I am working with Fiona on this project, perhaps some
background information and the current state of play
would help (including the problems we face).
Until Panorama at least two services (Warwickshire and
Cumbria) used Diamorphine safely and effectively,
albeit technically illegally but tolerated (the
problem is that because diamorh can only be given on a
named patient basis PGDs cannot apply). Politically
the move is to nationalise paramedic guidelines and to
assist with this a number of new drugs were included
on the paramedic list including morphine BUT the
paramedic license only applies to over the age of 12
and, as with diamorphine, PGDs cannot be used to
extend this.
At present IV Nalbuphine continues as the drug of
choice below 12 as it is the only one we have.
We are looking at intranasal diamorph, fentanyl
lollipops, the full range, but the problem is that the
MCA will not approve anything outside of its license
so, for example, technically diamorph is not licensed
via the I/N route - doesn't preclude Drs but would
stop us.
The eventual plan is hopefully to prove morphine safe
in adults (when given by Paramedics) and apply to
change the MCA approval but this may take some time.
The more examples of how other people operate the
better, both in the long term for changing the
morphine license and in the short term for finding an
alternative.
Many thanks
Ian
Ian Todd
Paramedic Officer
Research Fellow, Univ. Warwick.
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