EMS Medication Administration - Buccal Route

EMS Providers need to be knowledgeable about buccal medication administration to ensure effective and safe patient care. 

Here are some key points they should know:

1. Indications and Contraindications

Indications:

• Need for rapid absorption and onset of action.
• Medications commonly administered via buccal route include glucose gel (for hypoglycemia), midazolam (for seizures), and certain analgesics or antiemetics.
• Patients who can follow instructions and keep the medication in the buccal cavity without swallowing.

Contraindications:

• Altered mental status or decreased level of consciousness.
• Inability to follow instructions or maintain medication placement in the buccal cavity.
• Severe oral infections or injuries.
• Allergy to the medication.

2. Mechanism of Action

• Rapid Absorption: Medications administered buccally are absorbed directly into the bloodstream through the mucous membranes in the cheek, bypassing the gastrointestinal tract and first-pass metabolism in the liver.

3. Preparation and Technique

Medication Preparation:

• Verify the “Six Rights” of medication administration: right patient, right medication, right dose, right route, right time and right documentation.
• Ensure the medication is appropriate for buccal administration and prepare it according to protocol.

Patient Preparation:

• Ensure the patient is in a seated or semi-reclined position to facilitate administration and reduce the risk of choking or aspiration.
• Clear the buccal area if necessary to ensure the medication can be placed correctly.

4. Administration Techniques

Administering the Medication:

• Instruct the patient to open their mouth and gently pull back their cheek.
• Place the medication between the patient’s gum and cheek.
• Instruct the patient to hold the medication in place and not to chew or swallow it.
• Ensure the medication remains in place until it is fully dissolved or absorbed.

5. Patient Communication and Education

Explain the Medication: 

• Inform the patient about the purpose of the medication, how it will help, and any potential side effects.

Instructions: 

• Provide clear instructions on how to keep the medication in the buccal cavity without swallowing or chewing it.

6. Monitoring and Follow-Up

Observe for Effects: 

• Monitor the patient for the expected therapeutic effects and any adverse reactions.

Reassessment: 

• Regularly reassess the patient’s condition to determine the effectiveness of the medication and any need for additional intervention.

7. Complications and Management

Ineffective Absorption: 

• Ensure proper technique to maximize absorption; consider a second dose if no response and protocol allows.

Adverse Reactions: 

• Be prepared to manage potential adverse reactions, including allergic reactions or local irritation.

Oral Discomfort: 

Reassure the patient about any transient discomfort in the buccal area.

8. Special Considerations

Pediatric and Geriatric Patients: 

• Adjust instructions and dosage appropriately; children may require more gentle handling, and the elderly may have difficulty keeping the medication in place.

Environmental Factors: 

• Consider the environment, such as the need for privacy or managing in a moving vehicle.

Patient Condition: 

• Be aware of any conditions that might affect buccal administration, such as dry mouth or oral lesions.

9. Training and Proficiency

Simulation Training: 

• Regular practice using simulation models to maintain proficiency in buccal medication administration techniques.

Continuing Education: 

• Stay updated on best practices, new medications, and techniques for buccal administration.

10. Legal and Ethical Considerations

Scope of Practice: 

• Adhere to the legal scope of practice for their certification level and local regulations.

Informed Consent: 

• Obtain informed consent from the patient or guardian whenever possible.

Documentation: 

• Accurate documentation of medication name, dose, route, time of administration, and any observed effects or adverse reactions.

Conclusion

Effective buccal medication administration requires EMS providers to combine theoretical knowledge with practical skills. 

Continuous training, adherence to protocols, and understanding the indications, techniques, and potential complications are essential for safe and effective patient care.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Bledsoe, B. E. & Clayden, D. (2018) Prehospital Emergency Pharmacology (8th Ed). Boston, Massachusetts: Pearson.

Guy, J. S. (2019) Pharmacology for the Prehospital Professional (2nd Ed) Burlington, Massachusetts: Jones & Bartlett Learning.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell 

EMS Equipment - The Power Paradox

Despite powered advancements in patient movement, the initial ground lift remains a manual task for EMS providers.

The attached JEMS article addresses a critical issue in EMS that despite heavy investments in advanced power stretchers and other power-assisted patient handling devices, the initial task of lifting a patient from the ground remains manual and risky. 

This inconsistency, termed the "power paradox," exposes EMS Providers to significant musculoskeletal injuries, with nearly half of EMS workers experiencing such injuries due to manual patient handling.

