Should I85s be allowed to help with pain managment?

[EMT91]

I was recently thinking about how awesome and useful it would be if, as an I85, I could administer something, be it Ibuprofen or some other non-narcotic pain medicine be it via IV or PO. Do you think I85s should be allowed to administer something for pain?

 

[usalsfyre]

Personally I don't see the danger of narcotic admin at the I85 level..

 

[EMT91]

Personally I don't see the danger of narcotic admin at the I85 level..

I would love to be able to administer narcotics but I felt that many would be like "oh heck no!" I was thinking pain management of like minor to moderate issues, bad headaches, strains etc.

 

[Doczilla]

The problem is paperwork. Most ALS systems require a paramedic to sign the narc log--- which stems from state DOH regulations. Alot more would have to change than just scope of practice.

The only non opioid that would really be worth it would be toradol, which is very effective for some stuff. Other non opiates like nubain work well but I haven't seen them utilized stateside for prehospital care.

As far as PO meds are concerned, I doubt a MD would sign off on it for beurocratic and practicality reasons. As with many things, you have to ask if what you are doing will truly make a difference within your continuum of care.

 

[EMT91]

The problem is paperwork. Most ALS systems require a paramedic to sign the narc log--- which stems from state DOH regulations. Alot more would have to change than just scope of practice.

The only non opioid that would really be worth it would be toradol, which is very effective for some stuff. Other non opiates like nubain work well but I haven't seen them utilized stateside for prehospital care.

As far as PO meds are concerned, I doubt a MD would sign off on it for beurocratic and practicality reasons. As with many things, you have to ask if what you are doing will truly make a difference within your continuum of care.

True true. I guess I was thinking PO meds because we administer ASA for cardiac related chest pain.

 

[Melclin]

I don't see why you shouldn't be allowed to administer any drugs that people can administer to themselves after trotting down to the local drug store.

Acetaminophen/codeine preparations, ibuprofen etc.

IV acetaminophen is pretty affective.

Really though, I don't see why it would be an issue to use IV morphine or fent. I guess if the DOH is problem then there is more to it than the clinical issues, but there isn't really a lot IV opioid management. If they're so worried about ODing pts, they can introduce a guidelines that is very conservative and expand it as people become more confident.

2.5mg IV q5 to a max of 10 or something. Better than nothing at all.

 

[exodus]

What about just giving them nitronox?

 

[Tigger]

I would like to see the intermediate level provider have narcotic pain management at their disposal, as well as ACLS in its entirety. I think that would be a fair trade for eliminating endotracheal intuabation and sticking with "rescue" airways. I'm totally sold on how they did it in New Zealand (not to sound like a broken record). Three year bachelor's degree gives one the ability to practice at the ILS level with the scope as above. The degree has 24 classes, of which only two can be electives. Chem, Bio, Psych, English Composition, the works. After the first year I think class credit could be received for doing ride/hospital time. Every urban ambulance has at least one ILS crew member, most have two. Advanced Care Paramedics were in flycars, they had the same scope as what one would find at a progressive paramedic agency here, but had at least another year of schooling to go with ACP level.

 

[JPINFV]

I don't see why you shouldn't be allowed to administer any drugs that people can administer to themselves after trotting down to the local drug store.

...because there's a huge difference between taking something on your own accord and taking something because a medical professional told you to take it.

 

[JPINFV]

True true. I guess I was thinking PO meds because we administer ASA for cardiac related chest pain.

...but you don't give ASA for pain management.

 

[Veneficus]

True true. I guess I was thinking PO meds because we administer ASA for cardiac related chest pain.

I think this demonstrates wy intermediates are not permitted to administer it.

It is unfortunate that prehospital pain management in the US has to be a narcotic or nothing most of the time.

 

[Melclin]

...because there's a huge difference between taking something on your own accord and taking something because a medical professional told you to take it.

How? I can understand if this is some BS legal argument but aside from that I don't get how this isn't a person choosing to take a medication.

Oh you've got pain? Hey I've got these pain pills, same as you'd take for a headache etc. Want some? Oh you do? Okay.

 

[JPINFV]

How? I can understand if this is some BS legal argument but aside from that I don't get how this isn't a person choosing to take a medication.

Oh you've got pain? Hey I've got these pain pills, same as you'd take for a headache etc. Want some? Oh you do? Okay.

So if your neighbor tells you to take an OTC pill it's given the same weight as a physician telling you to take an OTC pill? Granted, EMTs and paramedics are not physicians, but the average patient isn't going to draw that line. Then, of course, there's the issue of if there's any adverse reactions due to the patient's history and other medications (if any). Your neighbor can't be sued. The EMT can be. I'm not against giving some OTC medications to EMS providers, but it shouldn't be "Walgreens" in terms of breadth of medications.

 

[Aidey]

I don't see why you shouldn't be allowed to administer any drugs that people can administer to themselves after trotting down to the local drug store.

Acetaminophen/codeine preparations, ibuprofen etc.

IV acetaminophen is pretty affective.

Acetaminophen/Codeine preparations are not OTC in the US.

