Pain Management Certificate (Methoxyflurane) · PDF fileLearner Guide 1 Acknowledgements ... Assessment Information ... To commence training for the Pain Management Certificate (Methoxyflurane)

Pain Management Certificate

(Methoxyflurane) Learner Guide

Learner Guide

1

Acknowledgements

This education resource has been developed by the Australian Lifesaving Academy.

Surf Life Saving Australia (SLSA) would like to acknowledge the following people who contributed their time and expertise to support the development of this resource: Natalie Hood – National Medical Officer – Surf Life Saving Australia

Marcia Fife – State Emergency Care Advisor – Surf Life Saving Queensland

Stuart Wall – State Assessment Supervisor – Life Saving Victoria

Robert O’Brien – Resource Development Coordinator – Surf Life Saving Australia

SLSA would like to acknowledge the financial support it has received from the Federal Department of Education, Employment and Workplace Relations. The views expressed herein do not necessarily represent the views of the Commonwealth of Australia. The Commonwealth of Australia does not give any warranty or accept any liability in relation to the content of this work.

© Surf Life Saving Australia Ltd. This work is copyright, but permission is given to SLSA trainers and assessors to make copies for use within their own training environment. This permission does not extend to making copies for use outside the immediate training environment for which they are made, or the making of copies for hire or resale to third parties. For permission outside these guidelines, apply in writing to: Surf Life Saving Australia Locked Bag 1010, Roseberry NSW 2018 Ph: (02) 9215 8000 Fax: (02) 9215 8180 Web: www.sls.com.au All resources developed by Surf Life Saving Australia are reviewed at least annually and updated as required. Feedback can be supplied through the online Improvement Requests form on the Education Resources page at www.sls.com.au or in writing to the address above. Version 2.3 November 2012

http://www.sls.com.au/


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Contents

Acknowledgements .............................................................................................................................. 1

Course outcomes ............................................................................................................................. 3

Prerequisites .................................................................................................................................... 3

What you need to complete this course.......................................................................................... 3

Topic 1 - Pain and Analgesic Gases ..................................................................................................... 4

What is pain?.................................................................................................................................... 4

Measuring pain ................................................................................................................................ 4

Methoxyflurane ............................................................................................................................... 6

Penthrox Inhaler .............................................................................................................................. 6

Safety ............................................................................................................................................... 7

First Aid ............................................................................................................................................ 7

Topic 2 – Contraindications and Precautions ................................................................................... 10

Contraindications ........................................................................................................................... 10

Precautions .................................................................................................................................... 10

Casualty questioning ...................................................................................................................... 10

Assessing level of consciousness ................................................................................................... 11

Topic 3 – Administering Methoxyflurane ......................................................................................... 13

Administering methoxyflurane ...................................................................................................... 13

Self-administration ......................................................................................................................... 13

Procedure for administering methoxyflurane ............................................................................... 13

Special situations ........................................................................................................................... 16

Separation ...................................................................................................................................... 16

Hand-over to ambulance ............................................................................................................... 17

Topic 4 – Storage and Documentation ............................................................................................. 19

Storage ........................................................................................................................................... 19

Access ............................................................................................................................................. 19

Audit ............................................................................................................................................... 19

Disposal of drugs ............................................................................................................................ 19

Documentation .............................................................................................................................. 19

Casualty-specific documentation ................................................................................................... 20

Storage and supply documentation ............................................................................................... 20

Assessment Information .................................................................................................................... 22

Assessment Portfolio ........................................................................................................................... 1

Learner Guide

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Course Introduction Many casualties treated by surf lifesavers and first aid teams experience severe pain due to the injuries sustained. A casualty suffering severe pain can focus on little else and is often uncooperative and unwilling to help the first aider apply timely and effective treatments.

Methoxyflurane is an inhaled analgesic (pain relief) that has been used by ambulance services in Australia for many years. It takes effect quickly and wears off equally as fast, with minimal side effects. These properties allow the gas to be used to more effectively treat casualties in severe pain by lessening the disruptive effects of the painful stimulus.

Course outcomes

By the end of this course you should be able to:

Detail the principles of pain management

Demonstrate basic pain management techniques

Detail the safety considerations and procedures for administering methoxyflurane

Administer methoxyflurane

Complete documentation involved in the use of methoxyflurane.

You will also develop knowledge and skills to enable you to demonstrate competency in the nationally recognised unit of competency:

PUAEME005A Provide Pain Management.

This unit forms a part of the nationally recognised qualification Certificate III in Public Safety (Aquatic Search and Rescue)

Prerequisites

To commence training for the Pain Management Certificate (Methoxyflurane) you must meet the following course prerequisites.

