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MedicalI'm a 21 year old female Paramedic in the UK - AMA

Sep 28th 2016 by leah38124 • 13 Questions • 81 Points

Hi Reddit. As the title says, my name is Dr. Lynn Webster. I’m VP of Scientific Affairs at PRA Health Sciences (PRAHS) and a past president of the American Academy of Pain Medicine. Much of my life I have worked to develop new, safer medications for pain and addiction. One of the areas of my research is to test abuse-deterrent formulations of pain medications. We’re in the middle of conducting these types of studies right now.

It’s no secret there’s an opioid/painkiller abuse crisis in the United States. A disturbing number of people have died due to abusing opioids. A recent report from the Centers for Disease Control and Prevention estimates the financial cost exceeds 78 billion dollars annually. But, of course, far more important is the cost in human lives. The CDC states opioids are involved in 40 deaths each day in America. This is a staggering number. It is equivalent to a jumbo jet airplane crashing every 10 days. No wonder every governmental agency, including the White House, is involved in trying to curb this epidemic.

Nearly everyone in America knows someone who has developed an addiction or overdosed on opioids. There is no discrimination with this disease. It affects every social economic class. While opioids are necessary and help some people, they can be dangerous if not taken as directed. They can also be made safer.

The good news is that we are working hard to make opioids and other medications safer and more effective. The company I work for, PRA Health Sciences, is continually exploring ways to make existing and new drugs safer.

The way we study the abuse potential of drugs is to give the drugs to people and ask them how much they like the drug. The goal is to reduce “liking” in drugs while retaining the needed effect on pain receptors. We have volunteers compare the new drug, or drug formulation, with a drug that is commonly abused. The FDA requires that we conduct these studies in people who use these drugs for recreational purposes. These are people who are not addicted to the drugs but who are using the medication without a prescription.

In the past few years, the FDA has approved several of these abuse deterrent formulations. Early research suggests the abuse deterrent formulations are safer and associated with less harm.

It is my hope that, one day, we will have medications that cannot be abused but will provide relief to those who need the help.

In the meantime, I am happy to respond to your questions. Ask about the clinical trials, types of drugs we study, risks of opioids, addiction, or anything in the field of pain management or addiction. I will do my best to answer your questions.

Additional Reading and Verification:

For more information check out my book, The Painful Truth, blog, and documentary, as well as the following articles.

Edit: Thanks for your time, Reddit! This was a lot of fun. Thanks to everyone who asked questions–I hope it’s been informative. Feel free to continue to answer questions and I’ll try to answer as many as I can over the next day or so.

Q:
  1. Do you like your job?

  2. Which county do you live/work in?

  3. Do you see this as a career or as a stepping stone on to what you really want to do?

  4. What kind of call do you get the most?

  5. How common are drug overdoses?

  6. Did you vote Leave or Remain?

  7. Who is your favourite on the GBBO?

  8. Fish and chips or kebab?

  9. Manchester City or Manchester United?

  10. Tea or coffee?

A:

What do you think about cannabis research as a potential alternative for opiates?


Q:
  1. yes I love my job more than anything, when I'm I'll I get sad because I can't go in. I could think of nothing I'd rather be doing than something like this. I wake up every day having no idea what I'm gunna get to see or do and who I'm going to meet and it's the best feeling in the world!

  2. Buckinghamshire but I can work anywhere from here to Portsmouth

  3. I wouldn't mind doing this job forever, I'd love to be able to fully train in medicine but that depends on whether I'm smart enough to get in!! XD

  4. Normally falls from elderly people or chest pain.

  5. Depends on where you are, I get them fairly regularly where I am now, but they were way more common where I trained!

  6. Remain, I wasn't buying the "funnelling money into the NHS" imagine my surprise when it was revoked on national television xD

  7. Kate, she's pretty cool and she's a nurse so go her!

  8. Fish and chips, all day every day, there's a van that delivers it to my front door... I fear I may turn into a fish...

  9. Manchester United, all about the red devils

  10. Surprisingly neither... I like green tea though... If that counts?

A:

This is something that I've been recommending for some time. I've recommended the DEA reschedule cannabis so that research can be conducted more easily. It may well be a good substitute for opioids. BUT we need the research.

Edit: Here's an op-ed I wrote on the subject.


Q:

I like green tea though... If that counts?

Unfortunately not.

A:

Is there any way you can see the end to the stalemate of "cannabis is schedule 1 so it's really hard to research, and we won't make it schedule 2 until there is more research"?

Apart from just every state ignoring federal law one by one?