While EMS agencies have invested significantly in technologies like power stretchers, power loads, and power stair chairs, they often overlook the necessity of power patient lifts.

The lack of a comprehensive power-assisted patient handling approach leads providers to use makeshift solutions like bedsheets, increasing the risk of injuries to both the patient and the provider. 

Statistics from the National Institute for Occupational Safety and Health (NIOSH) highlight that nearly half of all EMS workers suffer from work-related musculoskeletal injuries, underscoring the need for a complete and integrated approach to patient lifting.

The solution lies in incorporating power patient lifts, which are affordable compared to the costs of potential injuries and liabilities. These lifts can significantly reduce the physical strain on EMS providers and enhance patient safety. 

The article emphasizes that EMS agencies need to prioritize injury prevention by embracing a holistic approach to powered patient handling. 

By doing so, they can protect their personnel, improve patient care, and mitigate liability risks, ensuring the sustainability and effectiveness of EMS operations​.

Journal of Emergency Medical Services 2024 

For more information, access the attached article link.

EMS In The News - Mom Wants Answers After Son Dies In Medics Care

Trea Ellinger could have died from the combined effects of being sedated and lying prone, experts say.

In Maryland, the family of a man who died after being sedated and restrained by medics is seeking answers. The incident involved 35-year-old Tony Ferrell, who was experiencing a mental health crisis.

Emergency responders administered ketamine and physically restrained him, leading to his subsequent death. The family questions the protocols and decisions made by the medics, raising concerns about the use of force and sedation in handling mental health emergencies.

This tragic case has sparked a broader conversation about the appropriate methods for managing such situations and ensuring patient safety.

For more information, visit the JEMS article.

Associated Press

EMS Operations - Reimagining the Future With Artificial Intelligence

The article "Reimagining the Future: Artificial Intelligence Implications for Emergency Medical Services" by Michael Wissemann discusses the growing role of artificial intelligence (AI) in healthcare, emphasizing both its potential benefits and challenges, particularly for EMS. 

AI has advanced significantly over the past decade, with applications ranging from radiology to real-time dispatch systems in EMS. 

While AI can improve efficiency and accuracy in various medical tasks, it also poses risks, such as ethical concerns and privacy issues, especially when dealing with sensitive patient information.

In the context of EMS, AI could revolutionize operations by predicting and managing incidents more effectively. For example, AI could optimize the dispatch of emergency units or even assist in triaging mass-casualty events. 

Additionally, AI's integration into vehicles and medical devices could enhance real-time decision-making and patient care. 

However, the article notes that implementing such technologies requires overcoming significant hurdles, including data standardization, ethical considerations, and ensuring patient privacy.

Despite these challenges, the article advocates for embracing AI in EMS to shape its development and application proactively. 

By doing so, EMS providers can ensure that AI advancements align with their needs and improve patient outcomes. Ignoring these advancements, on the other hand, could result in externally imposed changes that may not fully address the unique demands of emergency medical services. 

For the full article, access the JEMS link here.

EMS Medication Administration - Intranasal (IN) Route

EMS Providers should be knowledgeable about intranasal (IN) medication administration to ensure patient safety and effective treatment. 

Here are some points they should know:

1. INDICATIONS AND CONTRAINDICATIONS

Indications:

• Rapid absorption needed and IV access is not practical or available.
  
• Common medications include naloxone (for opioid overdose), midazolam (for seizures), fentanyl (for pain management), and certain sedatives or anxiolytics.

Contraindications:

• Nasal trauma or significant nasal obstruction.
  
• Excessive nasal secretions or epistaxis (nosebleed).
  
• Allergy to the medication.
  
• Severe head trauma with potential nasal fractures.

2. MECHANISM OF ACTION

Rapid Absorption: 

• Medications administered intranasally are absorbed through the nasal mucosa directly into the bloodstream, bypassing the gastrointestinal tract and first-pass metabolism in the liver.

3. PREPARATION AND TECHNIQUE

Medication Preparation:

• Verify the “Six Rights” of medication administration: right patient, right medication, right dose, right route, right time and right documentation.
• Ensure the medication is appropriate for intranasal administration and prepare it according to protocol.

Device Preparation:

• Use a mucosal atomization device (MAD) for proper delivery.
• Ensure the device is properly assembled and the medication is correctly loaded.

