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

[Arctickat]

It took our medics over a decade to have any pain management in addition to Entonox. We submitted protocol proposal after proposal to the College of Physicians and Surgeons that were consistently rejected. The reason? Concerns that the medics would inadvertently suppress the respiratory system. Never once did they consider the fact that medics were able to administer naloxone and could use a BVM. Now we have Fentanyl and Morphine in addition to Entonox.

[Kiwiology]

It took us probably 20 years to get any decent analgesia above entonox; nubain and fortral were in use during the 1980s only for selected "Paramedics" as they were then known (Advanced Care Officer). In 1990 they were replaced with morphine in very conservative doses; in 2001 morphine + midazolam was introduced, methoxyflurane in 2005 for limited space or weight restricted staff e.g. Ambulance Rescue or the Motorcycle Response Unit, ketamine in 2007 and fentanyl in 2011

[runswithneedles]

@ mikey medic. There is excessive pain involved with it. It requires pain management and LOTS of it. Also pt had a saline lock which under medicare standards does qualify as ALS I.

Edited April 7, 2012 by runswithneedles

[runswithneedles]

Unfortunately here are the 5 choices I have for employment within a driveable area and still make money

Names of the companies will be changed so I cant be hit for slander. (not sure if I can be but Id rather be safe than sorry)

Taco Med- Contracted with a nearby Level III hospital. Their equipment/protocols are crap (lifepak 10's, trucks are either broken or on the verge of exploding, same protocol book as ours, and equipment is always breaking and never fixed) 99% of their ENTIRE call volume is discharges and ITFT within 10 miles of their contracted hospital. Hell even a basics skills will die there. Management treats their emt/medic staff like ****. And they pay less.

Big city FD #1: within driving distance. dont have my fire cert so ill have to be a cadet which hours are limited to 12-18 hours per week. I will not be near a box. I will be doing BS errands. And once I get my medic. Again no narcotics, or anything resembling a decent protocol book , very similar to ours with the exception of adenocard, amiodarone, and terbutaline on their drug box. And having worked in private for a year now. I learned they think they are better than private medics because they are one the frontlines of real emergencies. (should've put real emergencies in quotations) And with my mouth I have no doubt that job will forever stain my resume. But more importantly. No box time. They run almost 100% medic& medic boxes. The few who are emt-B's or emt-I's are firemen.

Big city FD #2 Same as above and since its in the same town as my current employer same stuff applies as above. And despite having diazepam, and morphine theirs not a whole lot of difference between the other FD as far as me staying there after I become a medic. But most importantly, no box time as a EMT.

PB&J ambulance: Haven't seen there protocol books (applied there Thursday and they wont let me see them unless im already hired and doing the orientation process.) But from friends they are amazing as far as equipment and truck maintenance. The NICU team almost exclusively uses them. I have heard they are very progressive with their protocols and they do quite few complex medical runs because they have the equipment. First time I applied with them when I just got my EMT I never heard back from them. I heard its because i'm not 21 (so I cant drive the trucks) and i'm not a medic (which if I was a medic and not 21 they would've just put me in the back every shift.) But now Im trying again hoping that being pretty close and already having 1 year ITFT with my ACLS, ITLS, and PALS they will consider me.

The fifth one is the one im working for now

Edited April 7, 2012 by runswithneedles

[Kiwiology]

If that Lifepak 10 comes with a taco then where do I apply?

I miss the LP10

[runswithneedles]

If that Lifepak 10 comes with a taco then where do I apply?

I miss the LP10

funny as much as I bash it...its whats I used to perform my mega code for my ACLS cert. they are nice but I like my Zoll M series

[Kiwiology]

As much as I like the Lifepak 12 it's bulky and somewhat awkward to use and store; the LP10 is a much more practical shape

I have to admit the NiBP, 12 lead ECG (although you could do a 12 lead with a 10), ETCO₂ etc are nice

[runswithneedles]

As much as I like the Lifepak 12 it's bulky and somewhat awkward to use and store; the LP10 is a much more practical shape

I have to admit the NiBP, 12 lead ECG (although you could do a 12 lead with a 10), ETCO₂ etc are nice

I know for a fact that I will never commit myself to transferring a intubated patient without ETCO2. Had a close call that wouldve been prevented if that was utilized during a vent run a medic took. I like the zoll just because its what im used to. To me it just looks less intimidating.

[Kiwiology]

To me it just looks less intimidating.

Well nobody could ever call me intimidating; I'm a weak skinny pale Kiwi with a shonky eye ... but if you piss me off I'll just shoot you in the head with my .50 Desert Eagle, so I guess that could be intimidating but you'll be dead before you've got time to be intimidated

[mikeymedic1984]

I know for a fact that I will never commit myself to transferring a intubated patient without ETCO2. Had a close call that wouldve been prevented if that was utilized during a vent run a medic took. I like the zoll just because its what im used to. To me it just looks less intimidating.

If you need ETCO2 to tell if your patient is not being ventilated properly, then I agree, you should not be doing vent calls. What would you do for an out of hospital cardiac arrest if you did not have it ? Just saying, Roy and Gage never killed a patient and the only technology they had was a 50lb defibrilator and a 10lb portable radio to call Dixie at Rampart.

Edited April 7, 2012 by mikeymedic1984