IM injections

boomer_ie · 28-01-2010 05:11PM

sgthighway wrote: »

Just to add - AFAIK all DFB have to be at least EMT even if they don't work on the Ambulances.

Sgthighway I had thought it was Paramedic they had to be hence my surprise on seeing it.

paraletic · 28-01-2010 05:22PM

Sitric wrote: »

I'm quite surprised to hear read you don't carry naloxone. Surely the ambulance service must come across a significant no of overdoses?

What is done at major burn trauma sites? Are patients transported to hospital before being given any pain relief?

Are paramedics allowed give iv medications? Put in an iv line? I know a lot of people know how to do it just wondering if they are allowed?

we carry nalaxone, but only advanced paramedics and up can give it YET, advanced carry morphine, iv, io etc. all we have is entonox, which isn't always great!!

the issue is with our upskilling, which seems to be very slow going. it might sound shocking that we have to call a doctor to give naloxone, but you have to remember that as a service we are improving all the time, just slower than we would like.

hopefully soon we will get the stronger pain relief, not just calpol, and some more drugs to work with....

(I should have read the rest of the posts too!!!)

murf313 · 28-01-2010 06:00PM

paraletic wrote: »

we carry nalaxone, but only advanced paramedics and up can give it YET, advanced carry morphine, iv, io etc. all we have is entonox, which isn't always great!!

the issue is with our upskilling, which seems to be very slow going. it might sound shocking that we have to call a doctor to give naloxone, but you have to remember that as a service we are improving all the time, just slower than we would like.

hopefully soon we will get the stronger pain relief, not just calpol, and some more drugs to work with....

(I should have read the rest of the posts too!!!)

naloxone is in cpg 3. i dont know when these cpg's will be mainstream but in the college we are currently working off them

sgthighway · 28-01-2010 06:19PM

boomer_ie wrote: »

Sgthighway I had thought it was Paramedic they had to be hence my surprise on seeing it.

I know 2 lads that did the EMT and they work in DFB. They jobs depended on it. Mayve they upskill to Paramedics later. These lads were mainly in the Fire Fighting Side of the DFB; not Ambulance. Third man in the Ambulance rings a bell though. Someone from DFB will be along soon to confirm.

emtrgnmb · 30-01-2010 11:04AM

sgthighway wrote: »

@buzzman; It was stored in a Parabag and I don't really want to specify too much about the duty (it would pin point who I am) but it was remote and cold. There were 2 EMTs in the Team

Hi, just wondering what legislaton authorises EMTs to be in possession of a controlled drug??

thanks!

sgthighway · 30-01-2010 05:38PM

emtrgnmb wrote: »

Hi, just wondering what legislaton authorises EMTs to be in possession of a controlled drug??

thanks!

AFAIK there are exemptions under the Misuse of Drugs Regulations. Don't forget that an EMT is a Registered Medical Practitioner. Its important to note the conditions/reasons of when they are in possession.

emtrgnmb · 30-01-2010 05:51PM

sgthighway wrote: »

AFAIK there are exemptions under the Misuse of Drugs Regulations. Don't forget that an EMT is a Registered Medical Practitioner. Its important to note the conditions/reasons of when they are in possession.

In Ireland a Registered Medical Practitioner is a doctor registered with the Medical Council.

EMT/P/AP are Prehospital Care Practitioners.

I appreciate why they might need to carry such a drug and indeed agree where it is appropriate, however I though law was yet to be enacted to allow this.

Odysseus · 30-01-2010 06:16PM

paraletic wrote: »

we carry nalaxone, but only advanced paramedics and up can give it YET, advanced carry morphine, iv, io etc. all we have is entonox, which isn't always great!!

hopefully soon we will get the stronger pain relief, not just calpol, and some more drugs to work with....

(I should have read the rest of the posts too!!!)

I remember getting my leg straightened on the road following a bad crash on the bike, the gas was useless. Compound facture of tib and fib, they had to straighten it before they transported me. In the end I told the lad to turn the gas off and just held the mask to try block out my screams; while he got on with it. I had the usual rubberneckers hanging around, terrible that. It's one thing I took away from that incident, if I can't be of any use to the person, touch on and leave it to the people who can.

It was a relife to get to A+E and get 100mg pethidine iv form the reg. I'm not adding much to the debate, and this a good few years ago, but it would have made a significant difference if I could have being given an opiod at the first point of treatment.

