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Mass. ambulance to use non-opioid pain relievers

The medications were approved statewide in September, and the town had been awaiting state-approved training protocol


By Andy Tomolonis
The Standard-Times

ACUSHNET, Mass. — Beginning Tuesday, town ambulances will be equipped with intravenous Tylenol and two other non-opioid pain relievers, providing emergency patients with safer alternatives to potentially addictive fentanyl, Fire Chief Kevin Gallagher said.

The medications were approved statewide in September, and the town had been awaiting state-approved training protocol. Gallagher said he received notice Thursday, and town paramedics will be trained on Monday and Tuesday. Ambulances should be equipped with the alternative medications by noon on Tuesday, he added.

In the past, when emergency responders treated patients for pain, they could only choose ice or opioids (in the form of fentanyl or morphine). Amid the nationwide opioid epidemic, medical experts across the state, including paramedics in Acushnet, have pressed for non-opioid alternatives.

As of Jan. 1, 2018, all ambulances in the state will be required to carry the three non-opiod pain relievers—acetaminophen (commonly known by the brand-name Tylenol); ketorolac (brand-name Toradol); and ibuprofen.

Acetaminophen and ibuprofen will be administered orally, and ketorolac will be available in either intravenous or intramuscular injections, Gallagher said. He added that optional intravenous acetaminophen will be available with the approval of regional EMS directors.

Matthew Bivens, EMS medical director for St. Luke's Hospital in New Bedford, said he has approved the use of intravenous acetaminophen for ambulances in Acushnet, New Bedford and Fairhaven. He expects other communities outside his territory will be approved as well. He said fentanyl will still be an option for cases of extreme pain.

Training is basically a one-hour class delivered with a PowerPoint presentation, Gallagher said, noting that the program had to be reviewed and modified to ensure that it met the state's Office of Emergency Medical Services standards.

Paramedics are already trained and authorized to administer medications, Gallagher said, explaining that the additional lessons will cover ways to administer these particular pain relievers and possible reactions and warnings related to the specific medicines. Ketorolac, for instance, should not be administered to pregnant patients or someone at risk for strokes or ulcers, he said.

Acushnet has two ambulances with 15 EMTs, 10 of whom are paramedics and authorized to administer medications.

Gallagher said the additional non-opioid medications do not represent an extreme cost. He said Acushnet is contracted to purchase its meds through the pharmacy at St. Luke's Hospital, and his total bill to meet the state requirements was about $74 per ambulance.

"That is a very small price to pay to have an alternative to fentanyl," he said.

Each ambulance in town will be equipped with two doses of intravenous acetaminophen, two doses of ketorolac and six doses of oral ibuprofen, he said.

There have been instances in several communities around the state where ketorolac has been used with a waiver, on an experimental basis. It was the result of those trials, along with the recent request for intravenous acetaminophen from Acushnet Fire Department and Bivens that prompted the statewide changes.

Gallagher noted that during the past two months—after state approval but before implementation—town paramedics have said they responded to emergencies where they wished they could have used the approved non-opioid pain relievers.

Once the protocol is in use across the state, Gallagher says he's certain that there will be a substantial reduction in the use of fentanyl.

"I'd bet my last dime on it," he said.

Copyright 2017 The Standard-Times

McClatchy-Tribune News Service

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