Be at least 18 years of age on the date of final assessment

Hold the SLSA awards :

o Apply (Senior) First Aid Certificate o Advanced Resuscitation Certificate OR Advanced Resuscitation Techniques Certificate

have achieved the following units of competency

o HLTFA211A Apply First Aid o HLTFA412A Apply advanced resuscitation techniques o PUAOPE010C Operate a semi automatic defibrillator in an emergency o PUAEME003C Administer oxygen in an emergency situation

What you need to complete this course

A copy of this learner guide

A copy of your State Operating Procedure relating to Methoxyflurane administration


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Topic 1 - Pain and Analgesic Gases

This topic will assist course participants in developing the skills and knowledge to:

Describe what pain is

Explain the principles of pain management

Explain how to quantify pain

Identify a methoxyflurane vial and Penthrox inhaler

Explain the mode of action

Explain the safety precautions of methoxyflurane use

What is pain?

Pain is a sensation, ranging from mild discomfort to agony. The sensation of pain may be localised or systemic (widespread) and is subjective (varies from person to person). It is caused by stimulation of pain receptors.

Nerve cells convey information from receptors in the extremities and organs of the body to the brain, where they are processed and perceived by the casualty as pain.

Pain often serves as a protective mechanism, as sudden pain initiates a reflex that causes muscle contraction, thereby moving the limb away from the painful stimulus (such as burns or treading on a nail).

Principles of pain management

A casualty suffering extreme pain can focus on little else and is often uncooperative and unwilling to help the first aider apply timely and effective treatment. A gentle but confident and professional approach to any casualty will build trust and make treatment administration easier.

Whether applying simple pain management methods such as ice, or formal pain management techniques discussed in this course, the principles are the same — relieve the casualty’s suffering, as you are unlikely to be able to stop the cause of the pain.

Basic pain management

Basic pain management techniques that may be appropriate according to the casualty’s injuries include:

Reassurance

Cold packs for local skin pain

Heat for penetrating marine creature injuries

Administration of methoxyflurane for severe pain.

Measuring pain

Measuring a casualty’s level of pain before and during administration of an analgesic is important to gauge the effectiveness of the treatment and is valuable information to pass on to paramedics.

Learner Guide

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Verbal Numerical Rating Scale

This scale asks the casualty to rate their pain from “no pain” (0) to “worst pain possible” (10) and is suitable for use in adults and children over six years of age who have an understanding of the concepts of rank and order. Avoid using numbers on this scale to prevent the casualty receiving cues. Some casualties are unable to use this scale with only verbal instructions but may be able to look at a number scale and point to the number that describes the intensity of their pain.

Wong – Baker FACES Pain Rating Scale

This scale can be used with young children aged three years and older and may also be useful for adults and those from a non-English speaking background. Point to each face using the words provided to describe the pain intensity. Ask the child to choose face that best describes his/her own pain and record the appropriate number.

Figure 1.1 – Faces Pain Scale

From Wong D.L., Hockenberry-Eaton M., Wilson D., Winkelstein M.L., Schwartz P.: Wong's Essentials of Pediatric Nursing, ed. 6, St. Louis, 2001, p. 1301. Copyrighted by Mosby, Inc.

Analgesia

Analgesia is the relief of pain without the loss of consciousness. An analgesic is any of the drugs used to relieve pain and may more commonly be known as a pain killer. These work by:

blocking receptors in the central nervous system that receive pain signals

blocking transmission of pain signals along nerve pathways.

The SLSA policy regarding the use of analgesics can be found on the SLSA website www.slsa.com.au


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Methoxyflurane

The inhaled analgesic methoxyflurane can relieve discomfort, but will not completely eliminate pain. Methoxyflurane is an analgesic gas that is inhaled to provide pain relief. It comes in liquid form which vaporises at room temperature allowing inhalation by the casualty. The liquid is clear and colourless with a fruity odour.

Onset and washout

Pain relief from methoxyflurane (onset) occurs in two to three minutes and lasts four to five minutes once treatment has stopped (wash out).

Effective duration

Each 3 ml bottle of methoxyflurane will provide pain relief for 20-30 minutes.

Restricted drug classification

Methoxyflurane is a schedule 4 drug which means that it must be prescribed by a doctor. Surf lifesaving state organisations have approval for qualified members and employees to administer this drug following a protocol endorsed by the SLSA Medical Officer.

Identification

Methoxyflurane is produced in a 3 ml sealed amber glass bottle with a plastic wrap seal around the cap. It may be labelled as one of the following:

Methoxyflurane

Penthrox (brand name including inhaler device).

The methoxyflurane bottle and packaging will have a ‘Use by’ date. Never use methoxyflurane past this date, and never use bottles that have been tampered with (plastic wrap missing or damaged). These should be disposed of according to local authorities and replaced with fresh stock.