Tango Alpha 51 · 30-01-2010 06:18PM

Morphine in a parabag :eek::eek::eek:. Who signed out the morphine?. How do you get away carrying it in a bag when we have to keep it in a locked safe in the ambulance. Who signed it back in at the end of your duty?.

ivabiggon · 30-01-2010 06:19PM

sgthighway wrote: »

I know 2 lads that did the EMT and they work in DFB. They jobs depended on it. Mayve they upskill to Paramedics later. These lads were mainly in the Fire Fighting Side of the DFB; not Ambulance. Third man in the Ambulance rings a bell though. Someone from DFB will be along soon to confirm.

doesn't make sence you only do third man during a period of time while training and everybody training these days are trained to paramedic standard, also their is no facility in the DFB for issuing personal drugs to individual firefighter/paramedics, so unless they robbed them from the ambulance store in the station they shouldn't have them.

DubMedic · 30-01-2010 11:40PM

buzzman wrote: »

Morphine in a parabag :eek::eek::eek:. Who signed out the morphine?. How do you get away carrying it in a bag when we have to keep it in a locked safe in the ambulance. Who signed it back in at the end of your duty?.

Me thinks this will turn out just like the HEMS conversation.

'I'm sorry, can't contribute anymore etc'.

.

sgthighway · 31-01-2010 06:10PM

buzzman wrote: »

Morphine in a parabag :eek::eek::eek:. Who signed out the morphine?. How do you get away carrying it in a bag when we have to keep it in a locked safe in the ambulance. Who signed it back in at the end of your duty?.

Don't know who signed for it but it was signed and checked when it was given back. I know I cannot sign it out and don't know where to get it.

How do carry morphone to a patient who is far away from the ambulance? The Ambulance with the safe must be very heavy to carry. We were about 3 miles from a road so we had a bag; its much lighter

Tango Alpha 51 · 01-02-2010 04:17PM

You seem to be missing my point. Morphine as most people know is one of the most potent medicines available especially in the prehospital care side of things. It's also one of the most tightly controlled. The PHECC issued cpg's inrelation to EMT's administering morphine IM where a Dr couldn't be in attendance at the patient's side ie halfway down a cliff, up a mountain etc. Having spoken with people in PHECC this means that the morphine would be sent to the pt, not emt's having it in their possession just in case.

I'm not having a go at you personally but I do have an issue with carrying this drug in such a manner.

Who gave you the drug prior to you setting off on your duty?? (not looking for a name just what level of practionner they were)

boomer_ie · 01-02-2010 04:34PM

sgthighway wrote: »

Don't know who signed for it but it was signed and checked when it was given back. I know I cannot sign it out and don't know where to get it.

How do carry morphone to a patient who is far away from the ambulance? The Ambulance with the safe must be very heavy to carry. We were about 3 miles from a road so we had a bag; its much lighter

sgthighway, are you in the Order of Malta or Red Cross?

I only ask because some of your posts imply that you are in one of these two organisations.

I do know that the Order of Malta do not allow EMTs to order Morphine, it is not even listed as orderable for Paramedics through the Orders supplier.

sgthighway · 01-02-2010 05:04PM

The Bag was sealed with a blue tamper proof tie like this one

There was a laminated sheet attached to the bag with a photograph of the contents. I recall it containing 2 x Glucagon IM Boxes (I remember the orange).

I really don't want to say anymore in case I hang somebody but the duty was a call out to somebody who had fallen in a remote area.

DubMedic · 01-02-2010 11:09PM

sgthighway wrote: »

An EMT cannot decide the patient needs Morphine and simple administer it; HOWEVER
An EMT can administer Morphine from an ampoule if instructed to do so by a Doctor (URMPIO) when the Doctor could not get to where the EMT/Patient is; e.g. Injured up on a Mountain.

URMPIO - Authorised under PHECC CPGs under registered medical practitioner’s instructions only

Are you saying that this was the case?.

sgthighway wrote: »

I am not a lawyer but I would seek advise on this if I were you. I can't say 100% that an EMT can carry it but why would PHECC (Professionals like yourself) have a CPG made up and approved for an EMT to give Morphine when a Doctor is not present.

You should know why.

sgthighway wrote: »

I'm a Registered EMT with PHECC and signed up to the 3rd Edition CPGs.
I don't carry Morphine regularly and agree with Buzzman that it should not be carried in a bag.
I only ever had it once before and it was issued to me as I was the leading registered practitioner on the duty.
I don't believe a member of AGS can take it off me if i can verbally justify having it and have my ID. I will check this at our next CPD meet.

Is the organization that you 'were on duty with' signed up to the 3rd edition CPG's?.

sgthighway wrote: »

@buzzman; It was stored in a Parabag and I don't really want to specify too much about the duty (it would pin point who I am) but it was remote and cold. There were 2 EMTs in the Team.