Patient Preparation:

• Ensure the patient is in a semi-reclined or upright position to facilitate administration and absorption.
• Clear any visible nasal obstructions if possible.

4. ADMINISTRATION TECHNIQUES

Administering the Medication:

• Attach the MAD to the syringe containing the medication.
• Hold the patient’s head steady.
• Insert the MAD into one nostril and aim slightly upward and outward (towards the ear on the same side).
• Administer half of the medication dose rapidly and firmly, ensuring atomization.
• Repeat the process in the other nostril with the remaining dose to ensure maximal absorption.

Dosage Considerations:

• Split larger doses between both nostrils to increase mucosal surface area for absorption.
• Typical volumes per nostril should not exceed 1 mL to prevent runoff and ensure effective absorption.

5. PATIENT COMMUNICATION AND EDUCATION

Explain the Medication: 

• Inform the patient (if conscious) about the purpose of the medication, how it will help, and any potential side effects.

Instructions: 

• Provide clear instructions and reassurance to keep the patient calm and cooperative during administration.

6. MONITORING AND FOLLOW-UP

Observe for Effects: 

• Monitor the patient for the expected therapeutic effects and any adverse reactions.

Reassessment: 

• Regularly reassess the patient’s condition to determine the effectiveness of the medication and any need for additional intervention.

7. COMPLICATIONS AND MANAGEMENT

Ineffective Absorption: 

• Ensure proper technique to maximize absorption; consider a second dose if no response and protocol allows.

Adverse Reactions: 

• Be prepared to manage potential adverse reactions, including allergic reactions or local irritation.

Nasal Discomfort: 

• Reassure the patient about any transient burning or discomfort in the nasal passages.

8. SPECIAL CONSIDERATIONS

Pediatric and Geriatric Patients: 

• Adjust instructions and dosage appropriately; children may require smaller doses or more gentle handling.

Environmental Factors: 

• Consider the environment, such as the need for privacy or managing in a moving vehicle.

Patient Condition: 

• Be aware of any conditions that might affect intranasal administration, such as nasal obstructions or severe trauma.

9. TRAINING AND PROFICIENCY

Simulation Training: 

• Regular practice using simulation models to maintain proficiency in intranasal medication administration techniques.

Continuing Education: 

• Stay updated on best practices, new medications, and techniques for intranasal administration.

10. LEGAL AND ETHICAL CONSIDERATIONS

Scope of Practice: 

• Adhere to the legal scope of practice for their certification level and local regulations.

Informed Consent: 

• Obtain informed consent from the patient or guardian whenever possible.

Documentation: 

• Accurate documentation of medication name, dose, route, time of administration, and any observed effects or adverse reactions.

CONCLUSION

Effective intranasal medication administration requires EMS Providers to combine theoretical knowledge with practical skills. 

Continuous training, adherence to protocols, and understanding the indications, techniques, and potential complications are essential for safe and effective patient care.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Bledsoe, B. E. & Clayden, D. (2018) Prehospital Emergency Pharmacology (8th Ed). Boston, Massachusetts: Pearson.

Erich, J (2023) How Scared Kids Spurred The Development of Intranasal Medication Delivery. EMS 1 https://www.ems1.com/ems-products/medical-equipment/how-scared-kids-spurred-the-development-of-intranasal-medication-delivery Accessed July 2, 2024

Guy, J. S. (2019) Pharmacology for the Prehospital Professional (2nd Ed) Burlington, Massachusetts: Jones & Bartlett Learning.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell 

EMS Medication Administration - Inhalation Route

EMS Providers need to have a thorough understanding of inhaled medication administration to ensure patient safety and effective treatment. 

Here are some key points they should know:

1. Indications and Contraindications

Indications:

• Respiratory distress due to conditions like asthma, chronic obstructive pulmonary disease (COPD), or anaphylaxis.
• Administration of medications such as bronchodilators (e.g., albuterol), corticosteroids, and emergency medications (e.g., epinephrine via nebulizer for severe allergic reactions).

Contraindications:

• Allergy to the medication.
• Inability of the patient to effectively inhale the medication (e.g., severe respiratory distress, altered mental status).
• Situations where the administration method (e.g., nebulizer, metered-dose inhaler) is not suitable due to specific patient conditions or environmental factors.

2. Types of Inhaled Medications

Metered-Dose Inhalers (MDIs): 

Pressurized canisters that deliver a specific dose of medication in aerosol form.

