Slouching Toward Mediocrity

So we finally got Solu-Medrol on the ambulances here in Massachusetts.

It's a drug I used often in Connecticut once upon a time, to excellent effect on a variety of respiratory ailments. I don't care what the experts say, I've seen Solu-Medrol work its magic in under 10 minutes, and have always felt it was a missing piece in the Mass Paramedic armamentarium.

So now we have it.

This being Massachusetts, though, that sound you're hearing is the deafening shriek of someone standing on the brakes.

Why?

Here is the list of approved uses for Solu-Medrol, according to the most recent Statewide Treatment Protocols (Official Version # 8.03, Effective 3/1/2010) --

Anaphylaxis, asthma, spinal cord injury, croup, elevated intracranial pressure (prevention and treatment), as an adjunct to shock.

Pretty impressive, right?

Guess how many of those conditions Paramedics in Massachusetts will have the option of using Solu-Medrol to treat?

NONE. Nada. Zip.

Sadly, there is but one instance under which a Paramedic in the state of Massachusetts can call a physician and beg permission to administer Solu-Medrol: Known adrenal insufficiency.

True, Solu-Medrol can be a life-saving intervention for someone with adrenal insufficiency, where the namesake glands, located just behind the kidneys, fail to produce the cortisol and aldosterone which is critical to maintaining blood pressure, sugar and salt balance, and heart muscle tone.

Essentially the body loses its ability to handle stressors (in crisis, a normal person's adrenal glands can pump out up to 10 times their normal cortisol production; those with AI cannot), and the condition can be fatal.

Surely, for these people, having Solu-Medrol on the ambulances will be a life-saving development.

But the Office of Rare Diseases at the National Institutes of Health officially classifies adrenal insufficiency as a "rare" disease, meaning fewer than 200,000 people are affected by it.

That's 200,000 people out of a US population of about 300,000,000.

Locally, only about 3,800 people in Massachusetts have known adrenal insufficiency, or a little more than 10 people per town statewide on average.

Contrast that small patient population, for whom we have permission to treat (or, anyway, at least the permission to ask permission), to the vast population of respiratory patients who might also benefit from Solu-Medrol but who will not be afforded that opportunity.

It seems patently unfair, but I'm sure the experts have their reasons, and some day one of them may deign to enlighten the rest of us.

Until then, I'll keep scratching my head as I slouch toward the mediocrity that's being forced upon me, failing to understand the rationale behind carrying 375 mg of Solu-Medrol to treat a patient population I might see two, maybe three times in a decade, even though I see a dozen patients per week who might also benefit from the drug but to whom I must deny it.

Next Week: Epi-Pens, or, Why The State Is Punishing All Paramedics And Their Patients Instead of De-Certifying The Idiots Who Don't Know The Difference Between 1:1,000 And 1:10,000.........