Q:

D: I'm sorry!

A:

It is a Catch-22. The research has not been done because we can't do the research. Only the government can make sense of that.

I think when nearly every state in the Union legalizes marijuana, Congress will force the DEA to reschedule cannabis. I actually have an op-ed coming out in Pain Medicine News in its November issue on this topic.


Q:

Is Paramedic a real Job in the UK? In Germany its done mostly by 18 year olds doing their civil service and, well, lower class people who otherwise would be unemployed.

Only 2 years ago did they introduce a "real" job description with proper 3 year training for it. Before that it was like half a year "course".

A:

Do you foresee these drugs becoming available over the counter? Since there would be no risk of addiction or overdose.


Q:

Yes its a real professional job! You have to get a registration and everything before you're allowed to practice and it's illegal to impersonate a paramedic!

A:

Addiction and overdose are not the only risks associated with medications. Some of these new medications may be available over-the-counter, while others should not be available over the counter because of the risks associated with them beyond addiction or overdose.


Q:

Good for you. Our first "Notfallsanitäter" (the first "real" Paramedics in Germany) will only be on the cars next year. Then they have finished their 3 year training. Until then its still guys with half-years courses and a few with 1 and a half year "advanced" courses.

A:

Why do you hate fun?

No I'm totally kidding, my SO was addicted to opiates for several years, and constantly struggles with desire to relapse. I just have a morbid sense of humor.

My real questions are:

  1. Would a non-addictive pain medication avoid any of the negative side effects of opiates? I can barely tolerate most pain medications in any effective dosage because they make me nauseous and itchy.

  2. Would any of the options you are researching be helpful for weaning opiate addicts off the drugs safely, like suboxone or methadone (which, admittedly, have limited success)?

  3. In your opinion, how can we limit illegal access to opiates without denying them to patients who really need them?


Q:

That sounds pretty cool though! What kind of stuff can they do?

A:
  1. All medications have side effects–whether addictive or non-addictive–unique to that chemical and individual. People and their physicians have to evaluate whether the benefit outweighs the risk.

  2. Yes. We have several non-opioid treatments for people who have opioid addictions that we think are better than the current options.

  3. This is very difficult because there is so much profit and demand. Most of the harm produced by opioids occurs in those for whom opioids aren't currently prescribed. Most people prescribed opioids take them responsibly and are not harmed by them. Unfortunately, there is a subset of the population who are harmed.

Again, this is why we need to find alternatives to opioids.


Q:

The new ones? everything except operations / chirurgical stuff like the american Paramedics (can you operate?)

The half year courses guys could only drive the car, and get the vitals

The advanced course guys were allowed to prepare a port for infusions, but no independent medical administrations except stuff you can inhale like MADs

A:

Thank you! I think the work you're doing is incredible. I would love to live in a world where non-opiate painkillers are an option - it would benefit so many people.

Oh, I have one more question. Do you expect any pushback from pharmaceutical companies in the future?


Q:

WE can to chest decompressions and needle thoracocentesis but thats as far as our operating skills go!

A:

Thank you. My area of work is very interesting and rewarding when we can make a difference in other people's lives. I'm not sure what you mean by pushback, but the pharmaceutical companies are profit-drive and react to incentives. When there's a potential for profit, they will be there.


Q:

Manchester United

I mean, is there really another option? :P

A:

How can we separate the drug interactions in the brain between pain and addiction?

Feel free to go all geek on me!


Q:

I agree whole-heartedly! Wise people we have here XD

A:

I'm not sure I understand your question. Most drugs are not associated with addiction. There are medications that work in the brain that both treat pain and cause addiction. This is why we need to find safer, more effective therapies.


Q:

what 5 things would u try to experience if u could be the opposite gender for a day?

A:

How can we get the CDC and our elected representatives to separate opioid pain medication deaths from heroin deaths so we can get a better picture of the problems with prescribed opioids? I have no idea how dangerous my medication is, as prescribed, when they're grouped together in every study.


Q:

Errrm, Go out drinking Pull ups Sex Bath Go clothes shopping, boys clothes are awesome

A:

You have identified a MAJOR challenge. The CDC can only report what they receive from coroners and medical examiners. We need to have entirely different death reporting mechanisms to have better data.


Q:

Conversely, what advantages (physically) do you see being a girl instead of a guy?

A:

Dr. Webster, when do you foresee the government doing anything to help chronic pain patients who are now going from functioning to bedbound due to discontinuance of their pain meds?


Q:

Boobs...

