Pain Management - Is It An Important Focus Of Medical Care?

[ParamedicFNPwantabe]

As a current Paramedic working on transitioning to the dark side I read the following article and thought does nursing or any other medical profession really not understand the importance of pain management or is it really just an EMS problem? Having been a patient as well as an EMT and now a Paramedic I have experienced a number of different attitudes towards patients pain both prehospital and in hospital. So I guess really I am interested on what to expect as I advance in my education and move indoors in regards to pain management.

I also hope the article might also give you as a Nurse an ideal of why the patients you see brought in by ambulance may not all be treated the same way for the same injury or illness.

http://www.associatedcontent.com/article/5930346/is_an_ambulance_an_ambulance_the_differences.html?cat=5

[linearthinker, DNP, RN]

Whew ... are you sure you want to "go there" with this comment? Is it helpful?

Altra, CEN, CCRN

Is it somehow innapprorpate to say what my expectations are when I call an ambulance? I expect a ride to the hospital. I don't expect to be diagnosed and treated by ambulance personnel. I work directly with many fine paramedics whom I like and respect quite a bit. I don't want them making independent treatment decisions for me or my loved one that they re not qualified to make. That is not a negative reflection upon them, it is recognition of their appropriate role in the health care delivery system. I flew life light for years and worked with the best. I know what the best are capable of, and it doesn't include the kind of leeway the OP suggests paraprofessionals ought to have. What we did we did extremely well, but we didn't make independent treatment decisions. At no time have I ever been offended to have my scope of practice or professional limitations commented upon.

[CrufflerJJ, BSN, RN, EMT-P]

Is it somehow innapprorpate to say what my expectations are when I call an ambulance? I expect a ride to the hospital. I don't expect to be diagnosed and treated by ambulance personnel. I work directly with many fine paramedics whom I like and respect quite a bit.

Interesting....you have worked with paramedics who you "respect quite a bit", yet you expect them to merely give you a ride to the hospital and not treat you.

Admittedly, medics will/should not "diagnose" their pts. To apparently suggest, however, that they should not even begin treatment covered under their training/certification/scope of practice doesn't quite seem to reflect your level of "respect" for them. Should we go back to pre-Johny & Roy days of heorifices for pt transport? After all, some folks apparently just want a ride to the hospital with no treatment. This could be an excellent money saving opportunity (sarcasm warning)!

Get rid of all that useless oxygen, meds, cardiac monitoring, and training. Replace the ambulance personnel with a 16 year old with a driver's license. After all, he/she will be able to provide the required "ride to the hospital."

[linearthinker, DNP, RN]

I don't see Any reason for the hostility I'm inferring. You want to be upset, go ahead. Opinion were sought on an open forum, I gave mine. I think it's clear, so I won't elaborate further.

[ZippyGBR, BSN, RN]

I don't see Any reason for the hostility I'm inferring. You want to be upset, go ahead. Opinion were sought on an open forum, I gave mine. I think it's clear, so I won't elaborate further.

I don't know what planet or century you are posting from, but health professionals make determinations of patient condition all the time, it's pussyfooting around the issue to suggest that only physicians can make diagnoses or only physicians have the magic 'trained hands' to aloow them to make diagnostic decisions based on physical signs ...

While Paramedics in the USA are in the main not true health professionals ( in the way that they are in the UK or in the Dutch - Scandinavian systems ) they are still expected by their professional standards to make determinations and 'diagnoses' to guide their treatment and transport options, comments about the duration and clinical exposure of student paramedics in the USA could also be compared to the situation with Nurse education in the USA.

I presume you are also opposed to Nurse Prescribers, Patient Group Directions/ standing meds orders and Nurse / AHP requested investigations ? because after all we have have to make ' determinations' about patients status to undertake these roles ...

[BluegrassRN]

This has been a very instructive discussion. I appreciate the insight offered by those with more experience than myself.

[ParamedicFNPwantabe]

This is interesting. At least in the article mentioned in my original post the difference was EMT's can not give pain medicines in 95% of services while most Paramedics can administer pain medicine. It surprises me to see in the nursing field so many differences in opinion on use of pain management. It also surprises me to see so many that hold to the old ways that no pain medicine is best so you can properly diagnose or see changes. Then to see someone basically say either no pain medicine or "snow" the patient, there is such a thing as titrated to relief. I am a firm believer in giving pain relief.

