Can paramedic or EMT administer an IM med like Haldol or Ativan to help unruly pt?

Altra, BSN, RN · May 13, 2011

For those who are concerned about "not knowing what's going on". People generally don't make their medical condition better by being combative. The head injury is doing nothing good for his ICP and hypoxia. The meth/crack/PCP overdose is not helping out his base metabolic rate (and the resultant tissue hypoxia) by trying to kick your rear end into next week. The alcohol OD isn't helping out his airway. If we sedate these patients into airway compromise (unlikely) we have the tools, from a jaw thrust and suction all the way up to plastic between the vocal cords, to deal with this. Yes a sedated patient may slow down hospital course, but it will be certainly less slowed down than wrestling my patient to the hospital, stopping in the ED and waiting for a doc to provide orders for sedation and/or intubation, then gathering the staff/equipment/meds and performing said intervention prior to being able to perform any diagnotstics.

I agree. While transport times are generally 15 min. or less in my urban area (longer transports are often flown), I agree that there is nothing safe for the patient or for medics about 15 minutes of attempted ass-kicking in the back of a truck.

In my area, Versed, Ativan, and Valium are all carried on ALS trucks.

The only people who object to some sedation in the field are neuro residents.

usalsfyre · May 13, 2011

Some Paramedics can but it also comes down to their intent. If it is for abuse or amusement or for lack of understanding of certain medical conditions which has come into controversy in recert times with the "dart" treatment, that is an entirely different situation. If it is for controlling a patient who requires medical treatment, with the appropriate documentation, great.

I know a lot of medics. A LOT of medics. I have NEVER heard of a sedative being used in the manner you described. Even from the dumbest, hates medicine, came from a six month mill, would rather be on the engine firemedic. Sure, jokes may be made about "vitamin A" but it's the same stuff I hear from the ED.

Please explain to me how sedatives for a combative patient is in ANY way inapproprite? Even hypoxic patients can benefit from a benzo to facilitate proprer ventilation.

I haven't heard of any controversy surrounding sedative use other than from a few, older behind the times docs. Has something been going on I don't know about?

Editorial Team / Moderator · May 13, 2011

The Paramedic training does not contain much critical care training as far as medications and equipment. There is not even enough A&P to build for a good foundation for critical care knowledge at the appropriate level in the majority of programs in the US. Their rotations in the critical care world during their clinicals is slim to nil in some places.

TraumaSurfer, Every time I read your commentary on the state of EMS education, I am VERY thankful for my medic program -- solid A&P foundation (even a cadaver lab, no kidding!), tons of clinical time in critical care environments. I got lucky.

Where I ran as a paramedic (until I left for the Army in March), we have Versed in our box/protocols for unruly patients. Where I worked in the ED, the county medics do indeed carry Haldol, though I've never seen them use it.

TraumaSurfer · May 13, 2011

I know a lot of medics. A LOT of medics. I have NEVER heard of a sedative being used in the manner you described. Even from the dumbest, hates medicine, came from a six month mill, would rather be on the engine firemedic. Sure, jokes may be made about "vitamin A" but it's the same stuff I hear from the ED.
Please explain to me how sedatives for a combative patient is in ANY way inapproprite? Even hypoxic patients can benefit from a benzo to facilitate proprer ventilation.
I haven't heard of any controversy surrounding sedative use other than from a few, older behind the times docs. Has something been going on I don't know about?

At no time did I say sedatives were inappropriatet for the right use.

Are you going to tell me you are familiar with all the EMS agencies everywhere and are you always given information that might be considered privileged to the parties involved? Not everyone wants their dirty messes out in plain view of everyone to scrutinize if there is a complaint made. You may also not realize all the controversies behind sedatives or the lingo of some areas like "Dart". It is similar to the way some say "Bus" instead of ambulance. There have even been articles published about giving Versed to someone in police custody.

