SARASOTA COUNTY, Fla. — The Sarasota County Fire Department has adopted a new approach to pain management in the field, making intravenous acetaminophen the first-line medication for moderate to severe pain and removing opioids from front-line apparatus.
Department officials stated on social media that the change is aimed at improving patient-centered care while reducing reliance on opioids. Under the updated protocol, paramedics will use IV acetaminophen as an initial treatment option for qualifying patients, reserving opioids for situations where they are clinically necessary under appropriate oversight.
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The department cited research and national guidance indicating that pain can be undertreated before patients reach the hospital due to concerns about opioid side effects and operational barriers. The department also pointed to studies and the National Association of EMS Physicians guidance suggesting IV acetaminophen can provide pain relief comparable to IV opioids, while avoiding respiratory depression and other opioid-related risks.
Should IV acetaminophen replace opioids as a first-line option for moderate to severe pain in the prehospital setting? Why or why not?
EMS1 readers respond
“Glad to see them have acetaminophen as a choice for analgesia. But, to replace opiates and not to allow provider judgement to select the best med for the situation says that the system does not trust its people.”
“While I am including this in our agency protocols, I’m not restricting my clinicians’ ability to treat pain appropriately with ALL of their pharmaceutical resources, including opioids. But allowing your front-line providers, not just your supervisors, to be clinicians and to make those choices requires a significant amount of training that is often challenging for agencies to maintain.”
“This could be a great option for those with opioid tolerance or fear of opioids. We have two state prisons within our run district. I cannot tell you how many patients, from those institutions, legitimately were appropriate for pain control, but became very fearful at the mention of fentanyl.”
“That is medical abuse. There is not a study that supports IV Tylenol is a better option to treat moderate to severe pain in any situation. What is wrong with the people that are making these decisions. I thought people went to school for medical care to help people. Changing your protocols to use IV Tylenol in emergency care is torture for people. Whoever decided this and implemented this protocol should be ashamed of themselves and they need to get out of the medical care system. I feel so bad and it makes me sick to my stomach to even think about the people that are going to have to suffer horribly because of your inhumane decisions. I pray for the people in your community. People’s care should never be in the hands of people who have a personal incentive to remove pain medication from patients who are suffering from severe pain. It should be illegal to make people suffer because of someone’s personal belief or personal incentives. Shame on you.”
“I do not think Tylenol should be used in dire situations.”
“This is terrible! Severe pain needs fast-acting opioids, not Tylenol.”
“No it shouldn’t be used at all unless patient asked for it instead. They don’t care if they mess up liver more or if they are in serious pain. This is supposed be American where we have better healthcare it’s awful.”
“No, this is ridiculous and borderline torture.”
“We use it in the observation department and it works great. Less opioid use for sure. Patients really seem to like it. So many patients don’t want opioids. Add Toradol and it’s even better.”
“As an anesthesia provider, that has extensive use of IV acetaminophen, and have also been published for IV acetaminophen use in the OR setting, I can tell you it doesn’t not treat moderate to severe pain anywhere near what opioids like morphine and Dilaudid can do. This is not a good move.”
“This is going to be like peeing a on a brush fire for pain management. Pt will hate us.”
“If it works then yes. We have to remember morphine, as an example, is also given for side effects such as CHF and the venous pooling effects. Use of opioids should not be eliminated. Reduced yes but not eliminated.”
“IV acetaminophen should be considered first, but not as an absolute. The situation/injury dictates whether an opioid should be used or not.”
“I do believe that would be a great idea. Maybe even the AEMT could be written in their protocol as well.”
“As a paramedic in San Diego CA, I have had great success with IV Tylenol and just used it today!”
“Not sure about replace as (IMHO) opioids still have their place but certainly a long overdue complement to opioid analgesia.”
“Our EMS system in the Chicagoland area implemented this change several months ago, and the results have been very positive. Data show no significant difference between pre- and post-administration pain scores when comparing acetaminophen to fentanyl. Additionally, the frequency of pain management interventions has increased since the change.”
“It was a great first choice and experienced first hand that it can work as well as an opioid derivative. After weeks of excruciating headaches went to ER hoping for MRI/scan. They wanted to give me opiate however I refused as do not like or tolerate the mind altering feelings it gives. Was able to get pain relief and still able to make clear decisions for self after finding small brain bleeds.”
