Pain is Treatable

92yoF left hip and low back pain. She is in visible distress, seated in her apartment kitchen chair with her adult daughter nervously scurrying around.

Dispatched as cardiac emergency with chest pain.

My crew is a VERY seasoned EMT with his trainee.

Our pt is restless. She cannot sit still and is clenching to the side of her chair to try and relieve the pain from the left hip.

EMTs start with vitals and history. I listen as the new EMT gets some experience.

Pain started yesterday and has increasingly become worse. She has a Long history of lumbar herniated discs. Her daughter recounts her mother having intermittent back pain when she was growing up.

The pt is crying. She has short, shallow respirations. She winces in pain.

Her vitals are within normal limits. She said she was having chest and left arm pain. Although I believe this is positional and from clenching the chair, I do a 12, both because of her age and her long list of cardiac meds. The 12 is normal sinus in the 80s, no ST changes.

My seasoned EMT starts to package and I ask for my IV kit. He looks a little startled, but nods with a softness in his eyes. More on that later.

She is a hard stick and scared of needles. She is willing to temporarily dismiss her fears for my word. I have pain management. The trainee and daughter come over to hold her up and comfort her.

24g Left hand. Talk shit all you want, I proudly reach for a 24g instead of throwing the whole plan away.

85mcg of fentanyl on board. We lift the pt and move her to the stretcher and out of the apartment building in 10 degrees of icy winter winds. Her pain drops from a 10 to a 7 in transport. She stops crying. She can now speak in short sentences. Did I fix her? No. Did I magically make all the pain go away? No. However, I did enough that she can endure the transport. Enough to have her stop clenching the side bars. That is the best I can do.

The rest is the same. Transfer to nurse. Clean. Restock. Crew goes available.

So why the startled expression from my EMT when I asked for my IV kit?

Some of you already know. You are probably an EMT. An EMT who has been forced to move a patient in obvious pain and distress because the medic didn’t want to do their job. A medic saw stable vitals and kicked that all the way back to BLS.

Pain is a clinical finding. We can treat pain. We need to treat pain. We, as medics, need to do better.

This patient could have been dumped on my EMT. He knows this. I know this. His trainee doesn’t know this, yet.

After the call I tell his trainee, “Pain is a treatable clinical finding. That patient was in pain. If you think a patient is really in pain, you call for a medic. Some medics here are nasty and will fight you on it but you stick to your guns, don’t let a medic try to convince you a patient is not in pain.”

Medics, maybe believe your EMTs for a minute. At least listen, take vitals and do an assessment. Think about what happens next. Would you comfortably move this patient? Oh you have 20 charts back at the station? Get in the game. We can only do one call at a time, after all, so how about this one?

A few times over the past year I have been called by EMTs for patients in pain. One of the recent ones (girl broke a tib/fib falling off a bike) the EMT said “Oh thank god its you- I know you won’t write us off”

My heart sunk when the EMT said that outside the ambulance. It just solidifies how many medics are not taking pain seriously. It killed me.

This girl had obvious deformities and signs of pain. This means medics are writing off obvious traumatic injury patients like her…it makes me disgusted. It makes me even more disgusted when I hear that BLS rather transport a patient such as this one with no pain management than risk staying on scene longer for a medic to gaslight the crew (and pt) before ultimately kicking it back to them.

Pain management is good clinical care.

As providers, we want a bigger drug box. We bitch about the state and how medics aren’t taken seriously. Well, narcotics are pretty serious if you ask me… or the DEA. If we do not prove we are competent and compassionate providers in something that has the potential for immediate relief, why should the state or your medical director or anyone give you more tools in your tool box? Or why should they let us keep the ones we have if we are just going to BLS release it anyway…

You know what pain feels like. Treat it.