Let me ask you this, have you ever heard of someone giving Narcan just to see a reaction when it may not be appropriate? How about giving a paralytic without sedation even if BP could tolerate it? Ever hear of some of the painful "faker" maneuvers to get a response? Have you ever worked in a large city with many different EMS agencies or a large city hospital that sees dozens of EMS units each shift?

I see you dislike firefighters which would be part of your argumentative way. There are just as many private ambulance Paramedics from the the back room ambulance companies as well as those from these mills.

TraumaSurfer · May 13, 2011

TraumaSurfer, Every time I read your commentary on the state of EMS education, I am VERY thankful for my medic program -- solid A&P foundation (even a cadaver lab, no kidding!), tons of clinical time in critical care environments. I got lucky.

Yes, and some can put on blinders and ignor or deny there are any issues with EMS and all is nothing but roses. This is what keeps EMS from achieving what so many other professions have including nursing.

Haven't you even been the least bit curious why every state can do its own thing for certifying exams and that there have been over 40 certs without much consistency among the 50 states? Have you ever wondered why Texas could certify a Paramedic in as little as 600 hours and Kansas is one of two states that prefers an Associates?

Consider yourself very lucky especially if none of the problems of EMS affect you.

Medic2RN, BSN, RN, EMT-P · May 14, 2011

When I worked as a firefighter/paramedic, we had Haldol and Ativan for 'behavior modification'. Like some have mentioned before, there are different levels of EMS protocols according to the area, the department and medical director. We had very aggressive protocols and a medical director who would train us personally to his expectations. I learned a lot from him.

micuRNEMTP · May 17, 2011

The Paramedic training does not contain much critical care training as far as medications and equipment. There is not even enough A&P to build for a good foundation for critical care knowledge at the appropriate level in the majority of programs in the US. Their rotations in the critical care world during their clinicals is slim to nil in some places. Even the pathetic CCEMT-P course is barely a good overview and no company should ever believe a Paramedic is capable of doing critical care transport right after that course. But, unfortunately many do. The sooner you realize the limitations of the Paramedic the sooner they can get around to seeing they need to advance their education. Paramedics in other countries have the equivalent of a Bachelors degree and then go on for post grad work to do critical care transport.

So I am confused as to your extensive knowledge of the EMS profession, specifically NREMTPs. Obviously you are not a Nationally Registered EMT Paramedic, of course the old "brotherhood" may have been lost on you. I was first certified as a Paramedic in 1993, and have maintained that even today. I am required by my state's Department of Health to maintain Continuing Education, as well as attend Refresher/Update classes. Each state has different requirements, but this is no different that each state's requirements to be a Registered Nurse. Some states allow "fly by night" schools such as Platt College (pass rate

I am not sure where you got your information from, but the training that I received was from a college based program. Before one could even apply to the program, they had to complete the same course requirements of the Registered Nurse program. Anatomy / Physiology, Chemistry, Pharmacology, Biology, College Algebra, etc//

As for requirements, I will concede that years ago the foundational knowledge required to be a Paramedic/ Registered Nurse for that matter, was entirely minimal at best.

But I will clarify all of this with, no amount of "education in a classroom" will prepare you to be a critical care anything. As a CCRN and Paramedic, no amount of "classroom" time prepared me more to do my job, than actual hands on time doing the job. And just so that you are aware, after the pharmacology class, my Paramedic program force fed medication information to us every step of the way. We were required to know nearly every single detail regarding over 200 different medications that Paramedics would potentially come into contact with or use. This does not take into account the ACLS meds, or illegal varieties. I can assure you, my RN program did not require anywhere close to this amount.

Oh well, this CCRN/EMTP has to get to work. Can't play online paramedic today...

ImThatGuy, BSN, RN · May 17, 2011

So we're watching "Cops" and the episode showed a belligerent person being sat on the back of an ambulance or treatment of a cut on her face. She was kicking and screaming, so the police officer threatened to tase her. We were wondering, once someone is placed in the ambulance, can the paramedic or EMT administer an IM med like Haldol or Ativan to help control their behavior? I'm guessing so, but my husband doesn't think so. Anybody in emergency medicine know?

