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Narcotic Security Revisited


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Poll: Do you secure narcotics in the aircraft or on your person? (17 member(s) have cast votes)

Do you secure narcotics in the aircraft or on your person?

  1. On person (9 votes [52.94%] - View)

    Percentage of vote: 52.94%

  2. On aircraft (8 votes [47.06%] - View)

    Percentage of vote: 47.06%

  3. Both (0 votes [0.00%])

    Percentage of vote: 0.00%

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#1 Flitecowboy

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Posted 01 July 2010 - 03:10 PM

We have always carried our narcotics on our person. Recently, the company has decided to do away with this method and install "lock boxes" on the aircrafts to carry our controlled narcotics. I personally would rather carry them on my person. I have a greater sense of security and control over them rather than them sitting in the aircraft. The majority of our aircraft are based at an airport and not a hospital so it's not like we have locked down heliports which only we have access to. I am curious as to how your program handles narcotic security and what is your opinion of the method. I am not looking for a right and wrong answer, just everyone's thoughts.
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#2 PAMedicCop

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Posted 01 July 2010 - 07:51 PM

We are a Nurse/Medic program. Narcotic accountability is solely the responsibility of the nurse, and are carried solely by the nurse.
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#3 Jwade

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Posted 02 July 2010 - 02:30 AM

We are a Nurse/Medic program. Narcotic accountability is solely the responsibility of the nurse, and are carried solely by the nurse.




1. We carried them in a hard pelican case, BOTH responsible for signing narcotic sheet at beginning and end of every shift.



PAMedicCop,

I am curious as to why your program has this discriminatory practice in place? Policies like this have been proven to cause many problems, and definitely have the potential to impact patient care.

Respectfully,
JW
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John Wade MBA, CCEMT-P, FP-C, RN

"Have the courage to follow your heart and intuition, they somehow already know what you truly want to become" Steve Jobs

#4 PAMedicCop

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Posted 02 July 2010 - 12:10 PM

1. We carried them in a hard pelican case, BOTH responsible for signing narcotic sheet at beginning and end of every shift.



PAMedicCop,

I am curious as to why your program has this discriminatory practice in place? Policies like this have been proven to cause many problems, and definitely have the potential to impact patient care.

Respectfully,
JW


John-

Have any references for this? I've asked several times and management always tap-dances around the issue.

As an aside, the state we are based in (PA) is also cracking down on what meds Flight Medics can administer. We are now restricted to only administering meds that are on the state list for ground ALS units. This is a non-issue with narcotics, as all of the controlled substances we carry (fent, midaz, ativan, and morphine) are all approved for ground ALS use.
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MedicCop, BS, NREMT-P, FP-C

#5 old school

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Posted 02 July 2010 - 01:16 PM

PAMedicCop,

I am curious as to why your program has this discriminatory practice in place? Policies like this have been proven to cause many problems, and definitely have the potential to impact patient care.

Respectfully,
JW


I wonder why you'd automatically describe this practice as "discriminatory", not knowing the specifics of the policy or the reasoning behind it? I mean, I'm not familiar with the program in question but I would imagine they probably have reasons other than a dislike or distrust of their own paramedics.


The last program I was at, the narcs were signed for and carried only by the paramedics. This was strictly because the state's administrative requirements for narcotic security were much easier for the program to deal with if it was shown that the paramedics were accountable. No problems were ever caused by this practice during the 4 years I was there; if anything I think having a smaller number of people accountable increased security, made it easier to track, and leaves less to question if an issue should arise. I know our none of our nurses felt discriminated against in the least - the reason for the policy was well known and if anything they were glad they didn't have to worry about the narcs.


Where I am at now, we carry our narcs, RSI meds, and first-line ACLS meds in a small pouch that is supposed to be within arms' reach at all times. We aren't allowed to secure them in the aircraft, and I really wish we were - as long as they are double locked I would have no qualms about leaving them in the helicopter unattended, and in fact I think they'd be more secure that way than being carried with us everywhere we go all day, where they can potentially be misplaced or left somewhere (it has happened). Both crewmembers are considered equally responsible.
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#6 Jwade

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Posted 02 July 2010 - 11:27 PM

I wonder why you'd automatically describe this practice as "discriminatory", not knowing the specifics of the policy or the reasoning behind it? I mean, I'm not familiar with the program in question but I would imagine they probably have reasons other than a dislike or distrust of their own paramedics.