Figure 1.2 – Methoxyflurane vial

Penthrox Inhaler

The Penthrox Inhaler is a green cylinder designed to hold the methoxyflurane as it vaporises, to allow inhalation by the casualty. It is shown below with an activated carbon filter attached. The activated carbon filter is used to filter unused methoxyflurane from the air exhaled by the casualty, minimising exposure to the gas by the first aiders and bystanders.

Diutor

Mouthpiece

Figure 1.3 - Penthrox Inhaler with activated carbon filter attached

Activated carbon filter

Wrist strap

Learner Guide

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Mode of action

The mode of action is how the analgesic works to provide pain relief. On inhalation, methoxyflurane passes easily into the blood across the respiratory membrane in the lungs, in a similar way to oxygen. Methoxyflurane acts directly on the central nervous system, blocking receptors to reduce the sensation of pain.

Side effects

nausea

vomiting

headache

Serious less common side effects can be:

profound respiratory and circulatory depression

loss of consciousness

Safety

Methoxyflurane is expelled from the casualty’s lungs in the same form as it is inhaled. The methoxyflurane exhaled by a casualty may be absorbed and have an effect on people nearby.

Frequent exposure to or large doses of methoxyflurane may be harmful to the kidneys, so it is essential that methoxyflurane is only used in well-ventilated areas to avoid first aiders being exposed to the gas.

To minimise exposure to methoxyflurane, an activated carbon filter should be used when administering to a casualty indoors.

Personal Protective Equipment (PPE)

When pouring methoxyflurane into the inhaler, the first aider should wear appropriate PPE (gloves

and eye protection) to minimise the chance of spilling methoxyflurane on his/her skin or splashing

in his/her eyes.

Methoxyflurane volatility

Methoxyflurane is a highly volatile liquid, which may ignite under relatively normal conditions. The

flashpoint (lowest temperature for vapour above a liquid to be ignited in air) of methoxyflurane is

62.8°C in air and 32.8°C when mixed with oxygen. It is important that the methoxyflurane bottle is

not left in direct sunlight. Methoxyflurane ignites easily and extra care should be taken when using

supplementary oxygen therapy, in the presence of naked flames or in other flammable situations.

First Aid

If accidental contact occurs, the following first aid treatments should be followed.


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Swallowed DO NOT INDUCE VOMITING. Rinse the mouth out with water and then give water to drink. Seek immediate medical assistance.

Eye Immediately irrigate with copious amounts of water for at least 15 minutes. Hold the eyelids open. In all cases of eye contamination it is a sensible precaution to seek medical attention.

Skin Wash contaminated skin with plenty of soap and water. Remove contaminated clothing and wash before re-use. If irritation occurs seek medical attention.

Individual Activity 1.1: Review Questions

Answer the questions below to review your understanding of this topic.

1. Where in the body is pain processed?

.......................................................................................................................

.......................................................................................................................

......................................................................................................................

2. What is the simplest method of measuring a casualty’s level of pain?

.......................................................................................................................

.......................................................................................................................

.......................................................................................................................

3. Where can you find the surf lifesaving policy regarding the use of analgesic gases for pain management?

.......................................................................................................................

.......................................................................................................................

.......................................................................................................................

4. Methoxyflurane is a ___________________ liquid with a __________________ odour.

5. Onset occurs in ___________________ and once treatment has stopped will last for ___________________

6. List (4) side effects of methoxyflurane treatment.

1......................................................................................................................2.....................................................................................................................3.....................................................................................................................4.....................................................................................................................

Learner Guide

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7. What action should be taken if a casualty or carer swallows methoxyflurane?

.......................................................................................................................

.......................................................................................................................

.......................................................................................................................

8. What should you do if methoxyflurane comes in contact with the eyes?

.......................................................................................................................

.......................................................................................................................

.......................................................................................................................

9. When pouring methoxyflurane into the Penthrox inhaler it is recommended that you wear

___________________ and ___________________


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Topic 2 – Contraindications and Precautions


Identify the contraindications for methoxyflurane

Explain how the use of methoxyflurane in the presence of contraindications will affect the casualty

Identify casualties for whom extra caution should be used when administering methoxyflurane

Contraindications

A contraindication is a reason not to use a course of treatment or a medication. Contraindications for administering methoxyflurane to a casualty include:

The casualty cannot understand or comply with the instructions for use.

The casualty has a history of kidney disease (renal impairment or renal failure), as methoxyflurane may cause kidney damage.

There is a decreased level of consciousness - Head injury or drug/alcohol induced (see Assessing Level of Consciousness on page 20).

The casualty has a known allergy to methoxyflurane.

There has been a severe allergic reaction to general anaesthetics in the casualty or the casualty’s family.

Casualties who have received methoxyflurane at any time in the past week.

