[Fentanyl] Pre-Hospital Pain Management

[Dustdevil]

Robbie, your survey is flawed in its premise. The great majority of states do not have statewide protocols which affect every provider. Most leave treatment protocols to the domain of the local medical director. Therefore, except in those few retarded states that have a bureaucrat in the capitol dictating the treatment of every citizen of the state, the results of your survey have no real meaning. What exactly is it that you are attempting to show or prove?

[PMedic850]

Robbie, your survey is flawed in its premise. The great majority of states do not have statewide protocols which affect every provider. Most leave treatment protocols to the domain of the local medical director. Therefore, except in those few retarded states that have a bureaucrat in the capitol dictating the treatment of every citizen of the state, the results of your survey have no real meaning. What exactly is it that you are attempting to show or prove?

We are looking at what states allow certain narcotics for pain management. If a state allows one agency (or region) to utilize the drug, then they have set a precedence for other agencies (or regions).

You are correct, most states leave it up to the individual agency's (or region's) medical director. I do realize that different states do operate very differently (ie: Texas DOH approves each agency's protocols/drug lists; Pennsylvania/NY have regions where the state DOH will dictate what protocols/drugs can be utilized; & Maine has statewide protocols dictated by the state DOH).

However, SOME states are heavily bureaucratic and do not allow certain drugs (i.e.: not allowing any agency (or regions) to use Fentanyl). We are just trying to show which states have allowed the use of certain drugs for pain management.

Does that make more sense?

[Ridryder 911]

In Oklahoma, it is dependent on the medical directors discretion. The state does have a state protocol for those that do not have an active medical director or work upon individual protocols. I worked in the state as an bureaucrat and I can assure you the state has not a clue of each EMS services (200) protocols. They do go for review, but as long as it in within somewhat of normal reasons .... they are approved as long as you have an active medical director. I know of a ground service that (or at least last year) carried Fentyl.

Be safe.

R/R 911

[Dustdevil]

Does that make more sense?

Definitely. Thanks for the clarification.

I was afraid you were coming from a restrictive state point of view and weren't aware of the variations. It seems that many from such states can't fathom the concept of local autonomy.

[German EMT]

hi to all.

Here in Germany we use both, MSI and Fentanyl on our Emergency Physician Units. We actually only use MSI in myocardiac-infarction(hope I'm spelling right) due to its pre-load reduction.

Fentanyl is used in every other situations were pain-relief is needed. We use a initial dose of 0.2mg Fenta.

There is also now a big discussion about Ketanest here. Schould be used in cerebral-bleeding because it lowers cerebral pressure and the patient won't have breathing-depression (good for multiple trauma). The problem is that the dosage is hard to handle and patiant needs simmultain Midazolam to prevent him from nightmares.

[medicnow911]

Here in Michigan the EMS services follow the protocols written by their County Med Control. My service carries Dilaudid and Morphine for pain. Genessee County which includes the city of Flint is required by protocol to manage ANY & ALL pain equal/greater than "4" on "1-10" scale with Fentanyl or have good reason why they didn't. (Medics are complaining about the "frequent flyers" who have caught on to the game.) Detroit EMS ALS does not carry ANY narcotics at all.

[emt322632]

The region I operate within in NYS does not allow morphine as a standing order. The provider must request medical control clearance to administer morphine for pain.

As it is, the DOH must approve all agencies to carry narcotics, and this then has to be approved by the Regional Medical director. At least this is to the best of my knowledge, I'm only an AEMT-I at the current moment, going for AEMT-CC.

[djcokely]

In most Large Urban EMS settings where an agency has a high call volume and has the ability to "ship" a patient through a BLS ambulance (e.g. LA COUNTY FIRE ALS SQUADS and BLS AMBULANCES...just like Jonny and Roy on EMERGENCY) I think you are going to have a total lack of pain control. If they are stable enough for Morphine (only pain rx LA county has) the medics are going to ship it with the BLS ambulance and not follow up. If it is a major enough trauma or meets "follow up criteria" then they are going to come but because we dont have fentanyl then there is gong to be no pain control.

I did my internship with LACOFD and I can not tell you how many "hemodynamically stable" patients that had GSW's to their extremeties did not get an IV line and Morphine.

It has a lot to do with having to call and ask for it, and burn out, lack of empathy and just being lazy, if they can send it via BLS then they will because as one medic told me "I am not going to follow up on some pain control pt." when there is another real ALS call out there in our district, and the next squad is coming from a distance". So the patients suffer because we are really going to save the Asystolic arrest if we get there in 4 minutes as opposed to 6 minutes.....Right. Especially when ALS assesment engines are being implemented left and right.

Scary. But from what I hear from friends who work out in Riverside and S.B (less urban areas) they do not have Fentanyl (State thing of course) but they are rather liberal with M.S and they do not have to ask for it.

Thye may, and show approve Fent for CA, but LA COUNTY will not take it, (at least not for a while)...we can not even Pace out here....scary stuff, scarry stuff

[Ridryder 911]

I had heard rumors that LA was "far behind".. and medics has to "jump through hoops" to perform routine EMS care. Shame, that still occurs.

R/R 911

[fireflymedic]

I know several services which having standing orders for fentanyl. Seems to be a well liked drug around here. Morphine is given standing order as well, but I'm not familiar with many services that carry demerol, not to say they don't, I just don't know 'em !