I'm sure this was brought up in other replies.

It's going to depend solely on the state legislation governing scope of practice for EMS providers in that state. Can ground unit paramedics in my state do it? No. Can they deliver IM meds? Yes. Do they? Yes, and I have as well. We carried diazepam for seizures and sedation for cardioversion although we'd never actually use it for a cardiovert. No time to waste if it's needed in the field. If my state allowed Haldol or Ativan and it was in the protocols do it then yes they could here.

I believe Haldol is within the scope of air units. They have a longer list of admissable drugs, and no they're not all staffed with nurses.

Having said all that I'd rather tase someone. I've tased a few people in my LE career. The gratification is much greater than giving any medication.

ImThatGuy, BSN, RN · May 17, 2011

TraumaSurfer, Every time I read your commentary on the state of EMS education, I am VERY thankful for my medic program --

You and me both, Lunah.

I feel the foundation there was much better than anything nursing school has thus far offered.

TraumaSurfer · May 17, 2011

So I am confused as to your extensive knowledge of the EMS profession, specifically NREMTPs. Obviously you are not a Nationally Registered EMT Paramedic, of course the old "brotherhood" may have been lost on you. I was first certified as a Paramedic in 1993, and have maintained that even today. I am required by my state's Department of Health to maintain Continuing Education, as well as attend Refresher/Update classes. Each state has different requirements, but this is no different that each state's requirements to be a Registered Nurse. Some states allow "fly by night" schools such as Platt College (pass rate
I am not sure where you got your information from, but the training that I received was from a college based program. Before one could even apply to the program, they had to complete the same course requirements of the Registered Nurse program. Anatomy / Physiology, Chemistry, Pharmacology, Biology, College Algebra, etc//
As for requirements, I will concede that years ago the foundational knowledge required to be a Paramedic/ Registered Nurse for that matter, was entirely minimal at best.
But I will clarify all of this with, no amount of "education in a classroom" will prepare you to be a critical care anything. As a CCRN and Paramedic, no amount of "classroom" time prepared me more to do my job, than actual hands on time doing the job. And just so that you are aware, after the pharmacology class, my Paramedic program force fed medication information to us every step of the way. We were required to know nearly every single detail regarding over 200 different medications that Paramedics would potentially come into contact with or use. This does not take into account the ACLS meds, or illegal varieties. I can assure you, my RN program did not require anywhere close to this amount.
Oh well, this CCRN/EMTP has to get to work. Can't play online paramedic today...

For Paramedic requirements you can confirm the state requirements by just going to the EMS website for that state.

Here's a listing for you.

http://www.emsworld.com/survey/

Here's a link to the NREMT website also for you to refresh what it actually is.

http://www.nremt.org/

Only Kansas and Oregon requires a two year degree. You can also compare all the titles for EMS and how they differ along with the different exams when not all states require the NREMT. How many different exams are there to become a Registered Nurse? Is there a different exam for each state? Is there another title other than Registered Nurse used by the states? Example for EMS: Paramedic, EMT-P, MICP and MICT - titles for essentially the same level but different states.

I don't think anyone said a Paramedic does not need CEs.

I am not familar with Platt College for nurses but the online information shows it is an AS program of some type which is not exactly over night.

Are you familar with the 3 month Paramedic courses?

http://www.teex.org/teex.cfm?pageid=training&area=teex&Division=ESTI&Course=EMS135&templateid=14&navdiv=ESTI

http://programs.mpcc.edu/Accelerated_EMT-Paramedic.html

I'm also not saying that a Paramedic can not take a college course in the sciences or get a degree but the questions are how many programs requires such courses and how many Paramedics bother taking such courses if not required?

Why did you bother becoming an RN if you knew it all already?

