I recently ran across a fairly new blog that has made my regular read list. Mill Hill Ave Command is written by Brooks Walsh, an EMS medical control Doc in Bridgeport, Connecticut who comes from an EMS background (former EMT and paramedic). His posts center around recent research or interesting calls his medics have brought in. The posts are intelligent, easy to read and may change the way you practice or at least how you think about calls you are on. Recent posts tackle the issues of spinal immobilization, pain management, STEMI, cardiac arrest resuscitation and NTG in CHF and ACS. Walsh is also the coauthor of a recent study published in Prehospital Emergency Care about paramedic attitudes toward pain management that is quite eye-opening.
Paramedic attitudes regarding prehospital analgesia.
One of the best things about EMS I have seen over the years is the influx of motivated young EMS doctors who came from the streets themselves, who respect the work we do and are actively working to improve our systems and the care we provide. Brooks Walsh is one of these docs. You won’t be disappointed when you check his blog out.
Brooks also has another blog, Doc Cottle’s Desk, which is geared towards residents but equally applicable to EMS.
Christopher, thanks for the heads up on his other blog. I have to check that out.
Brooks is a pretty sharp guy and I enjoy reading and commenting on his blog.
Peter -
Thanks for the kind words!
Mostly, the writing is a way to keep me out of trouble – idle hands, and all – and act as a bully pulpit for certain issues. I don’t quite write with the same literary flavor as you do in many of your posts, but I’m hoping the gratuitous Tommy Boy and Simpsons references distract readers from that shortcoming.
Brooks
I just spent a pleasant hour reading through some of the posts on Doc Cottle’s blog. Really good stuff.
Keep up the great work, Brooks!
best,
Peter
Down in New Zealand we are very, very aggressive when it comes to managing pain and are spoiled for choice
- Entonox (BLS)
- Methoxyflurane* (BLS)
- Paracetamol (BLS)
- Morphine (ILS)
- Fentanyl (ILS)
- Ketamine (ALS)
- Midazolam plus opiate (ALS)
The indication for relief of pain is “pain”; it does not matter from where it comes and we keep giving it until it goes away or significantly relieved enough that the patient is happy with it, the only limit is common sense, obviously not going to give somebody an inappropriate dose of morphine if their blood pressure is quite low or give ketamine to somebody with myocardial ischaemia.
There is no logical argument that can be presented that I can think of which would prevent any EMS system from having adequate analgesic options.
Inadequate education and a conservative medical director are not logical and do not count.
Sorry if I come off as being a bit “one-up-man-ship” like but it makes my blood boil when people do not have access to proper tools to treat their patients, or are unwilling to do so because of some archaic notions that have no biologic or pathologic basis in reality.