Timmy

Mines Better

:twisted: NEVER!!!

<<<<<His Head Went That Way N His Legs Went This Way>>>>>

LMAO!

Well Timmy committed suicide, after girl friend problems. But 200 of my friends painted a large roadside boulder with the words: "In loving memory of Timmy” My friends left sports jerseys, flowers, and mementos of what I loved in life. My friends rock! lol

Well you don’t get in trouble if the whole crew accidentally falls asleep.

100% Sick We dont really have many slogans in Australia.

The author is clearly stated = Colleen M Hayes The information is correct = I would have no idea, it sounded fine to me. But yet again I have little qualifications in this area. The person who is posting can defend the claims they have made = That’s what I’m trying to do but you wont ease up, your expecting me to provide more information that I am not able to give. Is this too much to ask? = Probably not but what more can I do, I’ve made a mistake, apologised and I can’t offer more information because I don’t know. What more can I do?? Once again I do apologize for posting when I clearly had no idea about anything.

wow, I didn’t mean to start world war 3 here. Sorry I shouldn’t have posted that info, I have little experience and qualifications in this area. I am aware (basically) of what a reference is, but I didn’t stop to think to put it in my post, for that I apologize. Guys listen to Phil, he knows best, has the experience and he’s been to uni where I haven’t. I’ve just done a little first aidery course in basic medications and drugs. I look forward to reading his posts on some more clinical information and personal experiences he’s encounter with this drug.

Well I guess I sort of thought that this sentence might have given it away After the "Survivor" show EMSvillage.com staff was inundated with questions about this mystery drug. So we decided to get the scoop on pain control "down under." I found out (just for you guys) that the article was written by Colleen M Hayes, MBA, RN, EMT-P. So I congratulate Colleen on taking the time on a job well researched.

Oppss the reference my bad…. It was EMSVillage.com which had the only research article on methoxyflurane I could find, not sure who wrote it. Phill: I too see/use the drug on a regular bases. The article was written by Americans, I can only assume that EMS workers have written it, so when it states that Oz is more advanced than the U.S it’s coming from U.S people, not me. The article is generally referring to Australian health care as a whole, not by state. I was only trying to be helpful and give some more info for people who don't know about the drug....

Wow these scissors sound like bomb! Maybe I should get a pair for those Road Race Motorcycle guys who come off there bikes goen at some ungodly speed, into the cement wall. Would they be any good cutting though all the leather they wear for protection?

I think if someone wants to go to hospital its up to them. We don’t refuse to take people to hospital; everyone has the right to proper quality health care. So what if you don’t think they need to go to hospital, it’s not up to us to make that call. Either way you still get paid.

