In South Africa our paramedics have been given the protocol for Morphine
I.V. since early this year: A summary follows:
Indications:
1) Acute severe pain
2) Cardiogenic pulmonary oedema
Side Effects: - the standard list of 10+ effects
Contra-indications:
Known allergy or hypersensitivity
Special Precautions:
1) Elderly patients and babies <1 year
2) Pregnancy
Dosage and Administration:
Dilute MS with N/S to 1mg/ml
Adults: administer in 1 - 3 mg increments over 3 min I.V. with titration of
effect with Max 15mg total.
Children: 0,1mg/kg I.V. slowly over 5 min
Keep Naloxone ready in case of Respiratory Depression
The full protocol is +/- 2 pages long, but those are the pertinent points.
It must be remembered that Radio Medical Consent must still be sought from
the Supervising Medical Officer prior to MS use.
Also all S.African paramedics are registered with the same Health
Professions Council as the Doctors (this goes for private and state employed
EMS personnel, from Basic Ambulance Practitioner to Paramedics), and
therefore there is one National controling body - a situation that the U.K.
may find as the solution to the scope of practise problem.
Dr T C Hardcastle, MBChB, ATLS, FCS(SA)part 1
Senior Regisrar: General Surgery; University of Stellenbosch
Member: CMF, Trauma Soc SA, Critical Care Soc SA, Assn of Surgeons SA
SAMed Assn, Emerg Med Soc SA
Med advisor to SA Red Cross Soc NTT&HEC
Chairperson: WECECTCom
Part-time Med Director: WC Paramedic Services
Lecturer: University of Stellenbosch and Metro West Cape EMS College
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