The EMT Standard is good for the likes of Mountain Rescue & Aux Amb Associations where sometimes you are working with differernt crews and you can understand the scope of somebody elses skills. I don't know how the EFRs fair out but the EMTs in my area get together with a Phecc Tutor (mentor) and go through skills as part of our CPD.

You're attached to Mountain Rescue then, yes?.

sgthighway wrote: »

AFAIK there are exemptions under the Misuse of Drugs Regulations. Don't forget that an EMT is a Registered Medical Practitioner. Its important to note the conditions/reasons of when they are in possession.

No, a PHECC-EMT is a registered pre-hospital care practitioner.

sgthighway wrote: »

The Bag was sealed with a blue tamper proof tie like this one

There was a laminated sheet attached to the bag with a photograph of the contents. I recall it containing 2 x Glucagon IM Boxes (I remember the orange).

I really don't want to say anymore in case I hang somebody but the duty was a call out to somebody who had fallen in a remote area.

In case you hang somebody.. like who?.

.

Tango Alpha 51 · 02-02-2010 06:51AM

sgthighway wrote: »

The Bag was sealed with a blue tamper proof tie like this one

There was a laminated sheet attached to the bag with a photograph of the contents. I recall it containing 2 x Glucagon IM Boxes (I remember the orange).

I really don't want to say anymore in case I hang somebody but the duty was a call out to somebody who had fallen in a remote area.

That's the system we use in the HSE NAS. Who are you going to hang ??. What level was the practioner that gave you the drug/drug bag & can you clarify your last point in the above quote

paraletic · 03-02-2010 11:26AM

Odysseus wrote: »

I remember getting my leg straightened on the road following a bad crash on the bike, the gas was useless. Compound facture of tib and fib, they had to straighten it before they transported me. In the end I told the lad to turn the gas off and just held the mask to try block out my screams; while he got on with it. I had the usual rubberneckers hanging around, terrible that. It's one thing I took away from that incident, if I can't be of any use to the person, touch on and leave it to the people who can.

It was a relife to get to A+E and get 100mg pethidine iv form the reg. I'm not adding much to the debate, and this a good few years ago, but it would have made a significant difference if I could have being given an opiod at the first point of treatment.

sorry you had to suffer, unfortunattly this happens very often, the ugly fact is, our pain relief (entonox) is not good enough. we do call for advanced care (for the strong stuff) but that can take a long time to arrive, IF it is available at all.

on a selfish note: it is also embarising for us to have to tell a patient or their family, that a paramedic can't help with the pain!!

paraletic · 03-02-2010 11:42AM

sgthighway wrote: »

The Bag was sealed with a blue tamper proof tie like this one

There was a laminated sheet attached to the bag with a photograph of the contents. I recall it containing 2 x Glucagon IM Boxes (I remember the orange).

I really don't want to say anymore in case I hang somebody but the duty was a call out to somebody who had fallen in a remote area.

maybe, the only thing taken from the drug bag was a flush... i hope so.

in our area, if the drug bag had a BLUE tag, that means it should NOT have morphine in it. Moprphine should not be kept in the drug bag, it should be in a pouch in a locked safe, (A red tag means that something has been used.)

I don't think we'll get to the bottom of this story;)
it does sound like somebody messed up though!
however we weren't there, so we don't know what happened.

hopefully the outcome for the patient was positive.

Elessar · 03-02-2010 11:47AM

paraletic wrote: »

sorry you had to suffer, unfortunattly this happens very often, the ugly fact is, our pain relief (entonox) is not good enough. we do call for advanced care (for the strong stuff) but that can take a long time to arrive, IF it is available at all.

on a selfish note: it is also embarising for us to have to tell a patient or their family, that a paramedic can't help with the pain!!

It's my understanding that eventually AP meds and cpgs will filter down to Paramedic level. Did you hear anything about that?

paraletic · 03-02-2010 12:19PM

Elessar wrote: »

It's my understanding that eventually AP meds and cpgs will filter down to Paramedic level. Did you hear anything about that?

that would be great (if training was available) - unfortunatlly we only hear romours. did hear about cyclomorph -but prob just rumour

Hooch · 03-02-2010 05:35PM

Topic.....stay on:)

sedgley · 04-02-2010 02:04AM

God there's some amount of nonsense and oneupmanship on this thread and threads of this type, usually from vols bitching about how this should be done and how that should be stored. To clear up a few things i've seen;