During a recent episode of CBS' TV show "Survivor," show participant Michael Skupin, a publisher from Michigan, passed out while starting a camp fire. When he regained consciousness, but still in a partial stupor, he accidentally placed both of his hands into hot coals resulting in severe second degree burns to both of his hands. Stricken with immediate pain, he jumped into a lake to stop the burning. The show's standby paramedics rushed to his side and administered a "Penthrox Inhaler" to ease his pain. While the Penthrox Inhaler is well known to emergency medical caregivers in Australia, those of us watching the show in the U.S. wondered what the green whistle-like device was! The "Penthrox Inhaler" is a device that administers methoxyflurane (Penthrane or abbreviated MOF) vapors. MOF is a colorless, liquid with a fruity odor with analgesic properties when administered in low doses. After the "Survivor" show EMSvillage.com staff was inundated with questions about this mystery drug. So we decided to get the scoop on pain control "down under." First, let's take a look at the Australian attitude towards pain relief and identify drug options available for prehospital pain control. Then we'll explore the facts about methoxyflurane, the Penthrox Inhaler device, and the effectiveness and safety of MOF as a prehospital pain control medication. Options for Prehospital Pain Control in the Land "Down Under" After corresponding with an Australian first responder, a ER nurse, a physician medical director and a paramedic, we were pleasantly surprised to learn that the Australian emergency medical / prehospital care systems accepted standard of care for emergencies includes a humane and aggressive approach to the relief of pain. In fact, Australia is way ahead of the U.S. in their philosophy about prehospital pain control. Among the agents available to "ambos" (a term used to describe EMS workers), on standing orders, are the Penthrox Inhaler, Entonox and intravenous morphine. Even basic level providers in most systems can use the Penthrox Inhaler to help suffering patients. Jenny Moncur, a student MICA Paramedic from Victoria, Australia said, "As an Australian paramedic, I have used Penthrane on many occasions for control of a patient's pain, and generally with very good, although short term effect. On the occasions that it is not effective, it has generally been because the patient found the smell/taste nauseating and could not use it effectively." "It is very rewarding to be able to offer pain relief to my patients prior to arrival at the hospital. I believe Australia is unique in this regard, whereby ambos can give analgesia without the need to consult with a physician first. In fact, we have the privilege of being able to operate autonomously, utilizing Clinical Practice Guidelines, although consultation with senior clinicians and medical staff is always available, and is often utilized." said Moncur. While many providers are pleased with having readily available options to alleviate their patient's pain in both rural and urban systems, some physicians would like to see better medications used like morphine sulfate that have more reliable and more predictable effectiveness. There is also a clear concern about leaking vapors and the health effects on caregivers who inhale them. Inhaled analgesia may have a role in outdoor areas, but it appears to have limitations in unventilated and enclosed areas. Dr. John L. Holmes, Director Emergency Medicine of Mater Misericordiae Hospitals in Brisbane, Australia said, "Methoxyflurane - what an anachronism! Patients come into the ED sucking on these things like lollipops, the place takes on a fruity odor and god knows how many other people are being exposed to low levels of the stuff. Given its high lipid solubility and slow clearance, it could be interesting to measure psychomotor performance of ambulance officers and other clinical personnel working with these patients and breathing in MOF over time." Is MOF clinically effective? Is MOF an effective analgesic? The answer is, 'yes' according to the manufacturer's literature and 'maybe and sometimes' according to field reports! Field EMS workers report that only some patients obtain sufficient relief with MOF. Some patients who do not benefit from MOF will obtain relief with Entonox and vice versa. There is very little literature available that predicts a reliable percentage of patients who will obtain pain relief with this drug. In fact, one pediatric study indicated that 91.6% of those treated with MOF required additional analgesia in the Emergency Department. One reason that may explain inadequate effectiveness in some patients is that the drug is inhaled and self-administered leading to inadequate dosage in some patients who use the device incorrectly or can't self administer it properly. That may also partially explain some of the results of the pediatric study. According to Dr. Holmes, "Patients inhaling MOF still seem to be in pain unless they're off the planet with it. Similarly I think it is over rated in the prehospital situation. I also have concerns about obtunding LOC with these agents especially with full stomachs, head injuries and the rest. It's gratifying to see the Victorian Ambulance Service freeing up the use of morphine. The intravenous titration of morphine remains the gold standard for acute pain relief." Controversial Issues What are the main controversies surrounding the patient care guidelines for pain control? They include the use of MOF vs. Entonox, inhaled analgesia vs. intravenous morphine, and potential for abuse of MOF. MOF vs Entonox(nitrous oxide) In Australia methoxyflurane has largely replaced Entonox (nitrous oxide) as the inhaled analgesic of choice. Although many services still carry both, according to reports from