Ammonia

[Guest guest]

I am looking into the use of ammonia caps in prehospital care and am

constructing an article for publication about it.

Please help me to understand how many services carry ammonia caps and have

written protocols authorizing their use. If you use ammonia and have protocols

for it, please send me your protocols.

If you do not use it, please respond and tell me why you do not.

I would like to know the pros and cons of its use.

If you use it, please tell me why, and let me know whether or not you have

considered the possible risks of using it and how you have resolved those issues

in favor of using it. Please let me know, if possible, whether or not you

have a risk manager, or whether or not your risk manager doubles as a QA/QI

person, or whatever, and how issues such as this are addressed in your service.

If you do not use it, please let me know why you do not use it, et cetera.

If you are a medical director, I would appreciate any thoughts that you might

have about the use of ammonia in the field.

I am looking for people who are willing to be quoted in print as either

favoring the use of ammonia or against it.

If any of you have citations for research studies that have been done on

this, please let me know them. I have read the MSDS criteria, but I have not

found any definitive research studies one way or another about the use of

ammonia

caps.

If you write me off-line your thoughts will be kept strictly confidential.

I will not use any quotes, either online or offline, without express written

consent of the writer. So please feel free to express your thoughts.

I have no agenda for this article. I am seeking the truth about the use of

ammonia, and I will evaluate the information I receive and write my article

based upon the information I receive.

Thanks,

Gene Gandy, JD, LP

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[Guest guest]

Gene, I have worked for services which used ammonia as well as those

which didn't permit the use of ammonia. From the best of my

recollection, ammonia use was indicated prior to D50 and Narcan

utilization in those patients who were unresponsive. The use of

ammonia went hand in hand with the sternal rub, which was also

disallowed by my previous employer.

One service pulled the use of ammonia administration when an

employee noted in his patient care documentation that an activated

ammonia cap was placed inside the oxygen reservoir of a non-

rebreather then the reservoir was taped shut. The medic's

perception was that the patient was " faking " and I feel that the

medic expected a couple of things to happen by doing this. First,

he/she wanted to " wake " the patient and secondly, I feel he/she

wanted to " punish " the patient for " faking " , if that was in fact

what was happening. I guess one could call that vengeance. A

sternal rub can have the same effect yet causes physical pain

to " awaken " the patient.

The EMS organization with which I was last employed did not permit

the use of ammonia caps or a sternal rub. What I learned from the

director of that EMS service, besides having compassion on patients

which I'd come into contact with, without regard as to circumstances

of being called to interact with them is this; the patient should

receive the same treatment, the same respect as the little old lady

who fell at 3am. The patient is the one who defines what an

emergency is, not the EMS worker. If someone wants to " fake " in

injury or illness, who gave us the right to mock them or " punish "

them just because we got called out in freezing temperatures just

after you got to sleep? They should be treated that same as a

patient with a " legitimate " complaint. What good does it do to

inflict pain on them, or embarrass them? Yes, I have been guilty of

doing some of the things I mentioned, but thanks to an EMS director

who cared enough to demonstrate compassion and doing what is right,

my behavior has changed.

Brent K. McCain, LP