Casualties with inadequate respiratory effort or rate.

Casualties suffering multi-trauma and shock.

Precautions

A precaution is a condition where caution is indicated but where the condition does not necessarily rule out the treatment or medication. Where casualties exhibit any of the following conditions, caution should be taken, paying particular attention to these conditions and stopping treatment if the first responder becomes concerned:

Respiratory depression, as it may worsen the condition

Cardiovascular instability, as it may worsen circulatory depression.

Casualty questioning

The best way to ensure that the casualty has no contraindications is to question him/her. Be certain that none of the above contraindications exists before starting treatment. Below are four key questions to ask when assessing the casualty for contraindications to methoxyflurane administration.

Questioning for Methoxyflurane Contraindications

(Kidney) Renal Impairment

‘Do you have or have you had significant medical problems affecting your kidneys?’

Allergy to Methoxyflurane

“Have you been administered methoxyflurane* in the past?’ If yes, ‘Did you have an allergic reaction to it?’

Learner Guide

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Allergic Reaction to General Anaesthetics

‘Have you or anyone in your family had an allergic reaction to general anaesthetics?’

Recent Methoxyflurane use

‘Have you received methoxyflurane* in the past week?’

* An explanation that methoxyflurane is the pain relief given in the green inhaler (whistle) may assist the casualty in understanding if he/she has received methoxyflurane.

Assessing level of consciousness

A complication of methoxyflurane treatment is loss of consciousness, the danger of which is multiplied in casualties who already have a depressed level of consciousness. The casualty’s level of consciousness can be assessed using the AVPU Scale. The scale outlines four general levels of consciousness from Alert to Unconscious.

Alert

Voice: Responds to voice

Pain: Responds purposefully

Unconscious

Using the AVPU conscious state assessment, a casualty may receive methoxyflurane if he/she responds to voices and remains alert. People in the ‘Pain’ or ‘Unconscious’ categories are not candidates for methoxyflurane.

Alert

Eyes open

Speech clear

Moving

Orientated

Voice

Eyes open at request

Clear responses to questions

Moving

Remains awake/alert

Pain

Eyes open - pain stimulus

Casualty withdraws from pain

Comprehensible or non-comprehensible verbal noises

Unconscious

Does not meet above criteria

Maintain casualty airway


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1. Which of the following are contraindications for methoxyflurane therapy? (circle all correct answers):

a. The casualty is not accessible

b. The causalty has already received 6ml of methoxyflurane that day

c. The casualty is pregnant

d. The casualty does not understand the instructions

2. Name the scale commonly used to measure a casualty’s level of consciousness.

.......................................................................................................................

3. Fill the gaps in the AVPU consciousness level assessment.

A_____________

Voice: Responds to _____________

P____________: Responds purposefully

U____________

4. List two contradictions for methoxyflurane use.

1.....................................................................................................................

2.....................................................................................................................

5. What precaution should carers take if using methoxyflurane in any area with poor air circulation, including any confined space?

.......................................................................................................................

.......................................................................................................................

.......................................................................................................................

Learner Guide

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Topic 3 – Administering Methoxyflurane


Explain the treatment protocol for safely administering methoxyflurane to a casualty

Identify side effects associated with methoxyflurane use

Identify other considerations that need to be taken into account with methoxyflurane administration

Administering methoxyflurane

Methoxyflurane is self-administered by the casualty through an inhaler, which is disposable and for single use only.

Self-administration

Methoxyflurane is self-administered for two reasons. The first reason is that self-administration ensures that if the casualty loses consciousness the inhaler will fall away from the face and the casualty will inhale room air. Once the casualty stops inhaling they will quickly regain consciousness.

The second reason is that as the casualty is the best judge of their own pain, self-administration allows the casualty to control their pain. The casualty should be encouraged only to inhale methoxyflurane to achieve a more bearable level of pain.

Casualties with facial injuries may find the mouthpiece uncomfortable. In this situation the inhaler can be connected to a standard resuscitation mask. Casualties with facial or jaw injuries may not be able to tolerate either mask or mouthpiece. Always be sure you are not worsening an injury in your attempt to treat the casualty’s pain.

Procedure for administering methoxyflurane

1. Reassure the casualty.

2. Confirm indications for use (casualty is in pain).

3. Ascertain that there are no contraindications to methoxyflurane use.

4. Obtain methoxyflurane and check the expiry date and that the seal has not been tampered with.

5. Explain the procedure to the casualty

a) This is methoxyflurane, which will help relieve your pain

b) You must put the inhaler in your mouth while you breathe in

c) The gas will only be inhaled when u breathe in

d) Continue inhaling until the pain starts to dull. Aim for relief of discomfort rather than complete elimination of pain

e) If you feel any side effects, remove the inhaler. The unpleasant effects will wear off, but your pain will also worsen.