Dry Powder Inhalers (DPIs): 

• Devices that deliver medication in powder form which the patient inhales.

Nebulizers: 

• Devices that convert liquid medication into a fine mist for inhalation over several minutes.

Breath-Actuated Inhalers: 

• Devices that release medication automatically when the patient inhales.

3. Preparation and Technique

Medication Preparation:

• Verify the “Six Rights” of medication administration: right patient, right medication, right dose, right route, right time and right documentation.
• Ensure the inhaler or nebulizer is properly assembled and medication is correctly loaded.

Patient Preparation:

• Ensure the patient is in an upright position to maximize lung expansion and facilitate proper inhalation.
• Instruct the patient on how to use the inhaler or nebulizer correctly.

4. Administration Techniques

MDIs:

• Shake the inhaler well before use.
• Attach a spacer if recommended, which helps in delivering more medication to the lungs.
• Have the patient exhale fully, place the mouthpiece in their mouth, and inhale slowly and deeply while pressing the canister to release the medication.
• Instruct the patient to hold their breath for about 10 seconds before exhaling slowly.
• Wait about a minute between puffs if a second dose is needed.

DPIs:

• Load the dose according to the inhaler’s instructions.
• Have the patient exhale fully away from the inhaler, place the mouthpiece in their mouth, and inhale quickly and deeply.
• Instruct the patient to hold their breath for about 10 seconds before exhaling slowly.

Nebulizers:

• Assemble the nebulizer and add the prescribed medication to the medication cup.
• Attach the mouthpiece or mask to the nebulizer.
• Turn on the nebulizer and have the patient inhale the mist steadily until the medication is finished (usually 5-10 minutes).

5. Patient Communication and Education

Explain the Medication: 

• Inform the patient about the purpose of the medication, how it will help, and any potential side effects.

Instructions: 

• Provide clear instructions on how to use the inhaler or nebulizer, including breathing techniques and the importance of taking slow, deep breaths.

6. Monitoring and Follow-Up

Observe for Effects: 

• Monitor the patient for the expected therapeutic effects and any adverse reactions.

Reassessment: 

• Regularly reassess the patient’s respiratory status, including breath sounds, respiratory rate, and oxygen saturation, to determine the effectiveness of the medication and any need for additional intervention.

7. Complications and Management

Incorrect Usage: 

• Ensure the patient understands and correctly follows the administration technique to avoid ineffective dosing.

Adverse Reactions: 

• Be prepared to manage potential adverse reactions, such as tachycardia, tremors, or paradoxical bronchospasm.

Device Malfunction: 

• Recognize and troubleshoot any issues with the inhaler or nebulizer.

8. Special Considerations

Pediatric and Geriatric Patients: 

• Adjust instructions and consider additional challenges in administering inhaled medications to these populations, such as the use of spacers for children or coordination issues in the elderly.

Environmental Factors: 

• Ensure the environment is suitable for nebulizer use, especially in situations where power sources may be limited or there is a risk of spreading infectious aerosols.

Patient Condition: 

• Be aware of any conditions that might affect inhaled medication administration, such as severe respiratory distress, altered mental status, or inability to follow instructions.

9. Training and Proficiency

Simulation Training: 

• Regular practice using simulation models to maintain proficiency in inhaled medication administration techniques.

Continuing Education: 

• Stay updated on best practices, new medications, and techniques for inhaled administration.

10. Legal and Ethical Considerations

Scope of Practice: 

• Adhere to the legal scope of practice for their certification level and local regulations.

Informed Consent: 

• Obtain informed consent from the patient or guardian whenever possible.

Documentation: 

• Accurate documentation of medication name, dose, route, time of administration, and any observed effects or adverse reactions.

Conclusion

Effective inhaled medication administration requires EMS providers to combine theoretical knowledge with practical skills. 

Continuous training, adherence to protocols, and understanding the indications, techniques, and potential complications are essential for safe and effective patient care.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Bledsoe, B. E. & Clayden, D. (2018) Prehospital Emergency Pharmacology (8th Ed). Boston, Massachusetts: Pearson.

Guy, J. S. (2019) Pharmacology for the Prehospital Professional (2nd Ed) Burlington, Massachusetts: Jones & Bartlett Learning.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

EMS Operations - Rural Paramedics Making House Calls

In Terlingua, Texas, a new community paramedicine program is helping reduce emergency room visits by having paramedics regularly check on residents with chronic health issues.