 

[Melclin]

So if your neighbor tells you to take an OTC pill it's given the same weight as a physician telling you to take an OTC pill? Granted, EMTs and paramedics are not physicians, but the average patient isn't going to draw that line. Then, of course, there's the issue of if there's any adverse reactions due to the patient's history and other medications (if any). Your neighbor can't be sued. The EMT can be. I'm not against giving some OTC medications to EMS providers, but it shouldn't be "Walgreens" in terms of breadth of medications.

As I said I grant you the legal part of it in your country at least. I don't agree with it.

We have minimally educated providers handing out paracetamol willy nilly often without even an assessment. Whats the difference between a person going to an FR/EMT and saying, "I'm in pain, can I something for the pain?" "Oh you've got some Tylenol? I know what that is because who doesn't (granted I didn't. I had to google what American for panadol was) so I'm going to make a choice to take it myself that would be equally as informed as if I went to the 7/11 200 metres down the road. Whats the difference? Nobody is telling anyone to take anything. A drug that everyone is familiar with is simply available should a person chose to want to take it.

I should perhaps have been a bit more clear in my wording, I wasn't suggesting the entire contents of the drug store be piled into the ambulance. Just that I don't see a problem with any single (or a few) OTC medication being used. I'm pretty much exclusively talking about tylenol but I can see a use for a few others. In any case, there is a reason these drugs are OTC. They're pretty damn safe. Besides I/85s are involved in med administration right? So whats the big deal about adding a safe, incredibly cheap and effective drug to the list?

Acetaminophen/Codeine preparations are not OTC in the US.

Ah. My mistake.

My sympathy goes out to you all when you are hungover.

 

[Veneficus]

So if your neighbor tells you to take an OTC pill it's given the same weight as a physician telling you to take an OTC pill? Granted, EMTs and paramedics are not physicians, but the average patient isn't going to draw that line. Then, of course, there's the issue of if there's any adverse reactions due to the patient's history and other medications (if any). Your neighbor can't be sued. The EMT can be. I'm not against giving some OTC medications to EMS providers, but it shouldn't be "Walgreens" in terms of breadth of medications.

Along the same lines, I give out mortin 800s all day long. After I have assessed a patient and decided on a treatment plan.

That assessment does not require a host of adjuncts like labs and xrays all the time, but it does require knowledge and responsibility.

Sorry, but most of the US EMS providers are simply not capable of safely deciding a patient doesn't need a hospital or can make due with an OTC.

In other countries that require more education it is not an issue. In countries where the provider signs the chart and is held accountable to those decisions without pointing the finger at the doctor when something goes wrong, that is not an issue.

But the US is the most simplistic of protocol medicine in EMS. It is one size fits nearly all with just a few sizes in stock.

It would benefit not only the patients, but the economics for US providers to be at the same level as their counterparts in other modern nations.

But it is not a popular view on EMTlife, in the real world even less.

 

[NYMedic828]

I think this demonstrates wy intermediates are not permitted to administer it.

It is unfortunate that prehospital pain management in the US has to be a narcotic or nothing most of the time.

True true. I guess I was thinking PO meds because we administer ASA for cardiac related chest pain.

I know medics who don't know that either though Ven. (on the bright side, if the patient has inflammatory chest pain than it may help )

 

[Melclin]

Along the same lines, I give out mortin 800s all day long. After I have assessed a patient and decided on a treatment plan.

That assessment does not require a host of adjuncts like labs and xrays all the time, but it does require knowledge and responsibility.

Sorry, but most of the US EMS providers are simply not capable of safely deciding a patient doesn't need a hospital or can make due with an OTC.

In other countries that require more education it is not an issue. In countries where the provider signs the chart and is held accountable to those decisions without pointing the finger at the doctor when something goes wrong, that is not an issue.

But the US is the most simplistic of protocol medicine in EMS. It is one size fits nearly all with just a few sizes in stock.

It would benefit not only the patients, but the economics for US providers to be at the same level as their counterparts in other modern nations.

But it is not a popular view on EMTlife, in the real world even less.

An EMT giving a pt paracetamol wouldn't be deciding against transport, simply providing some safe and basic analgesia along the way.

I know medics who don't know that either though Ven. (on the bright side, if the patient has inflammatory chest pain than it may help )

and Vene:

Whats wrong with EMT91statement? Isn't he just saying they have PO drugs, they're familiar with the process of PO drug administration, contras dosages, allergies, 5 rights and all that, so why can't they apply the same idea to something as simple as using a safe OTC analgesic like tylenol.

 

[Veneficus]

An EMT giving a pt paracetamol wouldn't be deciding against transport, simply providing some safe and basic analgesia along the way.

and Vene:

Whats wrong with EMT91statement? Isn't he just saying they have PO drugs, they're familiar with the process of PO drug administration, contras dosages, allergies, 5 rights and all that, so why can't they apply the same idea to something as simple as using a safe OTC analgesic like tylenol.

people giving ASA for cardiac inflammation in CP?

 

[Melclin]

An EMT giving a pt paracetamol wouldn't be deciding against transport, simply providing some safe and basic analgesia along the way.





people giving ASA for cardiac inflammation in CP?

He said cardiac related chest pain. Whats wrong with that as a basic indication?