Date Published

September 29, 2016

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: Under the Analgesia & Moderate to Severe Pain Protocol. What is the definition of cancer pain? And if they fall under the guidelines of cancer pain, what kind of relief would a half dose of Ketorolac provide seeing as they are probably on much stronger medications?


**Update Feb 1, 2022: Under the ALS-PCS v4.9, the Medical Directive has changed to Analgesia Medical Directive and the Indications are now simply Pain. The Condition of severe pain has been removed to allow for paramedics to use clinical judgement in selecting the most appropriate medication based on clinical presentation.

Cancer related pain, as defined in the ALS PCS companion document (V3.1) as an indication for both Pediatric and Adult Analgesia Medical Directives is; Current history of cancer related pain refers to a current diagnosis of cancer and the pain associated with the disease.

If they are in severe pain (and granted have no contraindications) they can receive both morphine and ketorolac.  As stated in previous Ask MAC, if their pain is controlled with one analgesia, or the other, then you do not need to give them the second medication (please see Feb 18 2015 Ask MAC).

As for the dose of ketorolac, it is 10-15mg IM/IV.  The dosage range is based on different concentrations being carried by individual services.  However, both dosages are proven to be as efficacious as larger doses of ketorolac (for example the common 30mg IM/IV given in hospital) with less side effects than the larger dose.



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