Pain Survey, New Law, A Sandwich

Doctors at the University of Buffalo are conducting a survey on prehospital analgesia. Hit the link below to participate.

Prehospital Analgesia Survey

Providing sufficient pain relief to patients has been probably my number one concern or area that I have been trying to improve in in recent years(aside from trying to provide optimal airway care). I feel that while I am very aggressive with pain relief, I still don't give the patients enough.

I give an initial standing order dose, call for a specified additional amount. For instance, I may give 5mg, call for up to an additional 5 more, but then when I find that insufficient, I don't bother to call back again. I think what I need to do is ask for an opened ended amount titrated to pain. I could say, I've given the patient 5mg, their pain is down to an 8, I'd like to give them an additional 2mg every five minutes titrated to pain and provided their blood pressure is maintained.

I want to go beyond just taking the edge off, I want them to feel no pain, while still being alert. I want them to know their name, but I wouldn't mind if they were singing The Farmer in the Dell either.

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The state recently passed into law a new statue that allows the state Medical Advisory Board authority to allow prehospital providers to perform new treatment methods (provided their sponsor hospital allows them) without having to rewrite the state laws to include them in their scope of practice every time they want to let people do something new. People from many states will say what's the big deal. Here it is a big deal because it is constantly an issue that doctors want someone to do something, but they can't because the law doesn't allow it. A number of years ago, first responders couldn't use defibrillators because the law specificed that only EMTs could use them. Basics could not use combitubes or even give aspirin.

Sec. 5. (NEW) (Effective from passage) Notwithstanding any provision of the general statutes or any regulation adopted pursuant to chapter 368d of the general statutes, the scope of practice of any person certified or licensed as an emergency medical technician-basic, emergency medical technician-intermediate or emergency medical technician-paramedic under regulations adopted pursuant to section 19a-179 of the general statutes may include treatment modalities not specified in the regulations of Connecticut state agencies, provided such treatment modalities are (1) approved by the Connecticut Emergency Medical Services Medical Advisory Committee established pursuant to section 19a-178a of the general statutes and the Commissioner of Public Health, and (2) administered at the medical control and direction of a sponsor hospital, as defined in section 28-8b of the general statutes, as amended by this act.

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Started the day with a two person neck and back transport following a low speed MVA.

Later was sent on an MVA which turned out to be in the next town over. We were canceled en route.

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Seizure at a nursing home. Lasts two minutes, involves left side -- typical for patient. She had a seizure on Sunday after which they did lab work that showed her Trileptal was low. The lab results just came back this afternoon. The doctor ordered her Trileptal up, and before she could be given the pill, she had the seizure. A-O on our arrival. I suggested the nurse call the doctor, since they knew what the problem was, and they already had the order to up her meds. Maybe he wouldn't think it was neccessary to take her in. We want to to go, the nurse said. Okay, fine. I happened to want to go in to the hospital anyway and get a sandwich in the cafeteria because I was hungry. I was just trying to make the system run a little smoother.