Do You Feel You Have the Ability To Adequately Control Pain?

[theotherphil]

We can use Entonox, Paracetamol, Ibuprofen, OraMorph, Tramadol IV (up to 200mg prn) and Morphine IV (up to 20mg prn).

It is up to the Paramedic to decide what pain relief would best suit the patient's condition and the starting dose. This usually comes with experience. Eg for severe trauma, I'd probably start at 10mg Morphine and then titrate the further 10mg to response. If I knock the resps out, I wouldn't break out the Narcan....I'd just bag the patient for a while - at least their pain is under control.

There's been talk of us getting Ketamine to be used in sub anaesthetic doses but I don't think it'll be for a while yet.

[1EMT-P]

I think we could do a better job at managing pain in the field. I like to use combinations of medications like Benadryl + Morphine, Phenergan + Morphine & Phenergan+ Toradol for pain.

[1EMT-P]

In addition to pain medications, I also like to use breathing exercises, cold packs, position of comfort & splinting.

[1EMT-P]

I really would like to see additional education in the area of pain management for both hospital & pre-hospital providers.

[katbemeEMT-B]

The ALS service I work for carries several different pain meds with Morphine being the most widely used. To prevent the seekers from abusing the service we can use these on obvious injuries; ie: broken bone, major lac, major trauma. You get the picture. Any other medical/trauma we call med control to confirm its use and dosage and they check for patient info at the hospital.

An example of how this works is we had a patient reporting she had dislocated her hip after having a hip replacement. We arrived on scene and found her seated in her car. She had a walking boot on her right foot. :-k How can she drive with that on? Something didn't make sense. She claimed the boot got stuck under the brake pedal when she was getting out of her vehicle and that's when she heard a pop and felt the pain. She was crying to a point we could barely understand her. We made the decision to loosen the boot and try to remove it. While the medic attempted to obtain IV access (which was difficult) I worked on removing the boot. Well, she didn't even notice that I had moved her entire leg three inches to the left which should have left her screaming in pain. Her leg was free and we loaded her on the cot and into the rig. Med control confirmed that she was a seeker and no pain control should be given. She had been picked up by another one of our units earlier in the week. By working together, we kept her from duping us.

Do we have adequate pain control, I believe we do even though we are sometimes required to contact Med Control.

[Medic26]

The ALS service I work for carries several different pain meds with Morphine being the most widely used. To prevent the seekers from abusing the service we can use these on obvious injuries; ie: broken bone, major lac, major trauma. You get the picture. Any other medical/trauma we call med control to confirm its use and dosage and they check for patient info at the hospital.

Wouldn't you consider this a breach of the privacy laws? Don't get me wrong, I hate seekers but......

[katbemeEMT-B]

Wouldn't you consider this a breach of the privacy laws? Don't get me wrong, I hate seekers but......

No because they aren't actually telling us why we can't admin. the drug. There may be medical reasons such as allergy or contraindication with another medication or medical condition. It could also be what the doc feels is in the best interest of the patient at that time. One thing to keep in mind with my example is that when you have what appears to be a normally healthy 36y/o/f claiming to have just had a hip replacement two months prior followed by a fx tib/fib less then weeks old in a walking boot you automatically get suspicious. When we call Med Control we give them pt information, cc, vitals, and what we expect to be our course of treatment. What we get back is yes go ahead or a flat out no or sometimes an alternative treatment. It's not something that we have a very big problem with as most of the seekers in our area know that this is the routine not only with our service and hospital but also a couple of other services and hospitals close to us. So you see the only pt information shared is with the doc at the hospital to which we transport. No breach of the privacy laws.

[scope2776]

The ALS service I work for carries several different pain meds with Morphine being the most widely used. To prevent the seekers from abusing the service we can use these on obvious injuries; ie: broken bone, major lac, major trauma. You get the picture. Any other medical/trauma we call med control to confirm its use and dosage and they check for patient info at the hospital.

Your pain control management should not be set up to deny access to people you think might be seekers. It should be set up to provide pts in pain with appropriate medication. Furthermore, people can have legitimate pain without the outward appearance of injury or deformity and/or a change in vitals. You system is flawed because your rationale for pain control relies solely upon your judgement of how bad you think the pts pain is. While the Paramedics impression should certainly weigh in on the use of pn meds, the pts impression should also have equal bearing; depending on severity (0-10). Using the 1-10 scale is a quantitative approach, while using your impression is a qualitative. Which method is more suitable for protocol? The communication of pt information you describe seems to be a violation of privacy? And remember that seekers can actually have real conditions that may require analgesia.

It seems as if your pain management protocol is in need of a rehaul.

I would rather medicate a 100 seekers with protocol doses of analgesia then let one old lady with abdominal pain suffer all the way to the hospital in my ambulance. And this is how your pain management should be approached.

[katbemeEMT-B]

Your pain control management should not be set up to deny access to people you think might be seekers. It should be set up to provide pts in pain with appropriate medication. Furthermore, people can have legitimate pain without the outward appearance of injury or deformity and/or a change in vitals. You system is flawed because your rationale for pain control relies solely upon your judgement of how bad you think the pts pain is. While the Paramedics impression should certainly weigh in on the use of pn meds, the pts impression should also have equal bearing; depending on severity (0-10). Using the 1-10 scale is a quantitative approach, while using your impression is a qualitative. Which method is more suitable for protocol? The communication of pt information you describe seems to be a violation of privacy? And remember that seekers can actually have real conditions that may require analgesia.

It seems as if your pain management protocol is in need of a rehaul.

I would rather medicate a 100 seekers with protocol doses of analgesia then let one old lady with abdominal pain suffer all the way to the hospital in my ambulance. And this is how your pain management should be approached.

We ask our patients to rate their pain on a scale of 1-10. If you run on the elderly often you will find that most have a very high pain tolerance and that is very much taken into consideration when we are treating them. We have had hip fractures with little pain and still admin. pain medications. But we also have to be careful what we give them as many of them are on so many other medications we run the risk of medication interactions. That is why we are often required to check with Med Control. You also don't want to give a pain med to a patient who is going to have an adverse reaction to it.

As far patient privacy, I don't see how we even come close to violating that. Med Control is not giving us patient information. We call in and give patient reports on every patient we transport to the hospital. It's kind of like preregistering them. We give either the ER Doc or Nurse their name, birthdate, c/c vitals, allergies, medications, medical conditions, and any other pertinent information. If we need to talk to the doc regarding meds or what course of treatment we should be following how is that violating their privacy. He is not telling us they are seekers. He may be telling us to try some other treatment such as ice first. Depending on the c/c, he maybe telling us to adjust our IV. That's what he is there for.

[Dustdevil]

I would rather medicate a 100 seekers with protocol doses of analgesia then let one old lady with abdominal pain suffer all the way to the hospital in my ambulance. And this is how your pain management should be approached.

Plus 5.

This is more of the "public safety" mentality nonsense that permeates and soils EMS. People think because they have a uniform and red lights that they are now somehow responsible for law enforcement and criminal investigations. Wanna be a super sleuth? Quit EMS and go to the police academy. But right now, it ain't your job. Seriously, what do you care if you get played by a seeker? You gonna lose sleep over it? You're going to lose a lot more than sleep if you peg the wrong patient as a seeker. Your MD is going to rightfully label you an idiot, and you're sacked.