This initiative addresses the lack of nearby hospitals and doctors, providing preventative care and support, especially for elderly and reclusive individuals.

Funded by a USDA grant, the program aims to prove its cost-effectiveness by lowering readmissions, despite current challenges with insurance reimbursements for paramedic house calls.

The goal is to sustain these programs through demonstrated economic and health benefits.

A recent NAEMT report listed more than 150 of these kinds of community paramedicine programs across the country yet economic models are challenging.

For more details, visit the article below.

https://www.marketplace.org/2024/06/28/community-paramedicine-visits-west-texas-ems-paramedics/? 

Medication Administration - Sublingual (SL) Route

EMS Providers must be knowledgeable about sublingual (SL) medication administration to ensure patient safety and effective treatment. 

Here are some key points they should know:

1. Indications and Contraindications

Indications:

• Need for rapid absorption and onset of action.
• Common medications include nitroglycerin (for chest pain) and certain antiemetics or anxiolytics.
• Patients who can follow instructions and keep the medication under their tongue without swallowing.

Contraindications:

• Altered mental status or decreased level of consciousness.
• Difficulty following instructions or maintaining medication placement under the tongue.
• Severe mouth or tongue injuries.
• Allergies to the medication.

2. Mechanism of Action

Rapid Absorption: 

• Medications administered sublingually are absorbed directly into the bloodstream through the rich vascular supply under the tongue, bypassing the gastrointestinal tract and first-pass metabolism in the liver.

3. Preparation and Technique

Medication Preparation:

• Verify the “Six Rights” of medication administration: right patient, right medication, right dose, right route, right time and right documentation.
• Ensure the medication is appropriate for sublingual administration.

Patient Preparation:

• Ensure the patient is in a seated or semi-reclined position to facilitate easy administration and reduce the risk of aspiration.
• Instruct the patient to lift their tongue or open their mouth as needed.

Administration:

• Place the medication under the patient’s tongue.
• Instruct the patient to close their mouth and avoid chewing, swallowing, or moving the medication around.
• Ensure the patient understands to let the medication dissolve completely.

4. Patient Communication and Education

Explain the Medication: 

• Inform the patient about the purpose of the medication, how it will help, and any potential side effects.

Instructions: 

• Provide clear instructions on what to do with the medication (e.g., not to swallow or chew it) and how long it might take to dissolve.

5. Monitoring and Follow-Up

Observe for Effects: 

• Monitor the patient for the expected therapeutic effects and any adverse reactions.

Reassessment: 

• Regularly reassess the patient's condition to determine the effectiveness of the medication and any need for additional intervention.

6. Complications and Management

Ineffective Absorption: 

• Ensure the medication remains in place under the tongue to prevent reduced effectiveness.

Adverse Reactions: 

• Be prepared to manage potential adverse reactions, including allergic reactions or side effects specific to the medication being administered.

Local Irritation: 

• Monitor for signs of local irritation or discomfort under the tongue.

7. Special Considerations

Pediatric and Geriatric Patients: 

• Adjust instructions and consider additional challenges in administering sublingual medications to these populations.

Medication Properties: 

• Understand the specific characteristics of the sublingual medication being administered, including onset and duration of action.

Patient Condition: 

• Be aware of any conditions that might affect sublingual administration, such as dry mouth or oral lesions.

8. Training and Proficiency

Simulation Training: 

• Regular practice using simulation models to maintain proficiency in sublingual medication administration techniques.

Continuing Education: 

• Stay updated on best practices, new medications, and techniques for sublingual administration.

9. Legal and Ethical Considerations

Scope of Practice: 

• Adhere to the legal scope of practice for their certification level and local regulations.

Informed Consent: 

• Obtain informed consent from the patient or guardian whenever possible.

Documentation: 

• Accurate documentation of medication name, dose, route, time of administration, and any observed effects or adverse reactions.

Conclusion

Effective sublingual medication administration requires EMS Providers to combine theoretical knowledge with practical skills. 

Continuous training, adherence to protocols, and understanding the indications, techniques, and potential complications are essential for safe and effective patient care. 

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Bledsoe, B. E. & Clayden, D. (2018) Prehospital Emergency Pharmacology (8th Ed). Boston, Massachusetts: Pearson.