6. Ensure that the casualty understands the instructions for use.


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7. Prepare the inhaler for use:

a) Insert the activated Carbon device into the diluter hole

b) Hold the inhaler upright with the mouthpiece down. Open the vial and p[our the full 3ml into the base cap. Shake gently and wipe the mouthpiece.

8. Pass the inhaler to the casualty and allow him/her to breathe through the inhaler.

9. After the casualty has taken 8-10 breaths, he/she can be instructed to place a finger over the diluter hole to increase the concentration of methoxyflurane being inhaled.

Learner Guide

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10. Instrust the casualty to inhale the methoxyflurane intermittently but sufficiently to provide adequate pain relief.

Methoxyflurane given intermittently

Figure 2.1: Example of intermittent inhalation of methoxyflurane to provide pain relief.

11. Fasten the strap of the inhaler to the

casualty’s wrist.

12. Upon starting treatment record the following:

a) In the ‘Drug Register’

(i) date, casualty’s full name, date of birth

(ii) time therapy started

b) On the ‘Medical Response Form’

(i) time therapy started

13. When a satisfactory level of pain relief is achieved, check the level of consciousness by giving the casualty a simple command (e.g. lift your left arm, squeeze my hand, wiggle your toes). Continually assess the casualty’s level of consciousness while methoxyflurane is being inhaled.

0 20 40 60 80

100 120

1 4 7 10 13 16 19 22 25 28

% 0

f seru

m l

evel

Minutes

Penthrox given intermittently Pain Relief

6 breaths 6 breaths 6 breaths


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14. At the end of treatment, record the following:

a) In the ‘Drug Register’

(i) time therapy stopped

b) On the ‘Medical Response Form’

(i) time therapy stopped

(ii) total inhalation time

15. If the first dose of methoxyflurane runs

out, a second vial can be used. The total dose

administered must not exceed 6 ml (i.e. two vials maximum).

NOTE: A second Methoxyflurane unit will need to be opened

if a second vial is required

16. As soon as methoxyflurane treatment is stopped, place the casualty on oxygen therapy for at least three minutes.

17. Ensure a completed copy of the ‘Medical Response Form’ goes to the hospital with the casualty.

18. Participate in an operational debrief. This debrief may be performed with your supervisor, or by an external counselling support network.

Remember this!

The maximum dose of methoxyflurane to be given to a casualty in a 24 hour period is 6 ml (two vials)

Special situations

Inaccessible patient

Where a casualty cannot be reached by the first aider, but is communicating, can understand instructions and can be visually monitored by the first aider, load the inhaler and pass/throw it to the casualty.

NOTE: The Penthrox inhaler is single use only and must be discarded safely after use. The patient is likely to be still using the device when transported by the ambulance service to the hospital, so the device can be discarded in accordance with hospital protocols.

Separation

Casualties treated with methoxyflurane must not be allowed to leave the treatment site without further medical follow-up. Generally the nature of the injury or illness will require further medical aid. The casualty should be transported to hospital by ambulance.

Learner Guide

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If the casualty refuses further medical aid:

the casualty must sign a “Medical Treatment Waiver”

you must advise the casualty not to drive or operate dangerous machinery for 24 hours

Hand-over to ambulance

State that the casualty has been given methoxyflurane

Provide completed Medical Response Form and verbal information

o casualty's name o age o nature of injury o treatment of injury o methoxyflurane has been given o casualty’s condition since commencing treatment o side effects



1. How can the casualty increase the concentration of methoxyflurane that he/she is inhaling? (please circle the correct answer)

a. By breathing faster

b. By blocking the diluter hole with the finger

c. Both of the above

d. The dose cannot be changed

2. What is the maximum daily dose of methoxyflurane?

.......................................................................................................................

3. Put the following steps into the order that they would be performed:

- Explain procedure to the casualty

- Decant the methoxyflurane into the inhaler device

- Reassure the casualty

- Monitor the casualty

- Check for contraindications

- Confirm that the casualty is in need of pain relief

4. What form must be sent to the hospital with the casualty?

.......................................................................................................................


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5. List two reasons why it is important to have the casualty self-administer methoxyflurane

1.....................................................................................................................

.......................................................................................................................

2.....................................................................................................................

.......................................................................................................................

6. If the casualty recovers from their initial injury after having been administered methoxyflurane, are they allowed to leave your care and be looked after by family members or friends? (please circle correct answer)

Yes / No

7. What might you do if the casualty is unable to tolerate the mouthpiece of the inhaler?

.......................................................................................................................

.......................................................................................................................

.......................................................................................................................

