Okay, here are the studies I was refering to. These are taken from my paramedic class, I have not seen the actual studies myself. If anyone knows where I could get ahold of these studies I’d much appericate it. I would love to read them myself
in 1994 a study was done by Lewis, Sasater and brooks that showed:
56% of patients admited to the hospital with painful conditions received no analgesia
Meperidine was given in inadequate doses 55% of the time, and by a non prefered route 60% of the time
Only 31% of chest pain patients received analgesia
of 401 patients in the study with acute fractures, only 30% recieved analgesia in the ED.
The Boston Drug Collaborative Study showed that out of 11,892 patients who recieved opioid analgesc in the hospital, 4 devloped a dependency
the Perry study of 1982 showed that out of 10,000 burn patients (a little off the subject) who recieved an opioid none devloped an addiction
The Zolte and cust study: “Analgesia in the acute abdomen: 1986”; the Attard, Corlett and Kidner study: “Safety of early pain relief for acute abdomonal pain”; and the burke study: “the use of IV MS for early pain relief in patients with acute abdominal pain: 1994”
the three above studies showed that “titrated use of low doses of opioids does not interfere with the diagnostic process”
Two other studies: “Dunphy and Way: Current surgical diagnosis and treatment: 1994” and “Angell: The acute abdomen for the man on the spot: 1979” both showed that opioid use “actually improves the ability to make an accurate diagnosis”
Any thoughts or Ideas. Again if anyone has access to the studies, I would love to get copies of them. This info is taken second hand from my EMT-P class.
Often when Kervorkian took a life, the patient had complained of extreme pain that was not abated. Each time the medical community said that with proper medication the pain could have been controlled. Huh? After the fact they’re all willing to prescribe. This certainly isn’t an endorsement for Kervorkian (although I applaud the premise) but an appreciation for those who have lived with indescribable pain.
Ancecdotally? A cousin who was died of leukemia who had to leave her home state (South Dakota) to find a physician inclined to prescribe greater pain medication (Minnesota).
In California we voted passage of a medical marijuana bill. The researchers say that use is ‘inconclusive.’ Anecdotally again, my Mom found relief only when toking. This bill often gets overruled in court, but with more frequency individuals are winning their cases.
I appreciate all the info about medication given when a patient is in an emergency situation, but what about people who are dying? What difference should it make to anyone? Who owns my body? Me or the ‘state?’ Shouldn’t I be able to make that determination?
kinoons, as a fellow EMT, I sympathise with your argument - I have been in the same position on one or two occasions.
However, surely you carry another quick-acting non-opoid analgesic in your ambulance? Because I am not licensed to use morphine (next level up from me), I am limited to using a drug that is more commonly known as an anaesthetic - methoxyflurane. This has been used as a self-administered inhaled analgesic in Australia for almost 20 years, and it is reasonably effective in most cases that I have witnessed.
There are very few side effects, provided you limit the dose to the recommended daily maximum of 6 ml.
Maybe it will only take two tenths out of the pain score of someone with renal colic, but that’s better than not having anything available at all.
Kinoons, you said you requested morphine PREHOSPITAL. Well as a nurse who has worked in the ER, I can tell you that I have seen only one case of a doctor who would allow a trauma nurse to administer morphine, sight unseen. (I personally would not feel comfortable administering an opiate narcotic without an MD having seen the patient. Sorry, but it’s MY license!) You have to understand that it’s very risky to the Doctor to approve someone miles away over a radio to give morphine. Drug reactions aren’t restricted to different drugs, but can go as far as specific manufacturers, generic/brand names, etc. I did a home care case with a woman who was allergic to the generic drug warafin but could take the Name brand Coumadin wih no problems. (I don’t know why, exactly, but every time the pharmacy screwed up and she didn’t catch it and took the generic, she was in the hospital within hours.)
Also, while the studies you mentioned are good, society has limited the doctor’s ability in many cases. We live in a country of frivilous (sp?) ‘sue-happy’ people. So, it’s sad to say, but the following quote is probably true: "Lawyers and H.M.O.'s rule the world!" Add that to the fact that, sadly enough, Er’s are usually understaffed and underbudgeted, and you can see why doctors may be reluctant to give pain meds until they are damned certain what they are treating.
as an EMT-I I only have access to morphine, and only after direct radio contact with an MD. Paramedics have access to MS or Demerol(but generally not both. Most services don’t carry both on their trucks), valium, and N2O (I have yet to see that on a truck) We carry ASA and acetaminophen for non-analgesic purposes. A paramedic can give MS without an MD’s orders in the case of chest pain. Any other instance the drug is desired a paramedic generally has to call for permission as well
Red–
In New Mexico it is actually generally accepted for paramedics and EMT’s to call for prehospital MS. We (EMT-I’s) almost universally recieve the okay for chest pain and extrimity fractures to give MS. On rare occasions I’ve seen medics who an MD trusts get permission for MS in other instances.
Maybe I am young and idealistic, but if the studies can show that titrated doses of pain relief does not hinder, and my even assist in the diagnostic process, why are we not giving more out? How can a lawyer or an HMO argue with a process that benifiates the patients?