There is no properly educated Doctor that can not make a proper diagnosis on a patient that has had pain titrated to relief(note titrated not "snowed"). If it is something they are running into problems with they can even reverse the effects of the narcotics.

I am almost offended but more saddened that some think so poorly of Paramedics to demand only a ride. You must have been exposed to some of the worst Paramedics and lumped all of us into that group. It would be like me taking some of the RN's I have met that should never have been allowed to get near a patient and deciding because of them all RN's are horrible and should do nothing but wipe butts. I assure you that many of us "ambulance drivers" actually are very good patient care providers. Myself I am often requested to the ER when the RN's are not able to accomplish something. Why am I better than them? No but because I work a different environment I sometimes I can think of a different way to accomplish what is needed. It is a two way street though I do not hesitate to ask them if there is something I am having difficulty with. We are on the same team as patient advocates and as such should work together.

[CRF250Xpert]

I do t want a paramedic making any determination about my neuro status. I just want them to drive me to the ED.

lol...then you've obviously never taken report on the radio from that paramedic who gives you GCS on the scene or before he intubated the PT. Sorry, but paramedics are actually intelligent and know the same neuro exam you do. They probably conduct it 15 times a day more than you do unless you work on a spine or neuro floor.

[OttawaRPN]

While Paramedics in the USA are in the main not true health professionals ( in the way that they are in the UK or in the Dutch - Scandinavian systems ) they are still expected by their professional standards to make determinations and 'diagnoses' to guide their treatment and transport options, comments about the duration and clinical exposure of student paramedics in the USA could also be compared to the situation with Nurse education in the USA. .

Add Canadian paramedics to your list. We have several levels but ACP (advanced care paramedic) or CCP (critical care paramedic) especially have rigorous entry requirements and training and do way beyond what we nurses can do - ET/NT intubation, surgical airways, CVAs, a ton of meds, some can even do thoracotomy. Yeah, you bet I'd trust them with my life.

[leslie :-D]

I do t want a paramedic making any determination about my neuro status. I just want them to drive me to the ED.

this was my initial thought, too.

but after reading subsequent responses to your post, i have to admit that my 'kudos' to you, was based on 100% ignorance.

and the irony is, i resent it when the public hasn't a clue, as to what we nurses do, day in and day out.

yet, i was judging emts/paramedics on my ignorance.

and so, to all paramedics/emt's, if you guys stabilize pts and intervene as we nurses do, then yes, i would definitely want you doing your thing, en route to a hospital.

my sincere apologies, and kudos to y'all, for the enlightenment, and doing what you do.

finally, maybe i am wrong about not medicating for certain conditions.

i'm not sure yet.

but when usalsfrye responded to my allegation, that appy pts shouldn't be medicated, s/he noted that anyone would writhe/scream in pain, when palpating rlq.

duly noted, usalsfrye.

i'm just not 100% convinced yet, that we can always medicate w/o doing harm.

i have to believe that dr's, with their extensive training, must know something more than we do...most times.

leslie

[ParamedicFNPwantabe]

.

i have to believe that dr's, with their extensive training, must know something more than we do...most times.

leslie

Keep in mind that some Doctors like many other professionals do not always stay current with science. They continue doing things they have always done. So even though they have a great more education than most of us does not always mean it is current education.

[leslie :-D]

Keep in mind that some Doctors like many other professionals do not always stay current with science. They continue doing things they have always done. So even though they have a great more education than most of us does not always mean it is current education.

i agree, para.

still, does that mean we nurses, know more?

my point being, it's hard to feel righteous when uncertain about implications.

the example of my hospice pt, i still think applies.

maybe it was malpractice...but if slurred speech is the only indicator of a brain tumor, why would anyone think it was anything other than being overmedicated w/narcs?

if he hadn't been medicated, maybe he would have shown other s/s, i.e., headache, acute ms changes, etc.

that's all i'm saying.

leslie

[ParamedicFNPwantabe]

i agree, para.

still, does that mean we nurses, know more?

my point being, it's hard to feel righteous when uncertain about implications.

the example of my hospice pt, i still think applies.

maybe it was malpractice...but if slurred speech is the only indicator of a brain tumor, why would anyone think it was anything other than being overmedicated w/narcs?

if he hadn't been medicated, maybe he would have shown other s/s, i.e., headache, acute ms changes, etc.

that's all i'm saying.

leslie

If patient is Hospice perhaps he only wanted pain management and no other treatment. I deal with Hospice often and many patients are strictly comfort measures only.