several physicians and EMS workers, this switch is largely because the Penthrox Inhaler is easily stored, portable and lightweight. This is in contrast to Entonox which requires the rescuer to carry both an oxygen tank and a nitrous tank. One Australian first-response level EMS worker associated with the Australian Department of Defense said, "Comparing Entonox and methoxyflurane, I have found that methoxyflurane is the better of the two. The main reasons for this are the cost and portability of the equipment required. In my workplace Penthrox is the front-line analgesic given until an ALS trained person arrives. Only then with the higher level of training and expertise will a more effective analgesia be given." Inhaled Analgesia vs. Intravenous morphine When the inhaled analgesia works it has a quick onset and short-term effect. This means that patients who may be ill or injured in a rural area where ALS is not readily available can at least benefit from some pain control until ALS arrives with better medications, like intravenous morphine. Several physicians and nurses reported concerns about contamination of the ambulance and that there are concerns for the EMS worker's health due to exposure of the methoxyflurane vapors. While there are some engineering controls, leakage can and does happen with any inhalation system. Many report that these reasons should prompt a movement away from inhaled analgesia, at least in enclosed spaces. Australia is also beginning to take a look at how practical using inhaled analgesics are with the increased availability and capability of administering intravenous morphine, the accepted 'gold standard' for the treatment of acute pain. Moncur says that she is now training as an MICA (intensive care) paramedic and will have morphine sulfate at her disposal. "I still find occasions to use Penthrane, usually while I am gaining IV access, if the patient is in real distress, just to give some quick relief until the good stuff kicks in. There is a role for Penthrane, but MS is obviously preferable." Other comments included that Australia's EMS system is changing to more use of IV Morphine, but in rural areas, at special medical events, or in situations where there are long ALS response times, that the use of the Penthrox Inhaler may, and should continue for intermediary treatment of pain. Some also say after inhaled analgesia has been provided that IV pain medication is often effective at decreased dosages. Abuse Potential of Methoxyflurane Concerns about abuse are very real with any controlled substance. We asked if there are any actual or potential abuse issues with MOF. MOF and Entonox are controlled substances and must be accounted for in a drug register. Unfortunately, in the past, there has been some abuse by providers. Stricter controls on storage and accounting for the drugs have made it much more difficult to obtain them. Moncur said, "By virtue of the fact that Australian paramedics can administer analgesia without consultation, there will always exist the possibility of exploitation of the system by some." An interesting side effect of MOF includes anecdotal reports on its effect on the human libido, especially in women. Moncur said, "One very well recognized side effect, at least recognized by providers, I have not seen it in print, is the effect of lowered inhibitions in users, and most particularly in females. Most male ambos in Australia who have given Penthrane have been propositioned by female patients of any age. Obviously, care, compassion and tact is required by those of us who administer this drug." The Drug: Methoxyflurane Methoxyflurane (Penthrane, MOF) is a fluorinated hydrocarbon and volatile liquid intended for vaporization and inhalation of low doses for analgesic effects. The drug is administered through the Penthrox Inhaler device. Introduced in the 1960s, the drug initially showed promise because it appeared to be a safer anesthetic compared to halothane since it had less proarrhythmic effects and also appeared to provide more muscle relaxation than did halothane. It was discovered that an interesting property of methoxyflurane is that at subanesthetic (low) concentrations it induces analgesia (not anesthesia). Methoxyflurane is extremely soluble in blood and tissues resulting in slow induction and prolonged recovery. In addition, it undergoes extensive hepatic metabolism resulting in plasma fluoride concentrations sufficient to induce severe nephrotoxicity in some human patients. As a result, methoxyflurane lost its place in human medicine as an anesthetic but, it is still used as an inhaled analgesic by emergency medics in Australia. At low doses the nephrotoxic effects have been reported to be low risk. The Penthrox Inhaler is manufactured by a firm called Medical Developments located in Australia. The inhaler is self-administered by the patient and is indicated for emergency pain relief. The inhaler can be used with oxygen or with ambient air. Based on the available research, it is not approved for human use in the US, although it is used in veterinary medicine. Clinical Use of Methoxyflurane Note: The following information is based on analgesic levels of administration. The use of Methoxyflurane in higher doses as a sole anesthetic agent is not recommended. Methoxyflurane comes packed in 3 ml sealed bottles. The concentration of vapor when inhaled through the Penthrox Inhaler is about 0.2% to 0.4% with the diluter hole uncovered and about 0.4% to 0.7% with the diluter hole covered. Pain relief commences after 8-10 breaths, and continues for several minutes after use: an advantage when extricating trapped victims. According to the manufacturer, Medical Developments, the Penthrox Inhaler is widely used throughout Australia in Ambulance Services, First Aid Stations, Ski Rescue