With so many options out there, what is your sedation drug of choice. 

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We have haldol, versed, and ketamine they each fit into different protocols.

none!

good communication, strong working relationship with law enforcement

For psych pts, or pts bucking the tube after intubation?

(It doesn't really matter here in PA, because the only sedatives anyone carries are benzos--so I pretty much have to give orders for Versed in either case.)

These days, whatever can be kept in inventory!

Correct, and this is looking as if it will get worse before it gets better.

 

Some of the FDA standards that claim to raise the bar for drug purity and efficacy are raising the bar so high that the drug companies seem to be avoiding the bar-jumping contest.

 

Example: one of our neighboring systems got down to a single dose of Ativan, system-wide.  They have no prospects of getting more any time soon, despite some VERY creative efforts.



Skip Kirkwood said:

These days, whatever can be kept in inventory!

Are there any options on the table for getting medications from outside the country (ie: Canada, Europe, etc.)?  I'm sure the FDA would reply with a resounding "NO!!!", but I think they need to throw us a bone here.  That being said, I don't know what the purity standards are like in Canada or Europe, but I doubt they are much different than in the US.

Has this been suggested for a short-term fix until the US-based drug companies can get supply levels back up?

I always figured I could make a decent amount of money (not incredibly rich, but guaranteed not to go out of business either) by starting a medication company whose whole business was making generic emergency drugs. I've got the idea, does anyone know where I can get the capital? :)

I wouldn't say EMS has a lot of options... Depending on the system, the experience, the situation, and what is not on back order would dictate which of the few you would administer. Many EMS system do a poor job regarding patient comfort. Our options are limited due to many factors. I can say in NYC's system; we carry only Etomidate, Versed, Valium, and Ativan for sedation. Morphine for pain management. Not all are carried by every NYC EMS Agency for whatever reason. Lastly, EMS doses are limited; so complete sedation or cessation of pain is nearly impossible. Unless you have the ability to perform RSI even this has it's drawbacks...

We are all getting there. Our protocols are for the most part are progressive. Most systems provide more care than they did 5-10 years prior.

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