When I rode with St. John in Auckland (New Zealand) a coupe of weeks ago we gave one patient etonox. Patient was a 17 yo female who had sprained/possibly broken her ankle at a skating rink, no other complaints. Given this, the patient being hysterical, and the seven minute transport, the crew opted not to start and IV and use etenox along with PO liquid acetaminophen. In five minutes time 9/10 was reduced to 5/10 and patient was noticeably less anxious. I was fairly sold on it, it was in it's own D-tank sized cylinder that we just threw on the stretcher like you would oxygen when you get on scene. It had a mount right at the stretcher head so the patient could continue to use it during transport.
I was unaware of the potential for harm to providers however, obviously they do not see this as an issue down there. As with any drug, there are going to be contraindications so I don't see why that should stop its use.
A common theme on this board has been that the US EMS perspective on pain control is one of "all or nothing," and not everyone needs opiate based pain management. Perhaps entonox, with the proper delivery mechanism, could help fill this gap. It's a BLS drug in NZ too, the crew was shocked when I a) didn't know how to administer it and b) that we have ambulances in major urban areas that carry no more than pillows and cold packs for pain control.
Maybe I'll run into one while I'm taking the medic course.