10 Milligrams

When you graduate from paramedic school, the protocols that were in place for your initial certifying exam will be the ones you remember forever. With so much pressure to learn and master the procedures and the orders in them, the drugs, the dosages, stay ingrained in your memory. You might develop dementia 50 years from now and forget addresses and birthdays, but you’ll still remember every sedation drug and dosage from your graduation date. At least, I will.

But the world of medicine is an ever-changing landscape of innovation. New drugs come on the market replacing old ones, philosophies change regarding telemetry contact, and every once in a while, considerations are given towards changing methodologies that are problematic.

Thankfully, the orders involving patients who are actively seizing were included in that. Giving medications though an IV to people who are violently flailing their arms about has always been near impossible, but it was the only available way we were able to manage it. We old people like to pat ourselves on the back for the professional way we dealt with these situations, without all the fancy changes that have made things easier, but the truth is, we cursed the protocol committee MDs that seemed to encourage the high rate we were getting stuck with random needles.

Another issue was that the main drug of choice was a narcotic and back in the days when I carried a drug pouch, all narcotics required physician pre-approval for administration. This caused delays during life-threatening events, so today they can be given as a standing order and the physician contact, still required, can be handled after the call.

At one point, the regional MDs approved an additional drug option for active seizures, one that could be administered through a needle to the shoulder. It didn’t require physician approval prior to giving it, either. The new drug was called Versed (Midazolam), and it came out with great fanfare.

It could be used in other protocols, but its much-touted usage was for actively seizing individuals that you couldn’t obtain IV access on. When our Advanced Life Support Coordinator came to the stations to stock our narcotic lockers and drug pouches, he went through the new protocol changes with us, and notification bulletins were xeroxed and hung up on walls everywhere. For…

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