Activated Charcoal Use In The Field

[crotchitymedic1986]

This is a question, not a condemnation, but to all those who lean towards if it is been over 30/60 minutes, it is a waste of time; then why does the ER administer it 30 minutes later after you have arrived at their ER ? If it was too late on the scene, wouldnt it be too late as well at the ER ? Many prescription meds today are time-released or slow to release, so wouldnt it make since to give it in the field even if it has been over 30 minutes --- and if someone took a whole bottle of a med, how do you know that each pill was digested at the same rate, at the same time ? Maybe they took 10 of one pill, waited 10 minutes, took 20 of something else, waited 10 minutes and took a handful of something else, and then called 911.

I mean you give oxygen to some patients who are satting well, but may need the oxygen (MI, trauma), why not err on the side of caution and give the charcoal regardless of time of OD, like the ER will ?

[Arizonaffcep]

Yep, it makes no sense to me. And from the looks of it, he isn't going anywhere anytime soon. He's on the hospital board now. We do carry the charcoal on our rigs, but what I don't understand is....Even though the state says an emt is allowed to give it, why do our medics have to patch and get permission? Yes, you are understanding correctly. Our paramedics have to patch for a medication that can be given at and emt level. This particular medical director was already kicked out of one hospital, although I don't know the reasons why. He also tries to run the prehospital setting like a military. He came from the military so he's always trying to run things the way it was ran there. I wish we could have the old medical director back. He was pro ems and didn't have many restrictions on us.

Actually, I can tell you the most probable answer to that. The answer being, there is most likely no standing order or protocol in place that gives off line direction for its use. Also, as it is not an immediate life-threatening drug (when compared to 1:1k epi w/anaphylaxis for instance), then they would need orders for it. I would imagine though, that if it was given within an appropriate time frame and for the right reasons, the hospital would be hard pressed to say no.

[Arizonaffcep]

This is a question, not a condemnation, but to all those who lean towards if it is been over 30/60 minutes, it is a waste of time; then why does the ER administer it 30 minutes later after you have arrived at their ER ? If it was too late on the scene, wouldnt it be too late as well at the ER ? Many prescription meds today are time-released or slow to release, so wouldnt it make since to give it in the field even if it has been over 30 minutes --- and if someone took a whole bottle of a med, how do you know that each pill was digested at the same rate, at the same time ? Maybe they took 10 of one pill, waited 10 minutes, took 20 of something else, waited 10 minutes and took a handful of something else, and then called 911.

I mean you give oxygen to some patients who are satting well, but may need the oxygen (MI, trauma), why not err on the side of caution and give the charcoal regardless of time of OD, like the ER will ?

A very good point with the extended release pills. If it couldn't be confirmed, sure...does no real harm. And of course if it was confirmed (via pill bottle, etc), then go for it. However, if the patient said "I took these" and handed you bottles of pills that were not extended release (Xanax, etc.) then if it's over the 30 min mark, there is a higher chance that the charcoal and or stomach pumping (currently really going out of favor due to time frame involved) is a more punitive thing, rather than for medicinal purposes.

[JakeEMTP]

I have administered Activated Charcoal twice. Both times the pt. took it like a champ. The slow release of capsules makes the use of this medication prudent. Many time the pt. is going to have their stomach pumped anyway. However, beginning treatment in the field is my job and I would administer it again if I feel it's warranted.

[mobey]

Any Ab EMT's have a good reason it is not in our scope??

Really, it is a pretty safe solution considering the other protocol's we have.

I had a girl take her entire perscription of Lorazepam at once. We were about 20 min from town and I was wishin I had it.

I have only used it once, I learned very quickly that a K-Basin is for dentures not vomit! I also learned how to take the cot mounting equipment off the floor to clean under it!

[Richard B the EMT]

if it is been over 30/60 minutes, it is a waste of time; then why does the ER administer it 30 minutes later after you have arrived at their ER ? If it was too late on the scene, wouldnt it be too late as well at the ER ?

Beaten in by crotchitymedic1986 with the best question! I'll get mine in on another day.

[akroeze]

http://caep.ca/template.asp?id=A78E701ECB6...4896DFDBDD080BE

Certainly not worth changing practice over but interesting to note

[Don1977]

Required here in the trucks, but I have never used it before, as a matter of fact, I just got a rid of 2 tubes a few months ago that were expired.

I have seen it used in our children's hospital transfers, looks nasty.

[HellsBells]

Any Ab EMT's have a good reason it is not in our scope??

My guess would be due to the possibility of aspiration and the inability of an EMT to intubate if the airway is compromised.

[mshow00]

I have only given it once as a paramedic student doing my ER clinical... lady OD on H and sollowed several kinds of pills with a fifth as a chaser (not real sure of the order). She walked upstairs passed out and someone scene called 911. She was brought in in a BLS unit (only truck available, very very rare). The Dr ordered IV access, ET on stand-by, Narcan, NG tube, and charcoal. They nixed the ET, and let me do the NG and give the charcoal. Their charcoal came in the caulk-like tube and the tech that set it up for me and cut the tube to short. Needless to say it got everywhere, I spent the better part of an hour cleaning that room up after she was sent to ICU.

As for on the streets, we don't carry it and I'm not really sure. Most of our ODs are narcotic based, with the new thing seeming to be eating patches (morphine and fentanyl being the most common)