Ray, did your guidelines allow administration in children by *paramedics*?
If so, have you got any audit data that might be used in an argument for (or
indeed against) opiate use in children before hospital by them?
I was as surprised and disappointed as anyone when it was decided that
morphine use would be restricted to over twelves.I do not know of any
special evidence of bad outcomes (selectively) in children in the
prehospital setting. As soon as it was announced, I asked about using
intranasal diamorph (as that was the opiate I knew had been studied using
this route in kids) and was advised paramedics couldn't use it for the
reasons Ian Todd kindly expanded on in his post.
So if people can continue to give me any experience they have with
*paramedics* using any opiates prehospital anywhere in children I would be
grateful. Thus also my post re wanting other ideas - even if the request is
resubmitted it'll take time to process. It seems a shame that areas
succesfully using opiates were stopped but I gather it was the law.
Thank you everybody for your help and support so far!
Fiona Jewkes
----- Original Message -----
From: "rmcglone" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, October 01, 2001 8:03 PM
Subject: Re: Prehospital Analgesia for Children
> The Consultant Cardiologist (Dr.Robson) at Carlisle initially introduced
> diamorphine pre 1990 when he was Chairman of the Local Paramedic Steering
> Group. Although the Dept of Health knew about it they did not act against
> the Committee as once introduced it was difficult to explain the reasoning
> behind withdrawing it to the local crews and patients! It was self evident
> common sense to give the Paramedics something to provide adequate pain
> relief for the patients. Cumbria was not the only Ambulance service to
> introduce opiates. Of course if anything had gone wrong our heads would
have
> rolled ref : Sword of Damocles, 4th Century BC. see below
>
> There has been reference to giving Morphine intra nasally, diamorphine is
> superior simply because you can use a concentrated solution that is twice
as
> potent. I use 5 mg diamorphine in 0.5 ml of water. An intra nasal spray
> would be better and I understand that this is being developed.
>
> Colin wrote, "Cumbria Ambulance do take some unusual views when it comes
to
> selectively interpreting guidelines!" I think such comments need to be
> explained or not mentioned, otherwise it could be seen as mud slinging. I
> seem to remember a saying about stones and glass houses.
>
>
> Ray McGlone
> A&E Consultant
> Lancaster
>
>
> REF: A Sword of Damocles: an imminent danger; a constant threat,
especially
> in the midst of prosperity.
>
> Damocles (4th Century BC) a courtier of Dionysius the Elder, tyrant of
> Syracuse. Having extolled the happiness of royalty he was invited to a
> sumptuous royal feast , but on looking upwards he saw a sharp sword
suspened
> over his head by a single horse hair. Thus the tryant stressed the
constant
> danger there is surrounding power.
>
> ----- Original Message -----
> From: "Colin Hendry" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Sunday, September 30, 2001 10:46 PM
> Subject: Re: Prehospital Analgesia for Children
>
>
> > > This may sound like a stupid question , but i am interested in the
> > > legalities of Cumbria Ambulance service use of Diamorphine, as I was
> > under
> > > the impression that CDs could not be given under a group protocol or
> > similar
> > > except in a certain set of limited circumstances which have never
> included
> > > ambulance services and / or diamorph.
> > >
> > > but if you don't ask the stupid questions you don't learn
> > >
> > > Martyn Hodson
> >
> > I believe that officially it is a trial (which just happens to have
lasted
> > for some time). As to how they got round the legal situation, I don't
> know,
> > but Cumbria Ambulance do take some unusual views when it comes to
> > selectively interpreting guidelines!
> > Ray is on the Paramedic Steering group so I am sure he will provide
> further
> > information.
> >
> > Colin Hendry
> >
> >
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