A:

In order for policymakers to help people in pain, there will need to be a movement comparable to the level of activity put forth by AIDS patients and advocates in the 80s. We have to have a groundswell of voices demanding that patients are treated with humanity.


Q:

What are requirements to obtain your medic in UK? I know here in the US I got mine through a basic to medic bridger course. That being said, I know it tends to vary state by state and mine is only good for the state I work in, so wasn't sure how it worked on the other side of the pond. Just curious as to the different standards.

A:

That's kind of a big request of people in excruciating pain, isn't it?


Q:

We have two different routes to go through over here. You can join the service as early as 18 as an ECA (emergency care assistant) and work your way up through the ranks until you've qualified as a paramedic, or alternatively, you can go straight to university from school and do a course called paramedic science. They do a three and a two year option (which is what I did) and it allows you to skip the other ranks and enter the job straight away at paramedic level :) it's good for the whole of the UK too and abroad!

A:

Yes it is. That's why we need to find surrogates to help advocate for people in pain (and why I'm doing this AMA today). I'm trying to support the needs of people in pain.


Q:

Very nice, thats pretty awesome that its a universal standard. Degree programs are becoming more popular here, regardless of pathway 18 is the minimum age as far as I am aware. There is a National Registry program that requires 2 year recert as opposed to 4 with state level where you can get reciprocity to practice in other states though. As far as intubation goes, whats the limitations/extent you have?

A:

Could you please just invent one that doesn't make me hallucinate? I'm going to need surgery sooner or later in life and as of right now I'm fucked.


Q:

We don't really have many limitations, many services don't like you intubating kids, but we're all trained to do so just in case. I know that London ambulance service don't let their paramedics intubate at all! But to be honest if a patients unconscious and your concerned about their airway then as far as protocol goes, you can intubate away!

A:

I assume you are asking for a safer and more effective medication. There are many companies working to develop those products now. Hopefully they'll be available to you soon.


Q:

Nice, we don't tube any kids in my system, only adult arrest patients. How about "basic airways", do you use a combi-tube/king airway or like we just went to an IGel?

A:

Why is it we haven't seen such a major push of guidelines with regards to other types of controlled substances such as stimulants/adhd medications? I've heard some chatter about more restrictions for some people on them but for the most part there aren't expensive urine screens, regular pill counts (if any at all), or the requirement of needing a visit every 28-30 days for a new script. I'm curious about the focus on opioids only when there are many other types of meds that are able to be "abused".


Q:

We used to use Laryngeal mask airways but everywhere has swapped now to i-gels.. to be honest I prefer then to tubes! XD

A:

You're absolutely correct. There are many drugs that are commonly abused. The reason why there is a focus on opioids is just because of the number of people who have overdosed and died.


Q:

With gun violence being significantly lower in the UK than the states, how often are you called to scenes with gun violence? What's the hardest thing you've had to deal with?

A:

Are their ways to predict when regular or recreational use becomes addiction? And probably a sensitive question: what is your definition of problematic opiate use?


Q:

I personally have never been to a gun victim, I know people who have but it's so rare we maybe see it once a year? If that... We get much more knife crime round these parts! The worst stuff is probably the assault of that nature, or rape victims, because we can't do anything pre-hospital to help a rape victim, so its heart breaking to see sometimes...

A:

Addiction occurs when the use of an opioid is associated with craving and compulsive use despite harm. Problematic opioid use occurs when it's used for a non-medical or inappropriate purpose and when the potential risks exceed the potential benefits.


Q:

I didn't even think about how you have to deal with rape victims, that's rough :(

A:

I have additional question: How often do you run these trials and how do you ensure they're safe? Given that opiates are pretty addictive, this seems like a pretty big concern, recreational users or not.


Q:

Yeah it's not the nicest, sometimes it's not massive medical problems or dead people that bother us but the people that we can't help or do anything for...

A:

One, we are conducting trials on a continual basis. Our trials are not just about opioids. We may study antidepressants, stimulants, benzodiazepines, cannabinoids, new chemical entities, etc...

And two, safety is our number one concern. We are very familiar with the doses that are administered and monitored continuously during a clinical trial. Furthermore, the FDA reviews all protocols to be sure they are safe for the subjects.


Q:

Ummm...

A:

Bit of a trauma fan :L


Q:

So what's your favourite gnarly trauma?

A:

I actually went to one yesterday where a ladies leg had twisted back on itself by about 160 degrees, it was pretty cool looking :D I haven't been exposed to much trauma that's super gnarly :c But I can't wait to see some!