Learner Guide

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Topic 4 – Storage and Documentation


Identify the forms to be filled in when methoxyflurane is used

Complete the Medical Response Form when methoxyflurane is used

Complete logs according to Surf Life Saving Australia and specific State/Territory procedures

Storage

As methoxyflurane is a schedule 4 drug that has a restricted supply due to the possibility of misuse, it is required that it be securely stored. Secure storage generally requires that the drug be stored in a locked cabinet (either key or keypad entry) that is difficult to move, either because it is fixed to a wall or because of its weight. It is important that the methoxyflurane is always returned to the secure storage supplied at your club or service when not in immediate use.

Access

Access to the storage cabinets is allocated based on need to authorised and qualified personnel. This is to limit the amount of opportunity for abuse. While procedures may vary from state to state, the general principle is that if you are issued access (either key or code) it is for your personal use and you should not give your key or access code to anyone else. Should someone else require access using your key for a legitimate reason you should supervise the access and ensure the drug register and any additional documentation is correctly filled out. When you no longer require a key, it should be returned to the issuing authority.

Audit

As a requirement of being authorised to store and administer methoxyflurane, surf lifesaving services are required to audit their stocks of methoxyflurane and related records. This auditing is usually done by one or two independent auditors appointed by the relevant surf lifesaving state headquarters.

Disposal of drugs

All drug bottles requiring disposal are to be disposed of in accordance with your relevant State or Territory guidelines. This may include:

Out of date bottles

Damaged bottles

Used or empty bottles (some states may require the return of used bottles as a part of the tracking process).

Documentation

There is special documentation associated with the use of methoxyflurane, additional to the standard forms required for first aid treatment. These special forms are to meet the following requirements:

for accurate handover of casualty treatment

for tracking storage and use of the drug

to provide legal coverage.


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Records of the receipt and disposition of the inhalers are to be made in such a manner that stocks are accountable and that any diversion or inappropriate use is minimal and detectable. Such records are to be retained for twelve months from the date of the last entry.

Casualty-specific documentation

Medical Response Form

When a casualty is passed from the care of the first aider to another service it is always important that information about the casualty’s history and treatment is communicated to the receiving personnel to ensure best casualty care. When the use of a drug has been included in the treatment it becomes essential that accurate information is handed over in a written form. The Medical Response Form captures all of the relevant data for hand over of a casualty who has been administered methoxyflurane.

Treatment Waiver Form

Casualties treated with methoxyflurane must not be allowed to leave the treatment site without further medical follow-up (usually ambulance). If a casualty refuses to wait for the medical follow-up he/she must be asked to sign a Medical Treatment Waiver to acknowledge that he/she is leaving against advice. This form is to provide legal coverage for the first aider should the casualty suffer adverse reactions after leaving care.

Storage and supply documentation

Depending on specific state procedures there may be further documentation required regarding the storage and supply of methoxyflurane. The drug register is standard documentation required in all states.

Drug Register

First Aiders will be required to fill out the drug register that is stored with the drugs in the locked cabinet at the club or service. This should be filled out whenever drugs are removed from or placed into the storage cabinet. The purpose of the drug register is so that stocks can be accounted for and any diversion or inappropriate use is minimal and detectable. All transactions involving the addition or removal of the drugs must be logged and may include:

removing drugs for use in treating a casualty

returning excess drugs not used in treating a casualty

removing out of date drugs to send to state headquarters for disposal

receiving new supplies from state headquarters.



1. What are your State’s reporting obligations governing the use of methoxyflurane?

Learner Guide

21

.......................................................................................................................

.......................................................................................................................

.......................................................................................................................

2. What forms must be completed in addition to standard first aid logs when methoxyflurane is used?

.......................................................................................................................

.......................................................................................................................

.......................................................................................................................

3. What information needs to be recorded on a Medical Response Form?

.......................................................................................................................

.......................................................................................................................

.......................................................................................................................

4. What information needs to be recorded on a Medical Treatment Waiver?

.......................................................................................................................

.......................................................................................................................

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Assessment Information

Following is a description of the assessment tasks required to demonstrate competence in this course. This section is for information only. All evidence should be collected in the assessment portfolio section of this Learner Guide.

There are six assessment tasks to be completed for the Pain Management Certificate (Methoxyflurane) Course.

Task 1: Written questions

Task 2: Demonstration of pre-administration checks

Task 3: Demonstration of equipment set-up: Penthrox Inhaler

Task 4: Demonstration of administration procedures: Penthrox Inhaler

Task 5: Demonstration of post-administration procedures: Penthrox Inhaler

Task 6: Scenario

Assessment Task 1: Written Questions

You will be assessed on your understanding of pain management and the administration of methoxyflurane through a multiple choice theory assessment. All questions are based on information found in SLSA policies and this Learner Guide. The question paper is in the assessment portfolio section of this Learner Guide. Please write all answers on the sheet provided in the assessment portfolio section of this Learner Guide.

