Narcan Use Survey

[Andrew Nelson]

Please respond to my survey about Narcan use as a diagnostic tool. Thank you!

https://www.surveymonkey.com/r/CMKVYVC

 

[STXmedic]

Out of curiosity, what's the goal of that survey?

Also, you don't have zero as an option for number of times.

 

[WolfmanHarris]

So I completed your survey. However, if you're attempting to do research or a school assignment via this survey you need to do a LOT more work. Any data you collect from this is going to be garbage; you have zero context. Do I work rural or urban? Are narcotics OD's common in my area? Transport time? Etc.

The wording of your questions is slanted to pursue a desired outcome. Better to have a series of questions that establish attitudes towards narcan, experience and ease with using, fears and barriers to usage, etc.

That's without considering whether using a drug as a "diagnostic tool" is a good idea to begin with or ethical. You've taken these as givens.

If you're trying to make a case within your service, do it scientifically, don't hand over survey monkey from an anonymous website to your medical direction or management. Wallow in the research and make a case from the science.

For instance our current medical directive for narcan is surprisingly restrictive, especially given that narcan is available OTC for free in Ontario. Our directive provincially requires complications with ventilations and a patch to Base Hospital MD for permission (we very rarely patch in our system). My argument has been that PPV is not a benign intervention and has known, realistic complications that can only be partially mitigated by the Paramedic. Given reversible causes, intubation is a poor solution when a titration of IV narcan to restore adequate respiratory drive can remove these risks without exposing the crew to the hypothetical risk of violence. That's my opinion and I think it's reasonable, but until I'm ready to start backing that with research, usage stats from my area or comparable areas and actually back it up, it's just that, my opinion.

 

[Andrew Nelson]

I appreciate the response and I'm aware it's not best data collecting. It's for my third semester of paramedic school so needless to say I just need some numbers to throw on a paper with some words. Also the free account on survey monkey only allowed for four questions.

Regardless I can still somewhat gauge if medics are using it as a diagnostic tool in some cases when they are stumped. I am curious what would be unethical about giving 0.5 mg just to rule out a possible cause? Is it not given in codes with unknown etiology?

I originally came up with the topic because I witnessed ER doctors on more than one occasion ask EMS if they tried narcan to rule out narcotic overdose. If they had not they put in an order for it right away. As you know the docs go through a tad bit more schooling. So this sparked my idea that maybe it should be used more in the field to possibly help the doctors speed up treatment plans.

 

[Carlos Danger]

I appreciate the response and I'm aware it's not best data collecting. It's for my third semester of paramedic school so needless to say I just need some numbers to throw on a paper with some words. Also the free account on survey monkey only allowed for four questions.

It's pretty evident by the way that you worded your questions that you didn't take this project seriously, and your comment here just confirms that. Why should anyone else bother to help you with something that you don't care about yourself?

I can still somewhat gauge if medics are using it as a diagnostic tool in some cases when they are stumped.

No, no you can't. Not at all.

Let's say that 50% of respondents to your survey have never use naloxone as a diagnostic tool, because to many of us, the "coma cocktail" is a thing of the past. And let's say that many of those respondents chose "1-10", because 1 is the closest choice to the number of times that they've used it.

You now have 50% of respondents who actually never used it a single time, but your survey results will show as having used it as many as 10 times. The result is a completely inaccurate data set.

I am curious what would be unethical about giving 0.5 mg just to rule out a possible cause? Is it not given in codes with unknown etiology?

Are we talking about cardiac arrests where opioid OD is a potential cause, or more general circumstances where "they are stumped", as you put it?

It is one thing to give it to a 20 year old male cardiac arrest victim where no other etiology is apparent and opioid OD is therefore a plausible or even likely cause, and in which case you are using the naloxone as a potentially useful therapy, not as a diagnostic tool.

It is a very different thing to give it indiscriminately to everyone whose depressed state is of unknown cause - just to see if it works, which is the approach that your survey suggests.

