Zofran

[tcripp]

For those that use Zofran in their system and are at an EMT Basic or Intermediate level, does your system allow you to push the drug? Or is that considered an ALS treatment?

[EMS49393]

I know you asked for basics and intermediates, but Maryland has universal state protocols, and it is an EMT-I/paramedic level drug.

Pennsylvania also has fairly standard state protocols. They only recognize basic and paramedic. It is a paramedic level intervention in PA.

It's paramedic only at MEMS in Little Rock, AR; St. John's EMS in Springfield, MO; and CoxHealth EMS in Springfield, MO. No EMT-I level in AR or MO.

[DwayneEMTP]

Interesting question...I'm guessing that you mean without oversight like Albuterol etc, in some places?

I'm trying to think of any IV drug that a basic can push on standing orders other than saline...I can't think of any.

Why do you ask?

Dwayne

[Medic One]

Thats a great question and I have been pushing to allow EMT Basics and EMT-Intermediates now called AEMT's to be allowed to administer Zofran.

It's is a great drug that helps many people and almost no room for foolish errors.

I don't think IV zofran would be easy to get approval for EMT but ODT Zofran would be much easier to get passed by med control.

I mean emt's in our state have NTG, ASA, and Epi pens. Why not add zofran, cpap, albueterol and glucagon?

For advanced emt's they should have D50, IV zofran.

I wouldn't feel threatened by emt's having these Meds it would actually make my job easier.

Michael - "Medic One"

U.S. Veteran

FF/Paramedic, EMS-Instructor

Pace / Medical Car Driver Lime Rock Park

Sent from my iPhone using Tapatalk

[tcripp]

Why do you ask?

I'll preface that I'm from Texas where each service's capabilities are dictated by medical direction...which I think is pretty cool, by the way. My particular service is comprised of three levels...basic, intermediate and paramedic. Intermediates would be considered the Advanced EMT and our paramedics do work in a critical care capaticy.

Our trucks are staffed with EMT/Paramedic and, for the most part, the paramedic will take about 95-98% of all calls. Our Intermediates (Advanced EMT) can push via IV narcan, dextrose (10, 25, 50) and thiamine.

We occasionally have the patient (most likely coming out of a nursing home going to the local hospitals < 20 miles away) with a chief complaint of nausea/vomiting or possibly a stubbed toe but the patient wants transport and, oh by the way, gets car sick.

After an assessment, I occasionally believe the call could be handled by my intermediate partner without any issue. However, because I've determined that ondansetron (Zofran) is necessary, it becomes my patient.

Now, while that is not an issue and it is my job...I was curious if there were any services out there who had that medication at the intermediate level.

For the record, I didn't expect anyone to pony up to it being a basic skill since IVs aren't a basic skill either.

Toni

[DwayneEMTP]

Holy shit Toni, I so get this! Or at least think that I do....

My last basic partner was sharp as a tack, had every intention of furthering his education, and I trusted him...a lot. There were so many times I'd want him to be able to take a call..just to flex his mental muscles/skills but couldn't because the call was outside of his protocols. In Colorado we have quite a bit of leeway for allowing Basics to push drugs in our presence, but not so much leeway to say, "This is almost an ALS call, but not really, and I'm only a few feet away...I want to let him take it.." but couldn't.

He was smart enough that pharmacologically he ran all of our codes...but that was about all that I could allow. I don't see any here...have you found anyone else that has such protocols?

I'm interested to see if anyone has such a thing...

Dwayne

[tcripp]

I'm interested to see if anyone has such a thing...

Me too!

[JakeEMTP]

Yeah Toni, I hear ya! I think it comes down to the "only medics can push an antiemetic" mentality harkening back to the day when we only had the option of Phenergan . We still have that medication on the ambulance, but I can't remember the last time I used it. The side effects of Zofran are not that extreme although they do exist, and the contraindication is of course hypersensitivity.

Zofran side effects

blurred vision or temporary vision loss (lasting from only a few minutes to several hours);

*

slow heart rate, trouble breathing;

*

anxiety, agitation, shivering;

*

feeling like you might pass out; or

*

urinating less than usual or not at all.

Less serious Zofran side effects may include:

*

diarrhea or constipation;

*

weakness or tired feeling;

*

fever;

*

headache; or

*

dizziness, drowsiness.

Source: www.Drugs.com

I believe if EMT-I's can administer Epi or Benadryl, they should be able to push this really, REALLY good medication to pt.'s that could benefit from it. Pt. care. Remember that?

I have been in a constant battle with our Medical Director about this very subject. So far I'm not winning this argument, but I shall persevere!

[DwayneEMTP]

I love Phenergan! When I'm on the truck I push it a lot..not because it's the better anti-emetic, but it's side effects, in my opinion, are often better for those that need an anti-emetic..see?

But, back on track. I think that you're post is spot on Jake...

Dwayne

[2Rude4MyOwnGood]

For those that use Zofran in their system and are at an EMT Basic or Intermediate level, does your system allow you to push the drug? Or is that considered an ALS treatment?

It is an ALS skill to push Zofran here, but Intermediates are considered to be ALS providers so there is no issue with giving the med.

EMT-B's arent allowed to push any meds through an IV at all. They are limited to oxygen, oral nitro, IM epi, activated charcoal, oral glucose, and assisting the patient with their own inhaler.