Assessment Tasks 2, 3, 4 & 5: Demonstrations of pre-administration checks; equipment set-up; administration procedures and post-administration procedures.

You will be required to perform four demonstrations. Demonstrations may be combined where it will be more efficient and logical.

Your Facilitator or Assessor will assess you against the criteria outlined below:

Pre-administration

DRSABCD

Reassure the casualty

Recognise the need for methoxyflurane

Ascertain that there are no contraindications for use

Explain the procedure to the casualty

Ensure that the casualty understands the instructions for use

Retrieve correct drug and check the expiry date on the vial and packaging

Assessment Task 3: Demonstration of equipment set-up: Penthrox Inhaler

Equipment setup

Inhaler held correctly

Inhaler loaded

Learner Guide

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Inhaler gently shaken to dispel excess fluid

Mouth piece wiped

Administration

The casualty is instructed to use inhaler correctly

The casualty is instructed to inhale intermittently

The strap is gently fastened to the casualty’s wrist

The following information is recorded on the Medical Response Form:

Date, casualty’s full name, date of birth

Indication for treatment

Time therapy commenced

The casualty’s level of consciousness is continuously monitored

A second vial is loaded, if necessary

Post-administration

Record the time that treatment ceased

The casualty is placed on oxygen therapy

Relevant logs and documentation completed

Hand over the casualty to ambulance personnel

Unused drugs are disposed of appropriately

Assessment Task 6: Scenario

You will be assessed, in a scenario, on how well you deal with an incident that will require you to manage a casualty’s pain. The scenario will be made as real as possible and will be in line with the training and the association’s standards and policies.

After each scenario the group will discuss the outcomes of the incidents with the Assessors. This is to assess everyone’s ability to apply the skills and knowledge in a patrol situation.

Your Facilitator or Assessor will assess you against the criteria outlined below:

Scenario

DRSABCD

Control/manage the situation

Obtain information on the casualty’s injury

Recognise the need for methoxyflurane

Assess for contraindications

Retrieve correct drug and check it is within expiry date

Explain the procedure to the casualty

Load the inhaler

Safely administer Methoxyflurane


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Assess the casualty’s level of consciousness / vital signs

Continuously monitor the casualty

Respond to adverse effects

Complete a Medical Response Form

Hand over the casualty to ambulance personnel

Dispose of unused Methoxyflurane appropriately

Complete appropriate documentation

Debriefing/evaluation of treatment is completed with peers/assessor

Learner Guide

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Assessment Portfolio

This portfolio details all the evidence you are required to submit to your Assessor to

demonstrate competence in the Pain Management Certificate (Methoxyflurane).

Learner Details

First Name: Surname:

Date of Birth: Club / Group:

Competency Record

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Pain Management Certificate (Methoxyflurane)

Assessment Tasks

Task 1: Written questions completed

Task 2: Demonstration of pre-administration checks

Task 3: Demonstration of equipment set-up: Penthrox Inhaler

Task 4: Demonstration of administration procedures: Penthrox Inhaler

Task 5: Demonstration of post-administration procedures: Penthrox Inhaler

Task 6: Scenario

Nationally Recognised Unit of Competency

PUAEME005A Provide Pain Management

Assessor Name:

Assessor Signature: Date:

Assessment Task 1: Written questions

This is a question paper only

Do not mark this paper. Use the ANSWER SHEET provided in the assessment portfolio section of your Learner Guide.

Read each question carefully before circling the correct answer on the answer sheet.

Please return this paper to the Assessor at the end of the assessment with your completed answer sheet.

Pass mark

85% (17+ out of 20 correct) – Proceed to the next section of the assessment. Your assessor will discuss any incorrect answers with you.

Less than 85% correct - Unable to proceed any further. Your assessor will discuss a resit time with you.

Please speak to your assessor if you believe that you may have a learning difficulty that affects your ability to answer these questions.

All questions relate to information contained in the Pain Management Certificate (Methoxyflurane) Learner Guide

1. How can pain serve as a protective mechanism?

a. by initiating a reflex that moves the limb away from painful stimulus

b. by sending information from organs to the brain

c. by being systemic (widespread) or localised

d. by causing general muscle contractions

2. Methoxyflurane is a

a. clear liquid with no odour

b. clear liquid with a fruity odour

c. dark liquid

d. clear liquid with a bitter taste

3. Onset of action occurs

a. in 5-6 minutes

b. instantly

c. in 30 seconds

d. in 2-3 minutes

Learner Guide

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4. Once treatment has stopped pain relief will last for

a. 4-5 minutes

b. 6-7 minutes

c. 2-3 minutes

d. 7-8 minutes

5. What action should be taken if a casualty or carer swallows methoxyflurane?

a. induce vomiting

b. give large amounts of milk to drink

c. do not induce vomiting, rinse mouth then give water to drink and seek medical assistance