I originally came up with the topic because I witnessed ER doctors on more than one occasion ask EMS if they tried narcan to rule out narcotic overdose. If they had not they put in an order for it right away. As you know the docs go through a tad bit more schooling. So this sparked my idea that maybe it should be used more in the field to possibly help the doctors speed up treatment plans.

You are right, they do go through a tad bit more schooling. Which means that they may be giving it with an intentionality that you are not aware of, rather than for the reason that you presume to be the case. Or maybe they are giving it as just a shotgun approach.

Either way I would be careful about assuming that something is the right thing to do just because you've seen someone with more education than you do it.

 

[Andrew Nelson]

What intentionality would that be then? You can't just make unsubstantiated claims so that you can say that my inquiry is misguided. Also I'm curious why you're so against using it as a diagnostic tool. You've never given a reason. You just keep wagging your finger at me for gathering some opinions on the matter.

As for the rest of your criticism, I don't think I'm not taking this seriously enough, I think you're taking this too seriously. It's a mandated assignment that is jammed into an already intensely busy semester and I work for a full time fire department. So time and energy have been hard to come by. I needed a topic and I was curious what other people thought about this topic after I witnessed multiple doctors' practices regarding it. I think it's a pretty harmless survey and you're reading way too into it. If people want to take the 30 seconds to answer the questions, great! If not, I think I'll sleep just fine at night.

Also I'm aware I forgot a zero option. It was too late to redo it once I made the realization. Like I said, operating on fumes.

 

[Tigger]

What intentionality would that be then? You can't just make unsubstantiated claims so that you can say that my inquiry is misguided. Also I'm curious why you're so against using it as a diagnostic tool. You've never given a reason. You just keep wagging your finger at me for gathering some opinions on the matter.

As for the rest of your criticism, I don't think I'm not taking this seriously enough, I think you're taking this too seriously. It's a mandated assignment that is jammed into an already intensely busy semester and I work for a full time fire department. So time and energy have been hard to come by. I needed a topic and I was curious what other people thought about this topic after I witnessed multiple doctors' practices regarding it. I think it's a pretty harmless survey and you're reading way too into it. If people want to take the 30 seconds to answer the questions, great! If not, I think I'll sleep just fine at night.

Also I'm aware I forgot a zero option. It was too late to redo it once I made the realization. Like I said, operating on fumes.

Turns out paramedic education programs are actual college classes, and require real academic work which also includes writing papers.

 

[Andrew Nelson]

Hey captain obvious, Im not saying I disagree with doing the assignment. I'm saying I don't have the time or the energy to conduct an extensive research study worthy of being published.

 

[DesertMedic66]

Hey captain obvious, Im not saying I disagree with doing the assignment. I'm saying I don't have the time or the energy to conduct an extensive research study worthy of being published.

What everyone is saying is that if you are going to do an assignment and turn it in at least spend some extra time on doing a proper survey. 4 questions with not very good answer selections are not useful at all.

 

[gotbeerz001]

Hey captain obvious, Im not saying I disagree with doing the assignment. I'm saying I don't have the time or the energy to conduct an extensive research study worthy of being published.

Then just make the values up. That way you can have it conclude whatever you choose. Seems like you're putting TOO much effort into something that will be dog[poop].

Also, working full-time fire offers more (paid) time to study and dedicated time off than almost any other full-time job. Please do not add fuel to the fire of the proverbial lazy fire medic.


Sent from my iPhone using Tapatalk

 

[Andrew Nelson]

Too much effort =dog[poop]? Make up values and cheat on my assignment instead? Great logic. Are you one of those lazy medics?

The assignment is to gather opinions on an EMS topic to spark conversation so that we can continue to improve our profession. My topic and the four questions fulfill the requirements perfectly. This isn't a graduate level program thesis.

Finally, I don't assume to understand your life and its demands or the quality of employee you are, so don't sit behind your keyboard and make assumptions about mine.

 

[cprted]

I've never given naloxone as a diagnostic agent. I give it when I suspect an opiod overdose to be the primary cause of the patient's hypoventilation.

 

[Andrew Nelson]

Out of curiosity, what's the goal of that survey?

Also, you don't have zero as an option for number of times.

