[Fentanyl] Pre-Hospital Pain Management

[PMedic850]

Out of curiosity, what is the purpose of your research? Give us a little more info and we may be able to help you track down more info................

In our data collection, we have inclusion criteria for the use of Fentanyl; we [as an ALS agency] are planning on going through PCRs over a certain time period to determine if Fentanyl could have been used. We want to show that Fentanyl would be utilized and especially identify cases in which pain management was not utilized due to contraindications to Morphine (ie: hypotensive, hypersensitivity). Are patients being denied adequate pain management in the field?

In NY State, their primary concern is pre-hospital diversion (because it is the "#1 diverted drugs among anesthetists"). We have controlled substances & have had no instances of diversion in our region. However, recently the DOH released a statement at a regional protocol roll-out stating that they were giving us Morphine on standing orders because "we are not going to let our fear of diversion outweigh patient care"...If that was really true, then they need to get their story right.

So, I'm trying to determine what states approved Fentanyl for ground agencies. I would like to contact the respective regional or DOH EMS offices and seeing what obstacles they have overcome, try to collect data on instances of diversion in their state since implementation.

[flight-lp]

Yes patients are being denied pain managment Pre-Hospital. There were several threads extensively discussing this very issue (I'll try to track them down for you). There are very few agencies that allow medic autonomy to titrate analgesics to a patients pain response. In addition there are medics outs there who just flat out refuse to give it, stating such excuses like "he/she really wasn't hurting that much". Fentanyl is a wonderful drug and IMHO less hemodynamically altering. It is my analgesic of choice for the majority of my pain patients and as you stated is a wonderful alternative in cases where Morphine is contraindicated.

Now I have not had my coffee yet this morning, could you explain the "diversion" issue? I'm not following you........................

[flight-lp]

A couple of recent threads about pain management.....

http://www.emtcity.com/phpBB2/viewtopic.php?t=2229

http://www.emtcity.com/phpBB2/viewtopic.php?t=2817

[Dustdevil]

It should probably be noted for the purposes of your research that there are very few states who, like New York, control their EMS scope of practice from the top down. Most states leave SOP completely up to local medical control. Therefore, your question, as currently asked, really isn't going to get you the results you are looking for. Because the truth is, almost every state "allows" fentanyl or any other drug the local medical control approves.

Good luck.

[PMedic850]

Now I have not had my coffee yet this morning, could you explain the "diversion" issue? I'm not following you........................

Quote from the DEA's website: "Many problems associated with drug abuse are the result of legitimately-manufactured controlled substances being diverted from their lawful purpose into the illicit drug traffic. "

so diversion == stealing

[flight-lp]

It should probably be noted for the purposes of your research that there are very few states who, like New York, control their EMS scope of practice from the top down. Most states leave SOP completely up to local medical control. Therefore, your question, as currently asked, really isn't going to get you the results you are looking for. Because the truth is, almost every state "allows" fentanyl or any other drug the local medical control approves.

Good luck.

Yet another reason why I am glad to not be in New York state.............

Robbie,

Thanks for the clarification, however I have never heard of this being an issue in my neck of the woods..........

[island emt]

Dustdevil wrote:

"It should probably be noted for the purposes of your research that there are very few states who, like New York, control their EMS scope of practice from the top down. Most states leave SOP completely up to local medical control. Therefore, your question, as currently asked, really isn't going to get you the results you are looking for. Because the truth is, almost every state "allows" fentanyl or any other drug the local medical control approves. "

Not necessarily true: Here in maine as in other states we operate under a statewide protocol, where our drugbox contents are determined by a state medical director + the physicians control board. what this means is no matter where you are in the state every drug box has the same contents. we are supplied the boxes by the hospital pharmacies. Use something out of the box + trade it in for a fresh one at the receiving hospital.Every ALS provider in the state whether private, public third service or fire dept is operating under the same protocols. we do have a local medical control physician but they don't have the authority to add or delete from the statewide drug list.

[Dustdevil]

Not necessarily true: Here in maine as in other states we operate under a statewide protocol, where our drugbox contents are determined by a state medical director the physicians control board.

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

[TechMedic05]

New Hampshire carries Fentanyl as well, and has for about 8 or-so years now for some agencies.

Currently, it's standing orders for adults (25-50mcg q 5min x3) and pediatrics (0.5mcg/kg q5 min x3) statewide. I feel are a bit under dosing, but there's always med control for options of more.

NH State Protocols

Pain Managment is Protocol 2.9

[Ridryder 911]

Really, a shame that states and services would want more control over patient care in (state protocols) instead of dealing with the problem directly.

Be safe,

R/R 911