b. no harm will come to someone who swallows methoxyflurane

6. What should you do if methoxyflurane comes in contact with the eyes?

a. cover both eyes with pads

b. hold the upper lid over the lower lid and get the casualty to blink

c. pad the eye

d. flush the area with water for 15 minutes, seek medical advice

7. Methoxyflurane must not be administered if the

a. casualty has flushed red skin

b. casualty has cold clammy skin

c. casualty does not understand instructions

d. casualty is not accessible

8. Name the scale commonly used to measure a casualty’s level of consciousness

Course Feedback Form

a. Unconscious scale

b. Carol’s coma scale

c. AVPU scale

d. Richards response scale

9. Which of the following is contraindication for methoxyflurane therapy?

a. broken ankle

b. severe abdominal pain

c. history of kidney disease

d. b and c

10. What precaution should carers follow if using methoxyflurane in a confined space?

a. use an activated carbon filter

b. stay with the casualty

c. do not use in confined spaces

d. both b and c

11. When pouring methoxyflurane into the Penthrox inhaler it is recommended that you

a. wear gloves

b. wear safety glasses

c. do it quickly

d. both a and b

12. How can the casualty increase the concentration of methoxyflurane that they are inhaling?

a. by breathing faster

b. by covering the diluter hole with their finger

c. both a and b

d. the dose cannot be changed

13. What is the maximum dose of methoxyflurane in 24 hours?

a. 3 ml

b. 9 ml

c. 6 ml

d. 12 ml

14. What form must be sent to hospital with the casualty?

a. no forms need to be sent

b. IRD

c. medical response form

d. patrol log


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15. It is important that methoxyflurane be

a. administered by the first aider

b. self-administered

c. administered by family or a friend

d. held into the mouth of the casualty

16. Common side effects include

a. Nausea

b. vomiting

c. drowsiness

d. all of the above

17. If a casualty recovers from his/her initial injury he/she should

a. stay in your care until medical assistance arrives

b. be left in the care of friends or family

c. be left on his/her own to recover

d. be instructed to get himself/herself to hospital

18. Currently, all green Penthrox inhalers are

a. easily cleaned and reused

b. biodegradable

c. hypoallergenic

d. single use only

19. Which statement below is most true when considering if a casualty is suitable to receive treatment with methoxyflurane?

a. No considerations need to be made if a casualty has a history of kidney disease

b. A casualty who has received methoxyflurane in the previous three months cannot receive it again

c. A casualty who is suffering from shock should not receive methoxyflurane

d. It is acceptable to give a casualty with a personal or family history of allergic reactions anaesthetics methoxyflurane as they are different from analgesics.

20. What paperwork must be completed relating to an incident where methoxyflurane has been administered to a casualty?

a. Medical Response Form

b. Drug Register

c. Incident Report Form

d. All of the above


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Assessment Task 1: Written Questions – Answer Sheet

Please mark all answers on this sheet.

NAME:

________________________________________________

a. b. c. d. 11. a. b. c. d.

a. b. c. d. 12. a. b. c. d.

a. b. c. d. 13. a. b. c. d

a. b. c. d. 14. a. b. c. d.

a. b. c. d. 15. a. b. c. d.

a. b. c. d. 16. a. b. c. d.

a. b. c. d. 17. a. b. c. d.

a. b. c. d. 18. a. b. c. d.

a. b. c. d. 19. a. b. c. d.

a. b. c. d. 20. a. b. c. d.


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Course date: ______________ Location: ______________ Your name: ______________

(Optional)

Trainer(s) and Assessor(s): ______________________________________________________

Your evaluation of this program is very important. It enables us to improve our training programs and

the quality of our service.

Statements

Strongly disagree

Disagree

N/A

Agree

Strongly Agree

Course Content

The course was explained to me prior to commencing and met my expectations.

The course had the right balance between theory and practice.

The course was the right duration and intensity.

General comments on course content

Course Material

The course materials were clear and easy to follow.

The activities were realistic and effective.

The course materials will be a useful ongoing reference.

General comments on course material

Training Personnel

Their knowledge was sufficient to effectively deliver the course.

They kept the course interesting and interactive.

They provided clear and complete answers to questions.

General comments for the facilitator/s

Overall outcomes

My knowledge and skills have increased as a result of this course.

This course has helped me meet or clarify my goals.

The course assessment activities were fair and realistic.

General comments about the overall outcomes of the course

Thank you for taking the time to provide this feedback

Documents

Pain Management Certificate (Methoxyflurane) · PDF fileLearner Guide 1 Acknowledgements ... Assessment Information ... To commence training for the Pain Management Certificate (Methoxyflurane)