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

[Novisen]

We have Diklofenak, Ketobemidon, Morphine, Nitrious oxid and Ketamin to control pain Prehospital. I can decide on my own what drugs I will use.

[medic82942003]

I work in Detroit, MI. We have no pain meds in our box whats so ever. Not kidding.

we carry 10 mg valium for seizures only.

[Dustdevil]

I work in Detroit, MI. We have no pain meds in our box whats so ever. Not kidding.

Although less so now than in the 80's and 90's, this is actually not terribly uncommon in large, urban, municipal systems. Especially fire based systems. I guess the accountability problems (among others), are just too much for them to deal with on that large of a scale. No doctors or administrators are willing to put their name on it.

[spenac]

Who all carries nubain or stadol? i personally am allergic to Demerol and morphine doesnt do well unless its a huge dose, (6'3 275 lbs, With cronic Migraine) but a normal dose of stadol or nubain releives the headache. unfortunatly thats all they carry up here is morphine and demerol, i havent rode in a rig but once but it would be nice to have that other option available

Fireman1037

We have nubain amoungst other happy meds.

[Just Plain Ruff]

I prefer Dilaupid

[CBEMT]

Although less so now than in the 80's and 90's, this is actually not terribly uncommon in large, urban, municipal systems. Especially fire based systems. I guess the accountability problems (among others), are just too much for them to deal with on that large of a scale. No doctors or administrators are willing to put their name on it.

Around here it seems to be a money, crew safety, and transport time issue in the urban area.

[Dustdevil]

Around here it seems to be a money, crew safety, and transport time issue in the urban area.

Oooh, excellent points! I would agree that all three of those are significant factors in the decision of a system to include narcotics in the formulary. I think they are highly overrated though. Think about it:

• Money - A 10mg vial of morphine costs a couple of bucks. Even if you have a hundred ambulances, you still haven't spent a thousand bucks. And, of course, the item is billed for.

2. Crew Safety - Not carrying narcotics is a safety factor only if the public knows you are not carrying narcotics. They don't. They all assume we all carry narcotics. Consequently, those inclined to jack you up for drugs are going to do it anyhow. And when you have nothing to give them, they are going to kill you for holding out on them. Consequently, actually having narcotics makes you safer than not having them.

3. Transport Time - Really, the only one of the three that has any merit at all, and it's still negated by multiple factors. It doesn't matter how close you are to the hospital in an urban environment. Scene times, the time necessary to ingress and egress from urban structures and navigate traffic, as well as waiting time to get your patient to a doctor's side all negate the illusion of short patient care times in many urban systems. Regardless of transport time, your patient is still under your care for 20 to 30 minutes, minimum. Thirty minutes of 9/10 pain is an eternity, and there is no excuse for not treating it.

• Symptom relief is now an internationally recognised standard, unlike in the past. MONA is the universal gold standard of cardiac care. If your agency isn't meeting that gold standard, your agency sucks, and probably in many more ways than just this one.

And, of course, it has to be asked, if morphine were not a controlled substance requiring special recordkeeping, would your agency still reject it from their formulary? Would they hold any of the above reasons alone to be sufficient to not use it? Of course not. So really, it all comes down to one thing; they simply don't trust their people and don't want the hassle.

I would not live in that city. If the system administrators don't trust their medics, then I don't either.

[WendyT]

If he's not qualified, then what's he doing in EMS?

[CBEMT]

Well, we can't bill for meds or supplies- by law whatever ER we transport has to restock us, so it's illegal to bill for consumables.

That said, your point still stands because you only have to buy it once- so it's an even cheaper proposition.

Symptom relief is now an internationally recognised standard, unlike in the past. MONA is the universal gold standard of cardiac care. If your agency isn't meeting that gold standard, your agency sucks, and probably in many more ways than just this one.

For what it's worth, in our urban area, by the time you've given given your second round of nitro, dial the phone, wait on hold for a doc, get the order, and have it ready to go, you'll either be at one of 3 community hospitals or 2 more with cath labs.

I realize not everybody's city is like this one.

[Just Plain Ruff]

I agree with dust, even 10 minutes of 10/10 or 9/10 pain is unbearable.

I recently had a migraine that knocked me down for 2 days. I toughed it out but it was horrible.

having some type of pain control methods is a godsend to patients.

I've given dilaudid, morphine, nubain, stadol, demerol and countless others. The best pain releif I've seen has been with Dilaudid.