=naloxone&hl=en&as_sdt=0,5

3,480 articles published since the beginning of 2016 ...

Thanks! I'll definitely dive into those! But I would like Remi to post specific studies stating founded reasons supporting his stance.

 

[NomadicMedic]

 

[Tigger]

Hey captain obvious, Im not saying I disagree with doing the assignment. I'm saying I don't have the time or the energy to conduct an extensive research study worthy of being published.

Nor am I suggesting that. But to make a survey, give it to a very limited audience, and then use it to draw any sort of inclusions is not how even the most basic research works. There is research out there on this topic if you look for it. My program and every other paramedic program I am familiar required a few research papers throughout the year, and one of the biggest goals of these assignments is to get people used to looking up and analyzing published research to support or reject practices..."creating" your own data is not how you do that.

 

[Summit]

Thanks! I'll definitely dive into those! But I would like Remi to post specific studies stating founded reasons supporting his stance.

You want other people to give a lot more effort than you are willing to give. I bet your instructors see that too.

Reiterating what other said, I didn't submit results because my responses weren't any of the options.

 

[MMiz]

I think the group is being too harsh.

If I Google my old usernames I can find the time I did a survey on the death penalty my freshman year in college along with a few other surveys i hastily created to meet course requirements. These sort of assignments are mainstays on EMS programs.

I'm not sure it's fair to expect the typical EMS student to develop effective, scientific surveys and questionnaires.

 

[Andrew Nelson]

You want other people to give a lot more effort than you are willing to give. I bet your instructors see that too.

Reiterating what other said, I didn't submit results because my responses weren't any of the options.

I've never had less than a 93 average in any of the didactic sections along with perfect marks in my field work all year long.

Requesting sources of studies he's claiming exist so that he can belittle me on an Internet thread is not asking much at all.

If you don't fit into the survey, do not fill it out.

 

[Andrew Nelson]

Nor am I suggesting that. But to make a survey, give it to a very limited audience, and then use it to draw any sort of inclusions is not how even the most basic research works. There is research out there on this topic if you look for it. My program and every other paramedic program I am familiar required a few research papers throughout the year, and one of the biggest goals of these assignments is to get people used to looking up and analyzing published research to support or reject practices..."creating" your own data is not how you do that.

That is exactly what your statement implied. I am actually going above and beyond what was required by posting the survey on this forum and gathering answers from medics in other states and regions. We were told to just survey our local departments.

I think this is part of the disconnect with you people. You're assuming you know exactly what the assignment required. We were not told to analyze previous research to draw conclusions. The point was to survey already working medical providers on an approved topic so that we could have some conversations about some contested topics.

Y'all are a hoot though. Truly a wealth of useless feedback.

 

[Andrew Nelson]

I think the group is being too harsh.

If I Google my old usernames I can find the time I did a survey on the death penalty my freshman year in college along with a few other surveys i hastily created to meet course requirements. These sort of assignments are mainstays on EMS programs.

I'm not sure it's fair to expect the typical EMS student to develop effective, scientific surveys and questionnaires.

View attachment 2885

View attachment 2885

I think the group is being too harsh.

If I Google my old usernames I can find the time I did a survey on the death penalty my freshman year in college along with a few other surveys i hastily created to meet course requirements. These sort of assignments are mainstays on EMS programs.

I'm not sure it's fair to expect the typical EMS student to develop effective, scientific surveys and questionnaires.

Or to assume the expectations and requirements of the assignment. This one happens to fall into the "hastily created to meet course requirements" on both the teacher and student side. Given more time and resources and had the assignment laid out more stringent guidelines the survey would have been more thorough.

 

[NomadicMedic]

Wait, I think I'm confused.

Let me see if I've got this right...

The OP constructed a bias based survey with poor options to allow for any real data collection. When he was called out on it he replied,

It's for my third semester of paramedic school so needless to say I just need some numbers to throw on a paper with some words.

And now the the forum is being to harsh?

Please. Patting everyone on the head and saying, "it's okay honey, I know you tried" disgusts me. Do the work correctly and when someone calls you out for not doing it right, don't get defensive and try to talk your way out of it.
And @MMiz, just because you once did some "hastily constructed surveys", that means you give him a dispensation and its okay? How is that valid? Because you shoplifted once, that means it's okay if I do it?

When you show up in a group of EMS professionals, you should be able to handle criticism when you start to spout off. "We don't suffer fools gladly" fits this whole discussion to a T.

 

[Carlos Danger]

Thanks! I'll definitely dive into those! But I would like Remi to post specific studies stating founded reasons supporting his stance.

I'm done with school for now, and I'm not doing your homework for you. Sorry.

Suffice it to say there are reasons why this practice used to be common but is now frowned upon in most circles. Naloxone is a very safe drug when given for it's intended indications, but when given indiscriminately just because you don't know why someone is unresponsive.....not as safe, and usually ineffective. Do your own research to figure out why - that list that cprted linked for you is probably a good place to start. I am already intimately familiar with the drug and how it works and not in need of a refresher yet.

Y'all are a hoot though. Truly a wealth of useless feedback.

You are a freakin' paramedic student, get off your high horse. Some of the people here have been practicing since you were in diapers, and have forgotten more than you've learned so far. The ones who haven't been doing it that long are still a smart bunch with solid experience and generally a good appreciation for EBM. You'd be wise to listen more and spout off less.

 

[Nova1300]

Just as a starting point, Andrew- asking someone how many times in their career they have provided a therapy is a question which will be subject to a great deal of inaccuracy. This is called "recall bias." Unfortunately, your survey will be almost entirely composed of data which is made up by the people answering the question. That's not even a real survey, much less a study.

Maybe re-write focusing on providers' attitudes regarding narcan as a diagnostic tool, without asking the question "how many times have you ..."

This really could be a simple, easy survey reflecting people's attitudes about the practice. But you will need to spend a few minutes developing questions which actually lead to non-predetermined conclusions. This still should not take long.

Part of the pushback your are getting is about pride in the profession. If paramedicine is to move toward the arena of research and practice improvement, the onus is on the new generation to care about data collection and interpretation. And, you are part of the new generation. If you want to stay up to date in the field after certification, it would really be helpful to have some understanding of how to read and interpret basic research. Because the prehospital and emergency medicine literature is still very much in its infancy, this is an exciting time for EMS. I'm sorry if your instructor doesn't feel that way, but there are many, many medical directors in this country that do.

Definitely get the assignment done, but really this stuff is important and will only become more so in the future.

 

[Tigger]

I think the group is being too harsh.

If I Google my old usernames I can find the time I did a survey on the death penalty my freshman year in college along with a few other surveys i hastily created to meet course requirements. These sort of assignments are mainstays on EMS programs.

I'm not sure it's fair to expect the typical EMS student to develop effective, scientific surveys and questionnaires.

Developing your own research is very rare in any EMS course (or undergrad for that matter). It's for good reason, doing so is difficult and requires actually knowing how develop surveys and other data collection apparatuses. If in fact the assignment was to develop one's own data, that's absurd.

Being able to analyze studies is a big part of medicine, yet the OP seems to have no willingness to let us impose that point.