[QUOTE Maybe I am young and idealistic, but if the studies can show that titrated doses of pain relief does not hinder, and my even assist in the diagnostic process, why are we not giving more out? How can a lawyer or an HMO argue with a process that benifiates the patients? **[/QUOTE]
you’re right, you’re right, pain medicines, especially the opiate ones, could be used better. But ignorance is as tough to battle in the medical profession as it is in the general public. We haven’t even managed to convince most docs not to give their patients antibiotics for viral infections! And its the regulators, who are mostly lawyer-driven, that set a lot of policy about punishing people who “overprescribe”. And state medical examining boards find that their effectiveness is judged by the people and leaders of their state by the number of doctors it’s disciplined, not by whether what they’ve done makes sense or not. Combine those things with this ludicrous “war on drugs” the government is waging, and the end result is that people who need narcotics will end up being denied them.
[QUOTE]
*Originally posted by Qadgop the Mercotan *
**
I guess then the medical profession will have to do its best to change slowly over time. Is it that the studies are not widely circulated, or is it that medicine is one of the worst professions to go “thats the way I was taught, thats the way I am going to do it reguardless of what we can prove or disprove” – I plan to attend medical school post paramedic school. Maybe I can help make a difference. Or is it that the nail that stands up gets hammered down?
kinoons, perhaps you might like to come to South Australia.
Our paramedics (EMT-P) are licensed to administer morphine under protocol, but I think they are limited to use in trauma. That said, when the protocol requirements have been met, there is no further need to seek medical authority before administration. The same criteria applies for the drugs I am licensed to give (Advanced life Support level - roughly equivalent to your current status).
However, when the situation exceeds the protocol, a medical consult is mandatory before the medication can be used.
I’d love to come to South Australia regardless if I was practicing medicine or not.
New Mexico has a strange system for medical control (supervision of EMS). Our EMT’s have our own licenses, but we have to be “signed off” by a MD who acts as a services medical director. The medical director writes protocols that the EMT follows. Most all services have standing orders for MS in cases of chest pain, (for paramedics, EMT-I’s have to call and ask) and some for isolated extremity fractures. Generally the medic will call for anything not falling under chest pain. The services medical director can be very liberal, giving standing orders for several (if not all) medications, or can be VERY conservative (I’ve seen some services that have to call a doc to start an IV)Everything that is done is under the EMT’s own license. The MD’s are there for QI and to write protocols. I feel its a good system, as long as you can get a MD that is pro-ems and is willing to work to make the system run well.
I was once one of these ‘actors’. Actually, ‘junkie’ is a better word. Around 1980, it was pretty easy to get pain meds from a doctor, especially in the E.R. BTW, we really were in pain, so it was pretty easy to sell it to a doctor. All we had to do was come up with better sounding reason for the pain than withdrawl. For whatever reason, doctors are much harder to fool these days, I’m told.
Read it, agree with it, now if only regulatory agencies would heed it, and all state medical examining boards would require the new recommendations to be read before agreeing to renew each doc’s license.
No matter what we do, addicts will still scam docs and get drugs. This should not discourage docs from prescribing narcotics when, based on the knowledge they have on hand at the time, the patient seems to have a legitimate need for pain.
By the way, it is illegal for physicians to prescribe narcotics to maintain someone’s addiction, except in some very specific cases. The doc can be(and has been) suspended or revoked for knowingly doing so.
Autonomy: Noun; freedom to determine one’s actions; behaviours etc.
however, in DVous Means’s case, this autonomy is limited to their skill and training levels. The level above DVous, has a fair bit more autonomy, but this is only given after 3 years of training to enter the level that DVous is currently at, and then requires another 400 hours clinical training with a lot of “on the road” experience after that. Only then can you enjoy that sort of Autonomy.
Ten years ago, I suffered severe fractures of my right ulna and radius (my forearm curved…really gross to look at). I was taken to the ER, sat down on a bed for a good hour, then finally given a shot of some opioid (I don’t recall which), since it would be another half hour before they could x-ray me and another few hours before they could reduce the fracture.
So, kudos to them for giving it to me. Unfortunately, it did exactly jack. I noticed no difference whatsoever. Maybe it was just saline, those bastards…
Now, when they took me up to reduce the fracture (I probably should have been cut open and pinned, but the doctor was really good and managed to spare me that), the demarol drip did wonders.
So the moral of my pain anecdote: some pain meds aren’t all they’re cracked up to be.
Of course, I wouldn’t mind a little demarol every now and then…
Some months ago the state of Maine mandated that doctors treat pain more aggressively there, under threat to their license, and of prosecution if they did not. Just the other day a news story appeared, saying that Oxycontin, a long-acting opiate, was all the rage in Maine, with a large black market trade going on for it, fueled by people with chronic illnesses like severe arthritis, degenerative joint disease, or migraines, selling their pills for big bucks. The increase in the abuse was linked to the mandate for physicians to prescribe more. The suggested solution was to crack down on those physicians who prescribe it “too freely”, whatever that means.
The level of autonomy varies widely from state to state, country to country – Sense Adolph Peewee practices in a prehospital setting in another country. I am curious what level of autonomy he has compaired to what I can do in New Mexico
