Killer anaes­thetic ends dream of be­com­ing paramedic

The New Zealand Herald - - NEWS - Si­mon Collins

A Tau­ranga mother of four who has al­ways dreamed of be­com­ing a paramedic has been barred from vol­un­teer­ing on St John am­bu­lances be­cause they have changed their main anaes­thetic to one that could kill her.

Lynda Hodge, 37, a su­per­vi­sor at Spec­savers, started train­ing with St John just over a year ago to achieve what she says is “my life­long dream of be­com­ing a paramedic”.

But since July she has been barred from am­bu­lances be­cause St John has changed its main anaes­thetic from ni­trous ox­ide to methoxyflu­rane — a gas that can trig­ger a po­ten­tially fa­tal re­ac­tion called ma­lig­nant hy­per­ther­mia (MH) in fam­i­lies with a rare ge­netic ab­nor­mal­ity.

Hodge found out that her fam­ily car­ried the gene when her 10-yearold niece suf­fered a “hor­rific” MH at­tack in March af­ter be­ing given an anaes­thetic for a sim­ple op­er­a­tion in Tau­ranga Hospi­tal.

“She had four days in in­ten­sive care. It was touch and go, but be­cause of the train­ing that Tau­ranga Hospi­tal had, they picked up on it straight away,” Hodge said.

“My­self and my fam­ily — nine of us so far and still count­ing — have all found out we have MH and it has been 100 per cent passed on through us.

“My mother has passed it to all of her chil­dren, who have also passed it on, and I have passed it to all four of my chil­dren, which is very rare.”

St John changed its main anaes­thetic early this year de­spite re­peated pleas from the na­tional MH test­ing cen­tre in Palmer­ston North dat­ing back to 2007, when methoxyflu­rane was first in­tro­duced as one of sev­eral anaes­thetic op­tions on am­bu­lances.

Cen­tre di­rec­tor Dr Terasa Bul­ger said the change was driven by St John wanting to save space in its ve­hi­cles by re­mov­ing large ni­trous ox­ide cylin­ders.

Methoxyflu­rane was banned by the US Food and Drug Ad­min­is­tra­tion in 2005 be­cause of safety con­cerns and is now made only in Aus­tralia.

St John med­i­cal di­rec­tor Dr Tony Smith said Aus­tralian am­bu­lances had used the gas as their sole in­haled painkiller for more than a decade.

“More than a mil­lion doses have been ad­min­is­tered in Aus­tralia with­out any cases of ma­lig­nant hy­per­ther­mia re­ported,” he said.

Re­mov­ing the ni­trous ox­ide also en­abled paramedics to use neb­u­lised in­halers for pa­tients with lung con­di­tions, re­duc­ing risks in­volved in giv­ing them oxy­gen.

Al­though methoxyflu­rane is now the sole in­haled painkiller on St John am­bu­lances, Smith said am­bu­lances car­ried at least seven other non­in­haled painkillers.

Hodge and her chil­dren now wear bracelets stat­ing that they carry the MH gene.

Bul­ger said all hos­pi­tals that use anaes­thet­ics must hold stocks of dantro­lene, an an­ti­dote that stops an MH at­tack if it is given quickly enough. But St John am­bu­lances do not carry dantro­lene and Smith said he was not con­sid­er­ing stock­ing it.

“This is be­cause, if we con­sid­ered the risk high enough to carry the an­ti­dote, we would re­move methoxyflu­rane in the in­ter­est of pa­tient safety,” he said.

How­ever, Bul­ger asked why, in that case, Hodge and oth­ers car­ry­ing the MH gene were banned from am­bu­lance work and are also banned from join­ing the armed forces.

“Maybe the risk is small, but if it is zero, why won’t they let Lynda Hodge be a St John vol­un­teer?” she asked.

Smith replied: “St John’s pol­icy is that methoxyflu­rane should be with­held from pa­tients known to be ge­net­i­cally pre­dis­posed to ma­lig­nant hy­per­ther­mia. Like­wise, we have cho­sen to take the same pre­cau­tion for our front­line staff who are known to have the same con­di­tion.”

Picture / Alan Gib­son

Lynda Hodge has been barred from am­bu­lances.

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