[Fentanyl] Pre-Hospital Pain Management

[kevkei]

Up here it has been used for over 10 years that I know of. We carry both fentanyl and morphine in our service but our medical director prefers morphine because of it's duration of action compared to fentanyl.

Personally, I like to combine the two in certain situations, like fractures. I'll start off with fentanyl ( 1-2 mcg/kg) as it has faster onset of action and a faster peak effect. Then I'll reassess and repeat if needed. If I have the desired effect, I'll switch to morphine and give it 5-10 minutes after I last administered the fentanyl. I've found it is very effective and you get the combined positive aspects of both, quick symptom relief (fentanyl) as well as longer duration of action (morph).

[PMedic850]

To clarify, NYS has several different regions that control the pre-hospital protocols. However, I believe that anything related to narcotics have to be approved by the DOH (as they are state controlled).

Thanks TechMedic05 for the New Hampshire protocols.[/font:96ceab25bc]

[UMSTUDENT]

Okay, so far we have NYS and Maine. Hmmm... maybe it's just my math, but it still sounds like "very few" to me.

Maryland utilizes a statewide protocol through one central, state government sanction agency. Individual counties can choose to operate under a specific "pilot protocol," but it too requires approval from the state.

MIEMSS (The Maryland Institute for Emergency Medical Services Systems) is the state agency responsible for EMS regulation and implementation. COMAR (Code of Maryland Regulations) Title 30 is where most of their jurisdiction is had. They are independently financed by the state. Unlike most states, they aren't under a department of health or a few cubicles in an office building.

"The Maryland Medical Protocols for Emergency Medical Services Providers" is roughly 300 pages and dictates the protocols for both BLS and ALS providers. It can be found at http://www.miemss.org/Protocol2005.pdf

Individual private services can choose to use further skills so long as they have a medical director willing to let them do so. At least that is my understanding.

http://www.miemss.org

[Guest]

Up here it has been used for over 10 years that I know of. We carry both fentanyl and morphine in our service but our medical director prefers morphine because of it's duration of action compared to fentanyl.

Yup, fentanyl has been carried in most services for years, I can't imagine what it would be like to Not have it.

[mizzoumedic74]

We switched to Fentanyl over Demerol last year. The results have been great and it's uses show far better results. Many services around Missouri are making a similar switch.

~Jared

[spgmedic]

We use FENTANYL,MORPHINE AND DEMEROL in Missouri

[PMedic850]

After quite a bit of research and help from our regional medical director this is what we came up with for Fentanyl use (as well as other narcotics used for prehospital pain management).

Any corrections or updates would be appreciated.

[flight-lp]

Oklahoma, Iowa, Illinois, Kentucky, and Tennessee all have providers who allow Fentanyl administration on standing orders.

[PMedic850]

Oklahoma, Iowa, Illinois, Kentucky, and Tennessee all have providers who allow Fentanyl administration on standing orders.

Just to make sure, are the standing orders for ground ALS units or flight units? The above map was based on ground ALS units.

Thanks for the feedback!

[flight-lp]

Why would it matter? Both are Paramedic staffed units and both are pre-hospital....................

But to answer your question, they are air services.