Guy, J. S. (2019) Pharmacology for the Prehospital Professional (2nd Ed) Burlington, Massachusetts: Jones & Bartlett Learning.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

EMS Medfication Administration - Oral (PO) Route

EMS Providers should be well-informed about oral medication administration to ensure patient safety and effective treatment. 

Here are some key points they should know:

1. Indications and Contraindications

Indications:

Situations where the patient can safely swallow and absorb medications.

Management of mild to moderate pain, allergic reactions, nausea, or chronic conditions.

Administration of medications such as aspirin (for chest pain), glucose (for hypoglycemia), or activated charcoal (for certain poisonings).

Contraindications:

Altered mental status or decreased level of consciousness, posing a risk of aspiration.

Difficulty swallowing or a risk of choking.

Severe nausea or vomiting.

Certain medical conditions or contraindicated medications.

2. Types of Oral Medications

Tablets and Capsules: Solid dosage forms that may need to be swallowed whole or chewed.

Liquids: Solutions, suspensions, or syrups.

Orally Disintegrating Tablets (ODTs): Tablets that dissolve quickly in the mouth.

Buccal and Sublingual: Medications placed in the cheek pouch or under the tongue for rapid absorption.

3. Preparation and Technique

Verification:

Verify the “Six Rights” of medication administration: right patient, right medication, right dose, right route, right time and right documentation

Patient Positioning:

Ensure the patient is in an upright position to facilitate swallowing and reduce the risk of aspiration.

Medication Administation:

For tablets/capsules: Provide a full glass of water and instruct the patient to swallow the medication.

For liquids: Measure the correct dose using an appropriate measuring device and ensure the patient drinks it all.

For ODTs, buccal, and sublingual: Place the medication in the patient’s mouth as directed and ensure they do not chew or swallow it prematurely.

4. Patient Communication and Education

Explain the Medication: Inform the patient about the medication’s purpose, expected effects, and any potential side effects.

Instructions: Provide clear instructions on how to take the medication, including any specific considerations (e.g., take with food or on an empty stomach).

5. Monitoring and Follow-Up

Observe for Effects: Monitor the patient for expected therapeutic effects and any adverse reactions.

Reassessment: Regularly reassess the patient's condition to determine the effectiveness of the medication and any need for additional intervention.

6. Complications and Management

Aspiration: Recognize signs of aspiration (e.g., coughing, choking) and know how to manage it (e.g., positioning, suction, airway management).

Allergic Reactions: Be prepared to manage allergic reactions, including anaphylaxis, by monitoring for symptoms and having emergency medications available.

Gastrointestinal Upset: Some oral medications can cause nausea or gastrointestinal discomfort; provide supportive care as needed.

7. Special Considerations

Pediatric and Geriatric Patients: Adjust dosages appropriately and consider additional challenges in administering oral medications to these populations (e.g., difficulty swallowing, altered taste).

Patients with Chronic Conditions: Be aware of any chronic conditions that may affect medication administration or absorption.

Medication Interactions: Understand potential interactions with other medications the patient is taking.

8. Legal and Ethical Considerations

Scope of Practice: Adhere to the legal scope of practice for their certification level and local regulations.

Informed Consent: Obtain informed consent from the patient or guardian whenever possible.

Documentation: Accurate documentation of medication name, dose, route, time of administration, and any observed effects or adverse reactions.

Conclusion

Effective oral medication administration requires EMS providers to combine theoretical knowledge with practical skills.

Continuous training, adherence to protocols, and understanding the indications, techniques, and potential complications are essential for safe and effective patient care.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Bledsoe, B. E. & Clayden, D. (2018) Prehospital Emergency Pharmacology (8th Ed). Boston, Massachusetts: Pearson.

Guy, J. S. (2019) Pharmacology for the Prehospital Professional (2nd Ed) Burlington, Massachusetts: Jones & Bartlett Learning.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

EMS HazMat Emergencies - I Smell A Pool...We Don't Have A Pool...!

The article addresses the dangers of accidentally creating chlorine gas by mixing household bleach and vinegar, a common mistake due to misleading cleaning tips seen on social media. 

Chlorine gas exposure can lead to severe respiratory issues, including tachypnea, cyanosis, wheezing, and potentially fatal pulmonary edema. The Centers for Disease Control (CDC) warns of the risks, highlighting the need for immediate mitigation by removing the victim from the contaminated area and utilizing positive pressure ventilation (PPV) fans for decontamination.

