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

[ERDoc]

I will admit that I do not know anything about the OP but I think we need to be careful about the ethical/moral/right/etc thing to do. In an ideal world this would be true but in the real world it's a different story. Being right doesn't pay the bills, put food on the table or a roof over your head. Jobs are at a premium right now and EMS is no different. You can stand up for the pts all you want but do you put your wife/husband and kids at risk of being homless and starving to do so? I would agree that this company sucks and I hope the OP realizes that but it may be the only place he can get a job right now.

[runswithneedles]

If I was your patient, I would be talking to an attorney.

And this is the point I can kiss my license and what part of my ass is left goodbye.

[systemet]

You can stand up for the pts all you want but do you put your wife/husband and kids at risk of being homless and starving to do so? I would agree that this company sucks and I hope the OP realizes that but it may be the only place he can get a job right now.

Agreed, but if I was OP, I'd consider career pathing for a new position sooner rather than later.

[ERDoc]

Agreed systemet, but I think that is what the OP is doing.

[runswithneedles]

You know Needles, it's easy at this point to think, "what a bunch of assholes! I was in a tough spot, you don't know what it was like!"

If I had any thought of this. I would have already removed myself from anything that involves responsibility. That would display horrendous ignorance. Im here for the criticism im receiving on this post. Its this that helps me become a better EMT and hopefully a damn good medic. I want to be a medic who covers my ass and is a patient advocate. I want to to do whats right for my patient and if its not viewed as favorable by my boss I want to have something in my hand going into her office stating "I made the right call for this patient and you cannot fire me for this". And paramedic mike, dwayne. I know your not busting my balls. How can I grow up to be a better EMT. And having replayed that run in my head my service not only failed her but I did as well. And having a mother that underwent 5 abdominal surgeries and got out of her 6th this afternoon I am very disappointed at myself.

I feel like rocking the boat. I wont stand to see another human being in agony or risk transporting a patient that can potentially need something I dont have. Theirs another service I will go apply for tomorrow and from what ive heard they are a bit better.

Something my boss understands very clearly is bottom lines. And I know ambulance chasers love to dig into bottom lines. Can lack of proper equipment or supplies and still taking a patient be a potential lawsuit and is their anywhere where I can find statistics of the total costs of lawsuits in a certain occupation.

And something my boss likes is more money. Is their resources where I can locate utilization rates of medications, cost per unit and reimbursement rates for each medication used. If the medicare/ medicaid/ private insurance rates fluctuate due to administration of medications used enroute.

Also since some of the medications used for pain require special licenses required by the DEA. Where would I go.

If a emt-b can manage this company doing over 300+ calls per month. An emt-b should have no problem doing the necessary research and compile it into a document or powerpoint to present to the owner and medical director (if im lucky for him to stop by)

[Kiwiology]

Fail on the company you work at for not having any analgesia

Fail on the medical director (who is presumably a Consultant Physician) for allowing this

Fail on the sending Physician for considering analgesia for the next five hours

And lastly fail on you for not doing it either; did you tell the Doctor that you had no analgesia?

Bloody hell a five hour trip? Frigging helicopter be faster ...

Jobs are at a premium right now ...

Correct, spots in the Kiwiology vocational training program are limited and applications close soon; as I know the guy who runs the program we can probably gloss over the whole two years pre-vocational training requirement and skip you right up to the Advanced Kiwiology modules

But I dno, looks like you've got four years of medical education and only a three year vocational training program ... bit nunngered

Edited April 5, 2012 by Kiwiology

[paramedicmike]

If I had any thought of this. I would have already removed myself from anything that involves responsibility. That would display horrendous ignorance. Im here for the criticism im receiving on this post. Its this that helps me become a better EMT and hopefully a damn good medic. I want to be a medic who covers my ass and is a patient advocate. I want to to do whats right for my patient and if its not viewed as favorable by my boss I want to have something in my hand going into her office stating "I made the right call for this patient and you cannot fire me for this". And paramedic mike, dwayne. I know your not busting my balls. How can I grow up to be a better EMT. And having replayed that run in my head my service not only failed her but I did as well. And having a mother that underwent 5 abdominal surgeries and got out of her 6th this afternoon I am very disappointed at myself.

I feel like rocking the boat. I wont stand to see another human being in agony or risk transporting a patient that can potentially need something I dont have. Theirs another service I will go apply for tomorrow and from what ive heard they are a bit better.

Something my boss understands very clearly is bottom lines. And I know ambulance chasers love to dig into bottom lines. Can lack of proper equipment or supplies and still taking a patient be a potential lawsuit and is their anywhere where I can find statistics of the total costs of lawsuits in a certain occupation.

And something my boss likes is more money. Is their resources where I can locate utilization rates of medications, cost per unit and reimbursement rates for each medication used. If the medicare/ medicaid/ private insurance rates fluctuate due to administration of medications used enroute.

Also since some of the medications used for pain require special licenses required by the DEA. Where would I go.

If a emt-b can manage this company doing over 300+ calls per month. An emt-b should have no problem doing the necessary research and compile it into a document or powerpoint to present to the owner and medical director (if im lucky for him to stop by)

Dude! Seriously? Punctuation and spelling! It helps us understand what you're talking about and when you're asking questions.

This is not the first time you've been called on this. You should know better by now.

With regards to the "you can't fire me for this" bit, you can be fired for just about anything. Don't believe for a second that you being able to prove you did the right thing is going to protect you from termination.

[mikeymedic1984]

I am sorry, but I put 50/50 fault on you and the Nurse that transferred care to you.  The two of you should have thought this out before you loaded the patient.  Anytime I did a long distance transport (anything over an hour), I asked these four questions:

1.  How have you been managing the patients pain, when was the last dose of meds, do they have enough on board to make the trip (if not, can you please give her another dose, or give me a dose to administer when this wears off).

2.  Has this patient had any anxiety issues, sometimes patients who are already anxious get clostrophobic or nervous on long rides (again give them a pill then or one for the road).

3.  Has the patient had nausea or vomiting recently, or a history of motion sickness. Patients can get nausous riding backwards for hours.

4.  When was the last time the patient went to the bathroom (or when was last time diaper was changed ? (Can we go to the bathroom now, or can you send a couple of diapers with me)

Just because you were ignorant to the fact that you should have asked these questions, does not relieve you of the responsibility of treating your patient.  But the good news is that now you have learned from your mistake, and will probably not make it again.  This will not be the last time you experience this in EMS, there is no way your employer, your technical school that taught you, or your current training officer can prepare you for everything you will encounter; you have to be able to think on your feet and outside the textbook box.  

I am not trying to diss you, if my typed words sound that way, this is just a longwinded way of saying welcome to EMS, own your error, and move on.

Edited April 5, 2012 by mikeymedic1984

[island emt]

Actually there is very little blame for Mike as a 19 yo emt-b, he was sent by the crappy transport company he works for on a long distance transport.

He could have been a better pt advocate, but how much can we expect from a newbie without road exposure?]

This is not picking on you Mike, just a fact of lack of experience.

His dispatcher should have known that the pt required Paramedic level of care and those medics should have analgesia in their protocols and on the trucks to be given as needed. The fact that none of his company trucks have medications for pain relief speaks volumes about the type of service it is.

The second part of this big fail is the shipping hospital and Dr that felt the pt could travel for 5 hrs without further pain relief.

The bottom line is a greedy company trying to make the most they can , at the least expense.

Wanna bet they billed it as ALS-1 ????

Edited April 6, 2012 by island emt

[mikeymedic1984]

How does small bowel obstruction being transported 5 hours rise to an ALS call in any dispatch center ??