Services, Mines, Palliative Care, Obstetrics & Burns Units, Defense Forces. Indications: General indications for the use of methoxyflurane include: Prehospital pain relief with or without the simultaneous administration of oxygen. Management of pain in trapped or inaccessible patients. Short surgical procedures such as the change of burns dressings. Palliative care. Contraindications: Patients with preexisting renal disease, impairment of renal function, toxemia of pregnancy, or concurrently using tetracyclines should not receive methoxyflurane unless the benefits outweigh the increased risk of nephrotoxic effect. Nephrotoxicity can result from high dose methoxyflurane administration following anesthesia. In order to minimize renal injury the recommended maximum dose for methoxyflurane analgesia is 6 ml per day or 15 ml per patient. What is unknown, however, is how nephrotoxic the drug is when administered to patient's who are hypoperfused (in shock). Since the hypoperfused patient's kidneys are already vulnerable to injury from hypoxia it is really not known what dosage of MOF is safe in this patient population. Administration: Methoxyflurane analgesia is self administered under supervision using the hand held Penthrox Inhaler. If required, oxygen can be introduced simultaneously through the nipple in the base cap. The Penthrox Inhaler is charged with 3 ml or 6 ml of methoxyflurane, which provides approximately 25 or 55 minutes of analgesia respectively. The lowest effective concentration of methoxyflurane to provide analgesia should be used. With the diluter hole uncovered the inhaled vapor concentration is about 0.2 0.4%. Covering the diluter hole with a finger increases the inhaled concentration to about 0.4 - 0.7%. The maximum dosage allowed per day is 6 ml, or 55 minutes. See the chart at the right for more information about administration. Side Effects/Precautions: Methoxyflurane provides analgesia at low concentrations, therefore, drowsiness may occur but consciousness is retained. The patient may become nauseated or intolerant of the odor. This may result in subtherapeutic doses and inadequate pain relief. Because the drug is self-administered if the patient becomes unconscious the inhaler is dropped by the patient avoiding continued administration. One possible advantageous effect that has been observed in practice, is that the dose for the subsequent administration of narcotics may be able to be reduced. Although, the literature does not adequately describe or validate this anecdotal report. During Methoxyflurane analgesia, cardiac side effects are rare. Some decrease in blood pressure accompanied by bradycardia may also rarely occur. The Administration Device: The Penthrox Inhaler The Penthrox Inhaler is handheld inhaler, known commonly as the "whistle," for use with methoxyflurane and air or oxygen for pain relief. The Penthrox Inhaler can also be used for oxygen therapy. It is a green whistle-like tube with a wick. 3ml of the methoxyflurane solution is poured into the back of the inhaler. The dosage is regulated by two diluter holes that offers two concentrations. According to the manufacturer, when an oxygen hose line is attached to the inlet nipple in the base cap of the Penthrox Inhaler, 3 LPM provides average inspired oxygen concentrations of 35% and 8 LPM provides in excess of 50%. It is recommended that the line of the oxygen flow be arranged longitudinal as experiments have shown that side or other ports of entry do not achieve adequate inspired oxygen concentrations. Also according to the manufacturer, by using a longer hoseline, the Penthrox Inhaler can be used to provide oxygen enriched air, with or without pain relief, to remotely trapped victims. Summary Australia, especially in the rural area known as the "Outback" challenges prehospital care systems with tough environmental conditions and terrain. It is also tough for the patient in acute pain who may be hours from a hospital or ALS level ambulance care. The Penthrox Inhaler and MOF is used in wilderness medicine, mines, rural settings and even in cities where access to hospitals is only minutes away. While its clinical reliability and safety during use in enclosed areas may be in question, there seems to be a clear indication that inhaled analgesia should maintain a role in prehospital care settings such as in the wilderness or in rural settings until ALS level care arrives. However, there is a clear need for reliable prehospital studies to determine the appropriate role that inhaled analgesia should play to improve the pain control treatment that patient's receive in the field. There are more questions than answers. The Victorian Ambulance System is moving towards intravenous morphine use and is recognizing that this is the "gold standard" for control of acute pain. We must commend the Australian healthcare system for their commitment to providing high-quality prehospital patient care. The Australian philosophy towards alleviating pain in the prehospital setting sets an example of a healthcare attitude we can all learn from. The U.S. medical community is not yet as liberal, or compassionate, with its current attitude toward routine prehospital acute pain management. However, it is also not practical for every EMS system in the U.S. to administer parenteral pain medication. The Penthrox Inhaler and MOF are not approved for use in the United States. While nitrous oxide is approved for use in the U.S., it is not used routinely except in some rural EMS systems it can't be used in unventilated areas. Should we be using more inhaled analgesia in the U.S.? That will depend on whether nitrous oxide mixtures, MOF and the Penthrox Inhaler device can be studied more aggressively to discover if they are consistently effective enough to warrant their continued use.