PAMedicCop,

I will dig through some of my MBA school stuff and see what i can find for you. We studied these types of business practices extensively during Organizational Culture & Operations Management courses. For now, this is anecdotal, what i remember from business school and in my general experience, these types of polices are generally rooted from someone's own political agenda and or insecurities ( read: ego) Very few states have actual statutes regarding who can and who cannot carry narcs on a HEMS aircraft, in fact, i would be surprised if any state has such a law. So, then it boils down to, why does the xyz company have such a policy in place, why did it start, what was the driving force, is there any actual research and or science behind the policy, or was it brought up by some disgruntled manager with an agenda? This type of stuff happens ALL the time and creates a very malignant organizational culture from the top down. I have read research during school which proves clearly a malignant working environment makes for an inefficient and ineffective operation.


It does not surprise me you are getting a non-committal answer as I seriously doubt any of your managers could give a plausible explanation that would warrant such a policy. Again, my personal opinion on the subject and my policy states that if both partners have the potential to use the narcotics on a call, then both are responsible for checking them off at the beginning and end of the shift. If in the end, a policy is due to some state law, then by all means, follow it, but to make some arbitrary, usually unilateral rule about who can carry narcotics on a HEMS ship is not conducive to a positive corporate culture IMO..

Respectfully,
JW
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John Wade MBA, CCEMT-P, FP-C, RN

"Have the courage to follow your heart and intuition, they somehow already know what you truly want to become" Steve Jobs

#7 old school

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Posted 03 July 2010 - 01:05 AM

I will dig through some of my MBA school stuff and see what i can find for you. We studied these types of business practices extensively during Organizational Culture & Operations Management courses. For now, this is anecdotal, what i remember from business school and in my general experience, these types of polices are generally rooted from someone's own political agenda and or insecurities ( read: ego) Very few states have actual statutes regarding who can and who cannot carry narcs on a HEMS aircraft, in fact, i would be surprised if any state has such a law. So, then it boils down to, why does the xyz company have such a policy in place, why did it start, what was the driving force, is there any actual research and or science behind the policy, or was it brought up by some disgruntled manager with an agenda? This type of stuff happens ALL the time and creates a very malignant organizational culture from the top down. I have read research during school which proves clearly a malignant working environment makes for an inefficient and ineffective operation.


Wow, it must be nice to know so much about the motivations behind every policy written by every HEMS program in the US.....

What about the program who carries something that isn't authorized by the state EMS board for paramedics, and because the medics aren't allowed to give the med the program can't allow them to sign out a narc pack containing it?

Would that policy still be a result of ego?
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#8 Jwade

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Posted 03 July 2010 - 04:08 AM

Wow, it must be nice to know so much about the motivations behind every policy written by every HEMS program in the US.....

What about the program who carries something that isn't authorized by the state EMS board for paramedics, and because the medics aren't allowed to give the med the program can't allow them to sign out a narc pack containing it?

Would that policy still be a result of ego?



Dude,

Did you not read what i wrote? I specifically stated if it was state law, then by all means, i understand the need for the policy....

.However, having studied organizational culture and operations management extensively, i can tell you unequivocally, IN GENERAL, ( not HEMS specific only,) policies like these are often driven by someone's agenda and or need to show dominance for some deep rooted insecurity. As you pointed out, I do not know the " Reason" for this programs policy, I was simply pointing out many policies like these often have no legitimate reason behind them and are simply made up by mid-level managers trying to impose their personal beliefs on the collective.

Why do people do femoral pulse checks during CPR? The research CLEARLY proves this should not be done to guage CPR efficacy, yet, at some point someone thought this was a good idea and hence it was taught and implemented in many classes. Same goes true for many policies like described above.....

I completely see where your coming from, please don't get me wrong, I just have serious issues with people who try to implement policy without sound logical reasoning behind them.

Respectfully,
JW
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John Wade MBA, CCEMT-P, FP-C, RN

"Have the courage to follow your heart and intuition, they somehow already know what you truly want to become" Steve Jobs

#9 USDalum97

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Posted 03 July 2010 - 04:38 PM

Our narcs and RSI meds are kept together in a small bag. They are kept inside the medication bag (backpack style). The drug bag is kept inside the station when not on a call (security and temperature control reasons). All of the local hospital helipads are locked, single pads, so we keep the med bag in the helicopter when down in the ED dropping off a patient.

If the narcs cannot be secured with the helicopter, they are carried by the nurse. The medication bag is also the responsibility of the nurse. Narcotics are signed off before and after every shift by the nurse and medic.

