Pain managment techniques within the EMT-B and paramedic scope of practice

[Just Plain Ruff]

It's tragic that in the 21st century a first world nation still allows people who have no analgesia options whatsoever to treat people

I mean it's not like it's been known for thousands of years that treatment of pain is an important part of medicine

IT's all them damn drug seekers that makes the US health care system so freaking jumpy

[Kiwiology]

IT's all them damn drug seekers that makes the US health care system so freaking jumpy

Yeah I hear people in pain are really awesome as seeking pain relieving drugs

Eh, forget I said anything I'm not looking to start a thing ...

Edited April 9, 2012 by Kiwiology

[Asysin2leads]

I worked an area with one of the highest rates of drug abuse in North America. Not once did I ever have someone feigning injury in order to receive narcotics. Its not a valid argument. The number of people with horribly painful injuries that could have benefited from analgesia, on the other hand, was rather large.

[mikeymedic1984]

I have not seen faked injuries in a long time, but I have seen a lot of faked pain, but I just realized how much that has dropped off since the "pill-mill" pain clinics have flourished. Guess they do not need the ER as much anymore.

[Asysin2leads]

Oh, I've seen tons of faked pain. I've seen people who exhibit drug seeking behavior call 911 for transport to the hospital many times, but I never had anyone expect EMS to respond and give them a shot of morphine when they were jonesing. I never had anyone try to steal the narcs, either. Maybe they just weren't fully aware of our capabilities. The argument that providing access to analgesia or addict mediated naloxone will somehow increase addiction rates or create 911 system abuse with the end result of provision of narcotics is just plain silly. And spurious.

[island emt]

It only becomes a problem when the seekers have a greater knowledge of Pharmacology than the hospital pharmacists.

I agree that since the chronic pain drug sellers have set up shop, we see a lot less drug seeking pt's. It's a lot easier to pay $50.00 for a "consult at the pain clinic which will get you a script for a mayonnaise jar full of oxy's or suboxone, than going through the whole hassle of calling the ambulance & going to the ER while trying to hoodwink the Doc into feeling sorry for you.

[runswithneedles]

If you need ETCO2 to tell if your patient is not being ventilated properly, then I agree, you should not be doing vent calls. What would you do for an out of hospital cardiac arrest if you did not have it ? Just saying, Roy and Gage never killed a patient and the only technology they had was a 50lb defibrilator and a 10lb portable radio to call Dixie at Rampart.

I would like being able to have a look at what their expiratory CO2 levels are throughout a transfer. Especially with long haul transfers and have an extensive cardiopulmonary history. So once I have more training and better understand ventilatiors and settings I can (with medical directors permission) fine tune it as needed.

????????????? I agree that you cant kill a dead person with any act that you do after they are in arrest, but you have a much better chance of rescuscitation if their lungs are not full of puke, and the heart is actually getting a little oxygen.

Just a thought. But if you succeed in intubating a cardiac arrest patient that has vomited cant you use the ET tube for deep suctioning? On paper it sounds like you would get better oxygenation if you can get the gunk thats deep down in there where oral suction cant reach.(after of course clearing the gunk thats in the way of visualizing the vocal chords) And with the tube in place you don't have to worry about gastric distention (if placed properly) and more gunk being shoved down in deep because of BVM ventilations. Along with (if ROSC occurs) reducing the likelihood of pulmonary damage and pneumonia. And with Capnography should ROSC come you will know sooner.

If you ever do that I will be forced to hurt you badly. Get rid of obesity, stupidity, and alcohol and you take away about 90% of my business.

What about ignorance, denial, selfishness, greed, and complacent nurses and medics?

Is that ethical/legal? Can you intubate someone whose chief issue is agitation r/t mental illness? Very curious as to this line of thinking... to my thinking, RSI is a dangerous procedure with lots of potential sequelae involved with weaning them off the vent later, etc... can you justify it as a provider safety issue, based on those risks?

Wendy

CO EMT-B

Sounds like it is within the best interest of the patient and for the safety of the flight crew. Depending on whats the status of the cardiopulmonary system it seems that it wouldnt be hard to wean him off the vent once he has arrived at the receiving facility. And I have seen a patient RSI'ed for the reason that systemt pointed out. I can see it as a type of chemical restraint. What about something on the lines of a depolarizing paralytic and after the intubation is complete place him on a maintenance drip of diprivan ?

I do not agree with anaesthetising, paralysing and intubating somebody just because they're a bit agitated from a mental illness. Give them some ketamine and he'll be having a great snooze with none of that cardiorespiratory worry.

Can ketamine intensify psychiatric conditions such as schizophrenia? Especially since the gentleman was presenting symptoms

An INT does not meet ALS 1 requirements, if you are billing all calls with an INT as ALS 1, you will get a visit from the Feds at some point.

Not all calls are ALS I

Most we run are bls.

It was billed ALS I because the patient had an IV saline lock which according to medicare guidelines qualifies as ALS1. However, not all emts are allowed to take these and bill them as ALSI. The reason why I could was my supervisor selected me and two other emts who are paramedic students and had an instructor put us through additional "training" and our medical director signed off on it.

. But again, to answer all of these weird freak occurence calls, you should always have on-line Medical Control to hash out these problems. I wonder if a manager was involved, I may have missed that part of the conversation.

My manager was driving and lead emt on the box. (EMT-B not P)

IT's all them damn drug seekers that makes the US health care system so freaking jumpy

which now days is starting include the very medics, nurses, and doctors, administering them

I have not seen faked injuries in a long time, but I have seen a lot of faked pain, but I just realized how much that has dropped off since the "pill-mill" pain clinics have flourished. Guess they do not need the ER as much anymore.

Pill mill?? Never heard about them. Do enlighten me.

Sorry it took so long to get back to my post

[mobey]

I think wanting to withold drugs from drug seekers is a sorry ass excuse not to have ambulances stocked with analgesia and providers competent enough to provide them to the appropriate patients.

Some people just call 911 and request an ambulance to get a ride to the downtown core, then leave the ER. Perhaps we should stop providing transports too?

[Asysin2leads]

Not all calls are ALS I

Most we run are bls.

It was billed ALS I because the patient had an IV saline lock which according to medicare guidelines qualifies as ALS1. However, not all emts are allowed to take these and bill them as ALSI. The reason why I could was my supervisor selected me and two other emts who are paramedic students and had an instructor put us through additional "training" and our medical director signed off on it.

From the Medicarenhic.com website, "Ambulance Billing Guide" PDF:

"Advanced Life Support, Level 1 (ALS1) Non-emergency - ALS1 is transportation by ground ambulance vehicle, and the provision of, medically necessary supplies and services including an ALS assessment by ALS personnel or at least one ALS intervention."

I don't think a saline lock placed at the hospital counts as an intervention. According to the same PDF,

"Advanced life support (ALS) intervention is a procedure that is, in accordance with State and local laws, required to be performed by an emergency medical technician-intermediate (EMT-Intermediate) or EMT-Paramedic. An ALS intervention must be medically necessary to qualify for payment as an ALS level of service. An ALS intervention applies only to ground transports"

I still don't think if they did it at the hospital it counts as an ALS intervention. If it was, you'd need at least an EMT-I in the back. EMT-B + Saline lock + ALS1 = Medicare

Edited April 15, 2012 by Asysin2leads

[J306]

My favourite method of pain control is a "morphine patch" aka alcohol swab and opsite