Well this is probably off topic but, I’m in a volley organization. We provide first aid to events. We are a non profit service but we charge $32 an hour to be on stand by. We don’t transport or anything. We have fully equipped ambulances. Were a back up to the state government ambulance, so if there’s a bushfire or major MVA the government expects us to drop everything and cover the state ambulances service butts. Yet we don’t receive government funding. It costs an extreme amount of money to keep the service running, our only income is the event fee, people buying first aid kits and public donations. Many times we have spent more money on equipment, fuel, member welfare, supplies, communications ect than what the actual event pays to have us there, meaning were running at a loss. There’s an extremely increasing demand on our service and it’s getting tough to keep things afloat. I’ve never heard of a volunteer emergency ambulance service so I can’t really say anything that would help.

Well that defies everything we learn. Very controversial issue. I agree with Rid, I would love to see clinical trials.

Hmmm as Rid said the idea is great. Only problems I have, I’m not going to spend 5 minutes cleaning it making sure there’s no dust or dirt before we assemble it when there’s a kid dying out in the middle of the motocross track. While I can see how it would offer better immobilization while transporting, I don’t see how it would make any difference from doing a normal log roll onto a spine board.

My volley service is non for profit. We charge a small fee to have responders and ambulance working a standby event. We don’t transport unless the patient is of such a critical nature they require immediate medical attention, otherwise we call on the state ambulance to transport. We provide treatment to patients or members of the public completely free of charge. They can make a donation if they want. As Bushy said, the cost of equipment can easily be over what the event is donating for us to be there. But we’ve been told that patient care is more important than what our bank balance is.

echo-000, wow that must of hurt. I hope who ever did that got better.......

LMFAO... Trust you to do somthing like that ay! Good thing everyone went home. Well anywayz were buying Ferno FracSplints and SAM Splints... Should be good, thanks for the advice everyone.

Well instead of starting a new thread, I’d thought hijack this one. Hope its ok? I want to know what you people think of Air Splints, Ferno Cardboard Splints and Ferno Sam Splints. In my service were having a few problems with the splints. We mainly carry Air Splints but don’t really use them, but when we go to use them they have a crack or a hole and deflate as soon as you inflate. Were thinking about getting Ferno Cardboard, mainly as it will be more cost effective. What do you guys think? Are they just as effective as the Air Splints? Thanks

I just had to start a thread like this. Tell us what happened today at work or what a typical day at work is for you. You can lay it out in any format you want ie a story or time slots. Have fun.

Just to be on the safe side

I would have no idea were you would get the dogs trained nor have I ever heard of an S&R dog. Maybe an S&R provider would have a course?

My service makes us wear gloves as they can’t guarantee the safety of its members. It’s more of a big insurance thing all about infection control. They can’t guarantee that the patients don’t have infectious disease, vis-versa with the staff treating a patient. We even have to wear goggles when a patient is vomiting or bleeding anything more than a minor laceration. Normally one member treats the patients w/ gloves on and the other does the paper work or gets the equipment. Otherwise I treat the patient, control the bleeding or bodily fluids then remove my gloves and fill out the paper work. You could double glove if you wanted to…