The reason we leave it to the nurse is because the medic is responsible for the 1st-in bag (intubation kit, cric kit, chest decompression kit, etc). It splits the duties so we each have a bag to be responsible for. It should never happen (again) that someone says "I thought you had that bag!" and something gets left on scene. We don't allow any one on scene to handle our bags either. We teach this as part of our first responder training.
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#10 LTJ

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Posted 04 July 2010 - 06:03 PM

We are hospital based, our pad is on the roof, we are the only ones with prox access in the elevator to the roof, and to the door leading outside to the pad. Meds are secured in the aircraft or in a double locked cupboard in the hall during extreme temps (which is most of the time living in the mid-west 100+ summers and -0 winters) only the nurse carries the keys to the double locked cupboard.
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#11 MSDeltaFlt

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Posted 04 July 2010 - 07:35 PM

I personally do not believe that there is any such thing as a bigger and better mouse trap. If you carry narcs on your person, who's to say that you or one of your partners won't pee hot? If you carry it on the aircraft, just how secure is it? Usually all it would take is a well placed crow bar and a few seconds. I mean, really. Does anyone know what the street value is of half the stuff we carry?

The main jist of what I'm saying is that, from a corporate level, the company will more than likely have policies in place to ensure as best as they can everybody who handles the narcs and those who oversee those who handle the narcs. They will do what they can to save your butts. However, their butts will come first.
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Courage is resistance to fear, mastery of fear - not absence of fear -- Mark Twain

#12 old school

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Posted 05 July 2010 - 03:16 AM

Dude,

Did you not read what i wrote? I specifically stated if it was state law, then by all means, i understand the need for the policy....

.However, having studied organizational culture and operations management extensively, i can tell you unequivocally, IN GENERAL, ( not HEMS specific only,) policies like these are often driven by someone's agenda and or need to show dominance for some deep rooted insecurity. As you pointed out, I do not know the " Reason" for this programs policy, I was simply pointing out many policies like these often have no legitimate reason behind them and are simply made up by mid-level managers trying to impose their personal beliefs on the collective.


I read exactly what you wrote, John. What you said, in effect, was "the only reason for a policy such as this is ego and/or insecurity". And that is pure BS.

If you had written something like "policies such as this are sometimes the result of ego, and research shows that in those cases they can lead to organizational problems", then fine....but that isn't what you wrote - rather, you speak with authority - citing your education - as if you KNOW that there are only very rare justifications for a policy such as this. And the truth is, you actually have no way of know whether that is the case.

The thing is, there are a couple hundred flight programs in the US, and they all have different policies and practices and protocols and adhere to different state, county, local, and health system regulations and practices. So for any given policy, there are many potential reasons - aside from ego - that any one individual could not possibly be aware of. I'm sure the reasoning behind many policies is poor, but also many are not.


It wouldn't bother me, except that it seems to happen ALOT on these forums recently that people will state - authoritatively and without qualification - that a given practice or policy is bad or innefective or biased or unreasonable, just because they aren't familiar with it or don't like it personally.

What isn't fair or doesn't make any sense at all at one program or hospital may have perfectly good reasoning behind it at another agency a few states away.
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#13 Jwade

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Posted 05 July 2010 - 06:32 AM

I read exactly what you wrote, John. What you said, in effect, was "the only reason for a policy such as this is ego and/or insecurity". And that is pure BS.

If you had written something like "policies such as this are sometimes the result of ego, and research shows that in those cases they can lead to organizational problems", then fine....but that isn't what you wrote - rather, you speak with authority - citing your education - as if you KNOW that there are only very rare justifications for a policy such as this. And the truth is, you actually have no way of know whether that is the case.

The thing is, there are a couple hundred flight programs in the US, and they all have different policies and practices and protocols and adhere to different state, county, local, and health system regulations and practices. So for any given policy, there are many potential reasons - aside from ego - that any one individual could not possibly be aware of. I'm sure the reasoning behind many policies is poor, but also many are not.


It wouldn't bother me, except that it seems to happen ALOT on these forums recently that people will state - authoritatively and without qualification - that a given practice or policy is bad or innefective or biased or unreasonable, just because they aren't familiar with it or don't like it personally.

What isn't fair or doesn't make any sense at all at one program or hospital may have perfectly good reasoning behind it at another agency a few states away.



Hey man,

I understand where your coming from, I really do, and you make an excellent point. I should have qualified my statement a bit different. My apologies.

I do still stand by what I highlighted, we studied policy development pretty hard with a PhD professor who used to teach at Wharton, so, and from everything i read, studied, looked at many fortune 500 companies policies & procedures, i still feel the majority of these polices do not have any sound reasoning or judgment behind them.....However, you are right, I do not know for sure 100%, but, I would probably place my money on myself. :-)

Hope your well my friend....Fly Safe.
JW
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John Wade MBA, CCEMT-P, FP-C, RN

"Have the courage to follow your heart and intuition, they somehow already know what you truly want to become" Steve Jobs