EMS Providers must avoid exposure to chlorine gas without proper protective equipment like SCBA (Self-Contained Breathing Apparatus). They should prioritize ventilating the area and conducting a risk-benefit analysis before attempting rescues. 

The primary treatment for chlorine gas exposure involves removing contaminated clothing, administering oxygen, and using bronchodilators for wheezing. Long-term management may include monitoring for Reactive Airway Dysfunction Syndrome (RADS), a lifelong condition caused by chemical-induced asthma.

Effective communication with medical facilities and poison control is crucial during such incidents. The article emphasizes public education to prevent mixing household chemicals and highlights the historical and industrial uses of chlorine. 

Proper handling and awareness can prevent accidental poisonings and ensure safety in both residential and industrial settings.

Read the full article by accessing the link:

https://www.foamfrat.com/post/i-smell-a-pool-we-don-t-have-a-pool

EMS Medication Administration - Subcutaneous (SC) Route

EMS providers need to be well-versed in subcutaneous (SC) medication administration to ensure effective and safe patient care. Here are the key points they should know:

1. Indications and Contraindications

Indications:

Medications that require slow, sustained absorption such as insulin, heparin, and certain vaccines.

Situations where IV or IM routes are not appropriate or available.

Contraindications:

Allergy to the medication

Presence of infection or injury at the injection site

Conditions causing poor blood flow or perfusion to the skin, such as shock or severe edema.

2. Anatomy and Site Selection

Common SC Injection Sites:

Upper outer arm

Abdomen (avoiding a 2-inch radius around the navel)

Anterior thighs

Upper buttocks or hips

Site Selection Criteria:

Rotating sites to avoid tissue damage

Considering the patient's preference and comfort

Avoiding areas with scars, bruises, or inflammation

3. Preparation and Technique

Medication Preparation:

Verify the medication, dose, and expiration date.

Use aseptic technique to draw up the medication.

Injection Technique:

Clean the injection site with an antiseptic wipe.

Pinch the skin to lift the subcutaneous tissue away from underlying muscle.

Insert the needle at a 45-degree angle (or 90 degrees if using a short needle or for thicker subcutaneous tissue).

Inject the medication slowly and steadily.

Withdraw the needle and apply gentle pressure to the site with a sterile gauze.

4. Needle Selection

Needle Length: Typically 3/8 to 5/8 inches.

Needle Gauge: Usually 25 to 30 gauge, depending on the viscosity of the medication and the patient's subcutaneous tissue.

5. Medication Administration

Dosage and Volume: Adhere to recommended dosage and volume limits (generally up to 1 mL for subcutaneous injections).

Rate of Administration: Inject the medication slowly to reduce discomfort and ensure proper absorption.

6. Complications and Management

Pain and Discomfort: Techniques to minimize pain include using a quick, smooth insertion, and injecting the medication slowly.

Bleeding and Bruising: Applying gentle pressure post-injection can prevent these.

Infection: Use aseptic technique and proper site selection to prevent infection.

Lipodystrophy: Rotate injection sites to avoid lipodystrophy (abnormal distribution of fat tissue).

7. Special Considerations

Patient Age and Size: Adjust needle size and injection site based on the patient’s age, size, and subcutaneous tissue thickness.

Medication Properties: Some medications may cause irritation or require specific injection techniques.

Patient Positioning: Position the patient comfortably to ensure relaxation and reduce the risk of complications.

8. Training and Proficiency

Simulation Training: Regular practice using simulation models to maintain proficiency in SC injection techniques.

Continuing Education: Stay updated on best practices, new medications, and techniques.

9. Legal and Ethical Considerations

Scope of Practice: Adhere to the legal scope of practice for their certification level and local regulations.

Informed Consent: Obtain informed consent from the patient or guardian whenever possible.

Documentation: Accurate documentation of medication name, dose, route, site of injection, time of administration, and any adverse reactions.

Conclusion

Effective SC medication administration requires EMS providers to combine theoretical knowledge with practical skills. 

Continuous training, adherence to protocols, and understanding the indications, techniques, and potential complications are essential for safe and effective patient care.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Bledsoe, B. E. & Clayden, D. (2018) Prehospital Emergency Pharmacology (8th Ed). Boston, Massachusetts: Pearson.

Guy, J. S. (2019) Pharmacology for the Prehospital Professional (2nd Ed) Burlington, Massachusetts: Jones & Bartlett Learning.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell