Paramedics replace fentanyl with ice, IV Tylenol to prevent addiction
Fire Chief Kevin Gallagher and Dr. Matthew Bivens are working to close off one avenue that can lead to opioid addiction
By Wesley Sykes
ACUSHNET, Mass. — When a resident suffers an opioid overdose, Fire Chief Kevin Gallagher places a small purple flag in front of the Main Street department.
It serves as a visual reminder that the opioid crisis lives up to every bit of the term.
Gallagher's latest effort, fueled by the help of Dr. Matthew Bivens of St. Luke's Hospital Emergency Department, aims to close off one avenue that can lead to opioid addiction.
For paramedics and first responders across the state, managing a patient's pain before arriving to the hospital is limited to two extremes: ice or fentanyl.
"We've heard too many stories of addictions starting this way," Gallagher said.
Bivens and Gallagher would like to offer a third option: IV Tylenol (acetaminophen).
"IV Tylenol has very few downsides," Bivens said. "It's safe in pregnancy and safe in liver and kidney diseases. It's not magic, though. If you're in horrific pain, IV Tylenol may not be enough, but it's a great start for paramedics to use when the pain is bad enough, but (they) don't want to administer narcotics."
Bivens proposed the idea in late April to the state's Medical Services Committee, which unanimously approved IV Tylenol to be added to Protocol 2.13 Pain and Nausea Management Adult and Pediatric. Other non-narcotic pain relievers added to the emergency protocol updates were by-mouth Tylenol and Motrin and an IV option of Toradol, an anti-inflammatory.
The committee's recommendations then went to the Office of EMS, under new director Mark Miller, who in turn answers to the state Department of Public Health Commissioner. Bivens said the state is treating the recommendations as "high priority," but so far no final decision has been announced.
"It's a time-consuming process," Gallagher said. "We appreciate the process. Good news is on the horizon. I just wish the horizon came faster."
Perhaps the only hitch to the pain-relieving drug is the price per dose of $34.91. In comparison, a single of dose of fentanyl costs the town 90 cents while naloxone, the overdose reversing drug with the brand name Narcan, costs $12.75 per dose.
Gallagher said the money is not a problem, adding that the department is "financially solid" and getting IV Tylenol in the hands of paramedics, despite the cost, wouldn't break the bank.
"If we can lower a patient's pain, deliver them to the hospital and then let the doctors make the decision on opioid use maybe, just maybe, we can prevent one future addiction," he said.
Right now, Gallagher says paramedics don't have a Plan B in lieu of fentanyl. According to statistics obtained from the Acushnet Fire Department, an ice pack was administered 46 times between 2016 and now. Fentanyl was administered 48 times in that same span.
Digging deeper into the data, of the 36 times fentanyl was used last year there were 11 instances of musculoskeletal injuries, such as carpal tunnel syndrome, tendonitis or tendon strains. There were also six instances of abdominal pain, four instances of back pain, two instances of nausea or vomiting and one instance of soft tissue injury (bruising) where fentanyl was administered.
"How many of those did we really have to give fentanyl to and expose them to the risk of addiction," Gallagher asked.
He hopes that with the possible addition of a non-addictive tool to this toolbox, he'll have to place one less purple flag on the Fire Department's lawn.
"It's time we start calling fentanyl what it is—synthetic heroin," he said. "If I can keep one person off opioids by this, then it's a good thing."
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