The goal is to gather the rate at which medics have used narcan diagnostically, if they've seen success, and their opinion on protocols encouraging its use more in that fashion. It's for a paper that I need to write for school. The teacher likes the students to think of new ideas or issues that may spark conversation about changing and improving our progression.

Also my b on the zero. Realized it after the fact. I guess if you're a zero in that category then just don't complete the survey or skip that question.

 

[Andrew Nelson]

I've never given naloxone as a diagnostic agent. I give it when I suspect an opiod overdose to be the primary cause of the patient's hypoventilation.

Thanks for your answer! See everyone else? That wasn't so hard.

 

[DesertMedic66]

For those that are wondering it took me 5 minutes and 11 seconds to make a survey....

https://www.surveymonkey.com/r/QHZRH2P

 

[STXmedic]

Remi's point stands. You don't offer an option of zero- only 1-10. Your selections imply that using Narcan just because is something that everybody does, and you just want to know how often that is. The fact is, many (possibly even most) don't do that anymore. Opiates have a fairly specific presentation. If they meet that presentation and suspicion, they get Narcan. They don't get narcan just because they're unconscious/unresponsive/altered.

And in regards to cardiac arrest, that's also old practice. What role does Narcan play in cardiac arrest? What is the indication for Narcan during a standard opiate overdose prior to arrest? Narcan is intended to restore respiratory effort. Do you know what else fixes the hypoxia and hypoventilation? A BVM. Thus Narcan is not needed at any point during a cardiac arrest.

What people are trying to point out is that your survey is worded poorly, thus skewing the results and altering the productive discussion you're hoping for. That's not going to "improve our profession" in any way. All it's doing is propagating old, outdated dogma that many are trying to fight.

 

[DesertMedic66]

Also my b on the zero. Realized it after the fact. I guess if you're a zero in that category then just don't complete the survey or skip that question.

I wasn't able to just skip the question. The survey made me answer all questions before I could click the finish button. You are still able to edit the survey to include 0 as an answer.

If you want to gauge how often medics use Narcan as a diagnostic tool only then saying "skip that question" is going to give you a very biased answer base.

 

[Andrew Nelson]

Thank you for stating your opinion! I'll add it to the responses. You could have just taken the survey and hit the "strongly disagree" option for the last question and saved yourself some time.

 

[Andrew Nelson]

I wasn't able to just skip the question. The survey made me answer all questions before I could click the finish button. You are still able to edit the survey to include 0 as an answer.

If you want to gauge how often medics use Narcan as a diagnostic tool only then saying "skip that question" is going to give you a very biased answer base.

My apologies, this was my first time using survey monkey's services.

 

[Carlos Danger]

You can't just make unsubstantiated claims so that you can say that my inquiry is misguided.

Exactly what unsubstantiated claim did I make?

You are the one who tried to justify this practice by pointing out that "the ED physicians have a lot more training than we do", as though that means that everything you see done by every EM doc should be mimicked by every paramedic. I simply took your (true) statement in a slightly different direction and pointed out that, because they have much more training than you do, maybe they have reasons for doing things that you aren't aware of. You don't know what you don't know.

You can't hide behind the "but the docs do it and they know more than us" deal when it works in your favor and then run from it when someone suggests that maybe they are more qualified to make a certain decision than you are.

I'm curious why you're so against using it as a diagnostic tool.

Because it is just sloppy medicine.

The "coma cocktail" used to be common, but fell out of favor when we learned that it doesn't work. We also used to inject epi into the heart, compressed the lower torso to increase BP, and strapped people's entire bodies to hard boards in case their neck was injured. Before that we drained "bad humors" from sick people and literally blew smoke up people's butts in an attempt to regain a pulse. We stopped doing those things, too, when we realized that they didn't work.

Instead of using a poorly worded survey to fish for opinions that support your beliefs, try reading the actual clinical research on the topic.

As for the rest of your criticism, I don't think I'm not taking this seriously enough,

You'r words: "I just have to put some numbers on a paper with some words". Forgive me if I misinterpreted that when what it really meant was that you were trying hard to to a good job.