Q:

Awesome! Sounds like you have a pretty wide scope, which in my opinion, is what makes being a paramedic so great, it allows you to use your tools and think on your feet.

When you say, more advanced paramedic is that something like how here in the states we have EMT-Basics, Intermediate and paramedic?

A:

Yeah basically, they can catheterise and give antibiotics, suture and give far more drugs than we can!


Q:

Oh wow so they're more like a physician than a paramedic for us. That's awesome! Thanks for answering!

A:

No worries :D glad I could help!


Q:

Have you been called out to anything where the patient was in an embarrassing predicament?

A:

Yeah, we get a lot of "I didn't mean to put it up there!"'s or "it was an accident!" There are many occasions where we have to hold in our laughter and remain professional!


Q:

like what may I ask :)

A:

Normally random sex toys, I think the weirdest I've heard of was a goldfish...


Q:

Thanks for the reply :)

A:

No worries :D nice to hear from you!


Q:

I know british police wear Bobby hats...any comical paramedic uniform?

A:

Have you seen the UK paramedic uniform? It's bottle green and very unflattering.... The whole thing is pretty comical!

We have hazmat suits so sometimes we look like something from monsters inc. Our own helmets for when we're on the motorway, and massive High-vis jackets, that swamp me and make me look a bout 4 ft tall and like i'm 12... very hard to be taken seriously at a massive road accident by the fire and police when you look like you've lost your parents on a bicycle trip! :L


Q:

Lol!! Thank you

A:

You're welcome :D


Q:
  1. What made you pick a career as a paramedic and not as a nurse/doctor/consultant as you have mentioned you are a trauma fan?
  2. Do you usually have a more senior paramedic with you, or in certain scenarios do you call a clinical professional for advice?
  3. How can you say Manchester United!
  4. You cover Bucks, but not limited to said area, I'm guessing if they are short elsewhere you are able to respond to the other 3 counties?
  5. Do you live in the Bucks area, or commute?
A:

I wanted to be a doctor at first, but I'm not smart enough for that :L I felt that nurses were very under-appreciated and under-valued sometimes, and I wanted to be out where the action is! First on scene where patients are at their most vulnerable and relying on me completely. I just thought that was way more life affirming. We're a jack of all trades but a master of none so I actually know a little bit about everything :) I'm a doctor, midwife, nurse, physiotherapist, and social worker all rolled up into one :) and that makes it pretty cool! I love love LOVE trauma... it's quite disturbing to some people.. :O

Nope, I'm usually the most qualified person on my ambulance! we usually go out with an ECA who are not allowed to administer drugs and havent been clinically trained in a lot of the stuff we have. But they're absolutely amazing and I couldn't do what I do without them. On the rare occurrence we get placed on a double paramedic crew it's a very blissful shift though! We can bounce ideas off of each other and it makes the whole thing much less stressful. We have a clinical support desk we can call for advice if we get stuck or unsure though!

I'm sorry!!! you are entitled to your (wrong) opinion xDD

Not just the three counties! we cover beds, bucks, oxfordshire, hampshire, hertfordshire and berkshire. So we can pretty much go anywhere, especially if we get transfers to hospitals that are out of our area! I've been into london on many an occasion! But they try their hardest in our control room to keep us in our designated areas!

I live here luckily! some people I work with travel though! as much as an hour! Crazies...


Q:

Have you ever had to use an AED on-site? If so, how often? Or do coronary victims normally make it to the ER?

A:

We have full defibrillators not AED's. But yeah I use it on every job! It does vitals as well as shocking people. As for shocking, I've done it a fair few times yes! If a patient requires defibrillation more often than not, we take them in because they're more likely to be savable. As for coronary victims 9/10 they make it before we need to defibrillate, but sometimes they can go into cardiac arrest and thats when we get our pads out!


Q:

This is a tough job for sure. I've heard lots of people can't handle it with all the terrible trauma they witness (I know I couldn't).

Are you worried about seeing anything too disturbing and having to find a new profession sooner than you might think?

Follow up, what's the worst thing you've seen so far?

A:

To be honest there's not too much that bothers or gets to me, I think it would be sad to see a dead child which I thankfully haven't had to see... The worst thing I've seen is probably NSFW :L


Q:

Glad to know there's people who can do the job. Thank you for your service.

A:

Thanks :D


Q:

Can you choose which shifts you want to work?