How much hands on time did you get as a Paramedic working in the ICU as a primary without the supervison of an RN?

You put CCRN with your name. Does that mean you were allowed to work in the ICU for hands on experience as an RN? Did you not get a chance to learn anything as an RN if you worked in the ICU or was it all a waste of time for you since you already knew everything as a Paramedic? Do you believe the RN is too stupid to learn 200 meds or ACLS?

Did you not understand that the RN degree was a foundation for what was yet to come and the education did not stop at graduation? Do you know the difference between that and the tech school prep for job readiness of a Paramedic? Once you understand these basic concepts you will know a little more about the different type of educational methods and the certification process for licensing. Bash nursing if you want but at least they have pulled their profession together for some common standards for education and testing. EMS has yet to do that. So I do not consider nursing to be a useless profession and EMS could learn a few things from the way they have managed to raise the standards for over 3 million nurses.

TraumaSurfer · May 17, 2011

You and me both, Lunah.
I feel the foundation there was much better than anything nursing school has thus far offered.

I will ask you again, why are you attempting to become a nurse if you feel they are inferior to you as a Paramedic in training, eduation and scope? You have repeatedly made comparisons of how low the standards are for nursing and how great your Paramedic training is but I don't believe you are working in either profession.

ImThatGuy, BSN, RN · May 17, 2011

I will ask you again, why are you attempting to become a nurse if you feel they are inferior to you as a Paramedic in training, eduation and scope? You have repeatedly made comparisons of how low the standards are for nursing and how great your Paramedic training is but I don't believe you are working in either profession.

And you have repeatedly made it obvious that you think paramedics are knuckle dragging, idiots incapable of doing anything but scooping up bodies onto ambulances and proceeding at a modest rate of speed to the nearest hospital where critical care nurses will step in and save their lives despite the presence of other members of the healthcare team. Long sentence!

I talk about nursing school because I'm in nursing school. I'm a critical student. This isn't my first degree. I've made it clear to you that I do not work in EMS anymore nor do I want to. I've made the comparison before that I believe a lot of the essential knowledge a healthcare provider must have was presented to me better in paramedic school than this BSN program (that's nursing) does. I'm not hiding this!

Why did I get into nursing school? To become a plumber. Seriously, you're asking that? Let's see one becomes a RN after passing a licensing exam which you can't take until you've passed an accreditted program of nursing education which one usually does at an institution of higher education. Do you think lawyers go to law school just for the hell out if it?

EMS and nursing are and should be two different fields. Can a RN be trained/educated to be a paramedic? Yep! Can a paramedic be trained/educated to be a RN? Yep! As both fields have grown they have taken on additional roles and furthered their credentials? Some states allow RNs to work ground ambulances in place of paramedics. My state does not because the requisite education/training of a field provider is not included in nursing school. Yes, any person could read a book or sit through a few lectures and learn field-necessary material. There is no CCEMT-P here (thank God) because I'm guessing the legislature and governor's advisory council doesn't feel (thank God) that a few day course is adequate in training a classroom trained paramedic in critical care medicine.

Paramedics came about to help heart attack victims, and they generally do that rather well. They spawned from EMTs who were needed to help with motor vehicle collisions victims. They are PREhospital providers that have inherited interfacility transport because it's safer for the patient than loading up in the family station wagon with a defib and oxygen bottle and hoping for the best. I don't think they have any business (even though they can indeed learn) going out and doing PICC lines, sutures, or administering antibiotics. Likewise, I don't think medical-surgical nurse (which is basic nursing) has any business running out to an ambulance rushing to pluck a trauma code out from under the axle of a tractor trailer.

I'm very much in favor of nurses and medics doing their jobs well and learning as much about each other and from each other as possible. I feel like each profession should maximize their learning and do what they're licensed to do damn good.

By the way, TraumaSurfer, you're the one that won't share exactly what it is you do for a living. You're certified as a paramedic, but what is it that you do? You're a hospital tech now? Is that it?