The Joint Royal Colleges and Ambulance Liaison Committee have been negociating with the Medicines Agency over the use of opiates for pre-hospital analgesia by paramedics. The system is not noted for speed but did come up wiith the original list of drugs extending the paramedic range a couple of years ago. The approval will be a blanket one if at all; but some services have jumped the gun and may be jeopardising others.
-----Original Message-----
From: Stephen Dolphin <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 17 March 1999 14:48
Subject: Re: Nubain
-----Original Message-----
From: Dr Matthew W Cooke <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 16 March 1999 21:45
Subject: Re: Nubain
Mark
Your pharmacy should be able to give you info about Nubain from Martindale.
The reasons for Nubain in our area were:
1. Opiates cannot be given by paramedics as against the law (MCA have allowed Cumbria and Warwickshire to use it)
That's saying that we can't use it unless they say we can. If they can use it in Cumbria & Warwickshire, why not everybody? Or is it a trial?
2. Tramadol - advised against its use by ambulance services because of high incidence of vomiting
Also a problem with Nubain. Should we be giving an anti-emetic in either case?
3. Nubain is not a controlled drug
I refer the honourable gentleman to the answer I gave a few moments ago to No 1.
4. Nubain is safe for crews to carry in urban area as has no street value as minimal euphoria
Is there evidence of robbery from ambulances? I have personally never seen it happen.
5. Most UK ambulance services already use Nubain without problems
I understand the drugs are quite similar, so there should be no huge problems with opiates. Give us a protocol to follow and we generally tend to stick to it.
The disadvantages are:
1. Risk of delay on scene whilst administering it (encouraged to give in ambulance on the move)
BNF says that for acute pain Morphine can be given by subcutaneous or deep intramuscular injection. I think most of the delay on scene is probably due to cannulation. I could never understand why we have to cannulate to give Nubain, given that it can be administered by sub-cut, IM or IV.
2. partial antagonist action means further analgesia in form of opiates needs a variable dose, but not considered a major problem as in A&E usually titrate the IV dose anyway. But there has been recent discussion onthis list on this topic.
Surely this is not a real problem. Which is more important, a patient in unnecessary pain for up to an hour prehospital, or the convenience of A&E?
In other words, we thought Nubain was better than nothing except Entonox.
ps. Nice green wallpaper. :-)
Stephen Dolphin
Paramedic
