6/14/16 Please see the below letter from Dr. Fowler regarding the removal of morphine from our drug boxes.
To All Staff Members,
This week you will hear about a change in our drug boxes: The removal of morphine from our narcotic kits. I wanted to take a moment to explain why.
Morphine has lately fallen out of favor in emergency medicine, for a number of reasons. Allergies to morphine are common, respiratory depression can occur, and it cannot be given intra-nasally. New evidence has accumulated that shows that morphine may possibly be harmful in the setting of cardiac chest pain. One reason is concern for a possible effect of morphine on coronary artery blood flow, and another is evidence that morphine inhibits the effects of anti-platelet drugs that are given in-hospital for managing myocardial infarction. Two references follow below for your review.
We have fentanyl, which appears to be safe and effective for pain management in the field, and it can be given by all routes. It is slightly faster in onset, equally as effective, with fewer patients allergic to it, does not cause a histamine release, and it wears off a bit quicker. Fentanyl appears to be safe for use in cardiac chest pain resistant to nitroglycerin.
I welcome your feedback and thoughts.
Ray Fowler, MD, FACEP, DABEMS
Medical Director, Douglas County Fire Department
1. McCarthy CP, Mullins KV, Sidhu SS, Schulman SP, McEvoy JW. The on- and off-target effects of morphine in acute coronary syndrome: A narrative review. Am Heart J. 2016 Jun;176:114-21. doi: 10.1016/j.ahj.2016.04.004.
2. Thomas MR, Morton AC, Hossain R, Chen B, Luo L, Shahari NN, Hua P, Beniston RG, Judge HM, Storey RF. Morphine delays the onset of action of prasugrel in patients with prior history of ST-elevation myocardial infarction. Thromb Haemost. 2016 Apr 21;116(1).
5/11/16 This week 2 spare boards will be distributed to each station. Any shortages or excesses should be reported to Fire Notifications with attention to the Division Chiefs and arrangements made to correct these. It is recommended that any rescue down to 1 or no boards contact the Division Chief if the crew is unable to immediately obtain a board at their station or one of the decontamination stations: 1, 2, 5, and 7.
It is the responsibility of crews to retrieve boards left at area hospitals. If they are soiled they should be properly bagged and taken to one of the stations with decontamination capabilities for cleaning prior to being returned to service. Please report this through Fire Notifications with attention to the Division Chiefs.
4/7/16 New Study Shows Fentanyl is superior in STEMI compared to morphine!