Fentanyl Lozenges introduced for major incidents

Powerful analgesic lollipops to be made available by Essex & Herts Air Ambulance, especially for use in major incidents.

Today marks the 9^th anniversary of the Manchester Arena Bombing which we all remember with a great deal of sadness and ongoing reflection. Over 14000 people were at the Ariana Grande concert when the bombing took place, with countless family members and loved ones being affected on the night, but also in the weeks, months and years that have passed since. During the inquiry that followed, the Chairman Sir John Saunders explored in detail, opportunities to improve the emergency response for those that were killed, with recommendations made across all emergency services.

One important recommendation was that potent analgesia should be provided at the scene, as rapidly and efficiently as possible following the time of injury. For many years, our critical care doctors and paramedics have been ready to respond to such events with very strong pain killers, but usually in injection format. We’ve recognised that these injections take some time to prepare and might not be suitable for delivery to multiple patients in rapid succession. Time to analgesia during a mass casualty event has been recognised as vital by many Inquiries and Inquests over the years.

At Essex & Herts Air Ambulance we’re now one of a small number of air ambulances who are carrying fentanyl lollipops both for routine use and for potential use during a major incident.

Fentanyl lozenges look a bit like a lollipop. They contain one of the strongest pain killers that is available, even in hospital. Delivered by our senior clinical teams, these lozenges can be rapidly provided to multiple patients, such as those who are affected at scenes where many are injured, including car crashes, stabbings, and of course, events such as the Manchester Arena attack.

Dr Ali Watts, who led on delivering this project at EHAAT said,

‘It is really important to deliver safe, effective and rapid pain relief and we’re passionate about delivering that for our patients. The lozenges provide a way to do this without requiring waiting for delivery via a vein, especially in situations where we need to help multiple patients at the same time’’.

For patients who suddenly become injured, this is often a very frightening time. The lozenges work by being absorbed directly from the mouth. After being prescribed quickly by our team, the patient uses the lollipop by ‘toothbrushing’ it into their gums. Within minutes, the pain killer takes effect, and a patient can help manage their own pain by using the lollipop as they need to, depending on their pain.

Dr Gareth Grier, Associate Medical Director at EHAAT said,

‘The lozenges are a game changer for analgesia during multiple patient events and are something that we’re proud to introduce. For years, we’ve needed something that can be delivered easily, quickly, and that is strong enough to help with even the most severe of injuries. We hope these awful events never happen, but it is vital that we prepare for the worst’.

Fentanyl lollipops are often used in hospital for conditions such as sickle cell disease, where pain can be excruciating.

Dr Watts explained that during a mass casualty event, our vision is that fentanyl lollipops be delivered rapidly by our critical care teams, followed by further pain killers as more resources arrive at the scene. Some patients may need even further support from EHAAT, with powerful sedatives also being part of our every-day armoury of treatments.

Alice Kershberg, lead for our patient and family liaison team said, ‘One of the most important factors reported to us by our patients and their families is how effectively their pain was managed. Taking people out of pain rapidly is one of the most vital roles that air ambulance teams play and it is so important both in the immediate phase and in terms of long-term recovery’.

On the anniversary of the Manchester attack, our thoughts are with all those who continue to be affected/ We will continue to work tirelessly to make sure we’re prepared for whatever happens in the future.

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