A:

Not if you work for the NHS, you can if you work for a private country, and you can pick your overtime shifts


Q:

Any bad testicle or boob trauma you've seen? (or worst gender-specific injuries you've dealt with)

A:

No not really to be honest, we get the occasional genital mutilation from rape victims or testicular torsions


Q:

What's the strangest injury you have come across while on duty?

A:

Strangest? I had a patient yesterday who's leg was completely twisted round.. that was pretty strange xD it depends what you mean by strange! XD


Q:

Have any of your patients tried hitting on you?

A:

Yes numerous times, some try to touch me inappropriately too!


Q:
  1. What kind of shifts do you have? Do you get time in between calls?

  2. Do you drive an ambulance or work in the back. what's the difference? Take turns?

  3. I believe there's a colour code to the types of emergencies you go out too, is this true what are they?

  4. What's the difference between dispatching an ambulance and a car? What sceneries are they used in?

  5. Do you see regular ambulance/hospital visitors.

  6. Is it not hard to assess a patient with no information such as background or known drug allergies. How would you know what drugs to give?

  7. Do you serve a specific hospital or work in an area with multiple hospitals.

I am a frequent ambulance passenger with really brittle asthma and usually I just wait until I'm given magnesium then symptoms improve. Usually that's either in the ambulance or resus depending on the crew so interested in how it all works!

A:
  1. We work a mixture of 10 or 12 hour shifts. We also get a mix of days, lates and nights. We have to have 11 hours between shifts and we get half an hour break. We don't get time between calls normally but sometimes get 10/15 minutes of waiting for a new job, but its rare.
  2. We take it in turns to work in the back of the ambulance and drive, so I can do both! Normally we take half the shift each.
  3. There is a code that we use with four colours, it generally follows that Red 1 means the patient is dead or in a severely life threatening situation. Red 2 means the patient is in a condition that could become life threatening at any moment in the next few hours. Amber is potentially life threatening if left untreated but not in immediate danger. Green is not life threatening but needs assessment and Blue is not life threatening, already been seen by a medical professional or in professional care and requires transport only.
  4. Cars tend to be dispatched first to jobs (if there is one available) to do a rapid assessment and decide whether the patient needs to be in hospital. They don't tend to transport anyone and instead call for a certain level of backup (p1 -same as red, p2-amber, p3- green and p4 - blue) then an ambulance comes along and takes the patient where they need to go.
  5. We have A LOT of regulars, there are some I see every other shift. Not always ill patients either, just frequent callers.
  6. We tend to ask most patients their full history and go by what they say, if they say they're allergic to something we dont give it to them. If they're unconcious, we try our best to find out from family or carers but if not, in an emergency we give the drugs that are indicated, and if they have an allergic reaction, we have medication to deal with that too. We get taught what drugs to give and when in university, hence why its a 2 year course, but we have a little book called the JRCALC that reminds us of the indications and contra-indications of every drug we can give just in case.
  7. No we serve an area that contains many hospitals. There are 3 near me that we regularly use, and we take patients to the closest one :)

Q:

As someone who has trouble with bodily fluids and the General human body I'd like to ask if you ever had trouble with these?

A:

No it's never bothered me to be honest x


Q:

Thanks for the reply! It's interesting that it doesn't effect some but others can stricken by fear in the presence :)

A:

I think it's always been the Case that jobs like this require a certain type of person who can deal with that stuff, it's definitely harder than it sounds to deal with the things we see every day!


Q:

I remember once rushing to try and help someone who was lying on their back at Hull train station one morning as I arrived on my way to work only to find it was a CPR dummy they were doing training with. D'oh! Do you or did you ever find yourself having to do drills like that in public places? And any idiots like me who didn't realise it was a dummy?

A:

I've never actually done training in a public place, no! I had no idea anywhere actually did! We have specialist classrooms designed like public places and ambulances and stuff to practice so we've never had to go outside in the real world with our dummies xD x


Q:

That's much more sensible. To be honest I have no idea who was being trained because as soon as I realised what an idiot I'd been I kept my head down and scooted out. Thanks for replying and thanks of course for the service you provide to the community.

A:

No worries :D Glad I could answer :)


Q:

Why do you guys such funny sounding sirens?! Haha

A:

Haha! I've always wondered that! We have three types, I have named them the wail, the minion and the dog laser xD mainly because the wail literally sounds like someone crying, the minion does the classic "bee doo bee doo bee doo" and the dog laser sounds like exactly that... A barking dog or a laser beam xD x


Q:

Muslims in Europe

Yes or no?

A:

yes? what kind of question is that xD a person is a person... Idc what you believe in


Q:

I was under the impression this was ask me anything

A:

Fair enough xD