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    FES moves forward with Ketamine for acute pain

    FES moves forward with ketamine for acute pain

    Photo By Laurie Pearson | Fentanyl and its derivatives are extremely powerful narcotics with the chances of...... read more read more



    Story by Laurie Pearson 

    Marine Corps Logistics Base Barstow

    The pilot study which fire departments throughout California engaged in, testing the use of ketamine in addition to fentanyl, ended early and personnel with Fire and Emergency Services aboard Marine Corps Logistics Base Barstow, have effectively switched drugs used in their medical kits.

    “The study was scheduled to go 18 months,” said Greg Kunkel, Emergency Medical Services chief with FES. “It was cut short due to the excellent results with ketamine administration for acute pain.”

    The trial ended April 15, 2019. Now fire departments throughout the state have implemented the use of ketamine and phased out the use of fentanyl, an opioid.

    “Ketamine provided excellent pain control for acute traumatic injury to include burns,” Kunkel explained. “In the past fentanyl was the analgesic of choice. With the pilot study paramedics had the option to give either fentanyl or ketamine. With the nationwide epidemic of fentanyl and its analogs such as carfentanil, medical directors of EMS systems have been looking for alternatives to opioids.”

    All other Advanced Life Support agencies must carry ketamine in the drug inventory no later than July 15, 2019, he explained. This delay in timing is so that agencies not included in the study have ample time to train their personnel and purchase ketamine.

    “As of July 15, 2019, all ALS providers in the Inland Counties Medical Agency region must carry ketamine in their inventory,” Kunkel said. ICEMA is comprised of San Bernardino, Inyo, and Mono Counties.”

    With a nationwide opioid crisis, studies are showing that fentanyl has become a significant contributor to unintentional overdose deaths. “One study showed that 90 percent of unintentional overdose deaths in 24 counties between January and February 2017, involved fentanyl, fentanyl analogs like carfentanil, acryl fentanyl, or furanyl fentanyl,” Kunkel said. “The numbers are alarming. During a 2017 study, it was discovered that more than 130 people died every single day from opioid drug overdoses. Of the more than 70,000 overdose deaths in the United States, 47,600 were overdose deaths involving opioids, according to the U.S. Department of Health and Human Services.”

    The addiction to opioids, to include heroin and fentanyl, is driven by myriad complex issues.

    “In many cases, someone was prescribed a medication with good intentions,” said Carla Torres, New Parent Support Program coordinator, and licensed clinician. “Then, as the brain begins to recognize the chemical, and become dependent on it, they start to need more.”

    In some cases, people are using opioids to avoid pain.

    “We live in a society where many people want a quick fix and don’t want to necessarily put in the work and effort to process pain in its various forms, whether it’s physical pain, emotional pain, or mental health issues,” said James Maher, Behavioral Health Section head. “Cognitive Behavioral Therapy is a great tool we can use to help teach someone coping mechanisms and strategies to work through and process various types of pain. In short term crisis situations of course pain medication may be necessary. But if someone needs pain medication on an ongoing basis, he or she might want to look into alternative treatments and not rely just on medication.”

    A further complicating factor is the urge people may feel to avoid symptoms of withdrawal. Withdrawal symptoms can be severe and even life-threatening.

    “Some of the physical symptoms of withdrawal are similar to what we might see in someone who has the flu,” said Dawn Dialon, Substance Abuse Program counselor. Those symptoms may include body pain, fatigue, rapid heart rate, nausea, vomiting, either constipation or diarrhea, sweating, dilated pupils, cramping, tremors, and anxiety. That’s pretty miserable. So, someone addicted to opioids, which are designed to help people avoid pain, can be highly motivated to avoid those symptoms by getting their next dose.”

    From dose to dose, a person addicted to opioids has approximately 8-12 hours before they’ll feel compelled to find their next fix, she explained. “Alternative pain management methods are on the rise, even in the medical industry,” Maher said. “Practitioners are now recommending things such as meditation, acupuncture, acupressure, massage, CBT, and more to help people cope with pain in healthier ways.”

    “Fentanyl, a synthetic, short-acting opioid with 50-100 times the potency of morphine, mixed into heroin, cocaine and counterfeit pills, with or without the users’ knowledge, has increased the risk for fatal overdoses,” Kunkel said. “So, to help combat this, fire departments within ICEMA scope are changing protocols. Ketamine is to be used for acute traumatic pain, acute abdominal/flank pain, burn injuries, cancer-related pain, and sickle cell crisis.”

    Ketamine is a Schedule III controlled substance, which means that it has a potential for abuse less than a Schedule I or II and may lead to moderate or low physical dependence or high psychological dependence, he explained. In contrast, fentanyl is a Schedule II controlled substance. Substances in the Schedule II category have a high potential for abuse which may lead to severe psychological or physical dependence.

    “Paramedics do not have the ability to prescribe medicines for long term basis so the patients will be getting limited doses of ketamine,” Kunkel said. “MCLB Barstow FES has used ketamine on a limited basis for a few of our patients. In those cases, it has worked very well in a controlled setting. We applaud our Medical Director for being a staunch supporter of paramedics and giving us the opportunity to carry and use ketamine. In the end the patient is really the one who benefits from this medication and its effect on pain.”

    For further information about substance abuse, addictions and treatment options, contact Behavioral Health at 760-577-6533. If you have questions about the Ketamine vs. Fentanyl Study conducted by FES, contact EMS Chief Greg Kunkel at 760-577-6081.



    Date Taken: 06.13.2019
    Date Posted: 06.13.2019 15:12
    Story ID: 327300

    Web Views: 374
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