There is no such thing as an Advanced Paramedic in the United Kingdom. Instead, UK Paramedics have a similar clinical level.
UK NHS Ambulance Trusts have a policy of one Paramedic (UK) and one Emergency Medical Technician to drive and assist. You are safer in a UK ambo than an Irish one simply because all ambos have at least one person who can intubate and infuse patients.
Emergency Medical Technician has replaced Ambulance Technician and Assistance Ambulance Practitioner in most trusts in Eng/Wales.
DFB Firemen are trained to Paramedic minimum, not EMT and ALL staff must crew an ambulance on a rota basis.
No bloody way should anybody other than a doctor be carrying Morphine in any way, shape or form.
EMT is hardly comparable to the EFR course as it is a far higher clinical level. Remember its only a week long.
It is not possible to "upskill" to Paramedic in this country, (which is simply a disgrace in my honest opinion)

Lets talk about IM injections like at the start. I think EMTs should be allowed to administer Epinephrine IM manually. I also believe that IM Naloxone should be added to the matrix.

boomer_ie · 04-02-2010 08:21AM

sedgley wrote: »

[*]UK NHS Ambulance Trusts have a policy of one Paramedic (UK) and one Emergency Medical Technician to drive and assist. You are safer in a UK ambo than an Irish one simply because all ambos have at least one person who can intubate and infuse patients.

Incorrect, as I pointed out previously some ambulances in the UK are crewed by Emergency Care Assistants have a look at the forums on http://www.ambulance999.co.uk for details of this.

sedgley wrote: »

[*]Emergency Medical Technician has replaced Ambulance Technician and Assistance Ambulance Practitioner in most trusts in Eng/Wales.

The NHS in UK use Ambulance Technician or Paramedic title, all such jobs are advertised as such and not as Emergency Medical Technician.

sedgley wrote: »

Lets talk about IM injections like at the start. I think EMTs should be allowed to administer Epinephrine IM manually. I also believe that IM Naloxone should be added to the matrix.

Agreed, Mods is it possible to split the thread into appropriate sub threads?

EDIT:

sedgley wrote: »

[*]There is no such thing as an Advanced Paramedic in the United Kingdom. Instead, UK Paramedics have a similar clinical level.

I had been wondering where this came from until I read back through the entire thread, and saw the post you were referring to that may have implied I was saying there were Advanced Paras in the UK. What I had ment was the Paras and Adv Paras in Ireland being freed up to do 999 calls not anything to do with the UK.

Shield · 04-02-2010 09:55AM

boomer_ie wrote: »

Agreed, Mods is it possible to split the thread into appropriate sub threads?

Not really, but we can lock this one and you can start a new one if you want? We can then move or copy posts to the new thread to facilitate discussion.

paraletic · 04-02-2010 10:03AM

sedgley wrote: »

God there's some amount of nonsense and oneupmanship on this thread and threads of this type....

thats coz we're (all) always right, and, we have too much time on our hands

sedgley wrote: »

....Lets talk about IM injections like at the start. I think EMTs should be allowed to administer Epinephrine IM manually. I also believe that IM Naloxone should be added to the matrix.

i agree with the above, but the OP was asking how often we have used IM interventions, and i'd be curious too. (i have give 3 IM in a year).

(we do have a tendancy to go of the point, sorry mods)

Vorsprung · 04-02-2010 01:29PM

Haven't read through all of this thread (laziness, night shift) but in Queensland, Paramedics give IV (not a typo) morphine routinely.

sedgley · 04-02-2010 11:42PM

boomer_ie wrote: »

The NHS in UK use Ambulance Technician or Paramedic title, all such jobs are advertised as such and not as Emergency Medical Technician.

Ambulance Technician is no longer. They still exist but are being phased out. Although they may advertise under this title, the new titles are EMT and ECA. I have just been accepted to North West Ambulance Service as an EMT-1, however it was originally advertised as Assistant Ambulance Practitioner.

boomer_ie wrote: »

I had been wondering where this came from until I read back through the entire thread, and saw the post you were referring to that may have implied I was saying there were Advanced Paras in the UK. What I had ment was the Paras and Adv Paras in Ireland being freed up to do 999 calls not anything to do with the UK.

That was just to clear that up, wasn't a dig at your post.

05-02-2010 11:32PM

Is the uk's emt equivalant to our emt or is it our paramedic level?

boomer_ie · 05-02-2010 11:47PM

eireal wrote: »

Is the uk's emt equivalant to our emt or is it our paramedic level?

Eireal

Short answer is it depends

there are 1 week EMT courses in UK and there is an EMT version if IHCD Ambulance Technician now apparantly.

Phecc will look at each case individually before stating they are equivilent to EMT or para etc.

IM injections

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