An Evidence-based Guideline for Prehospital Analgesia in Trauma

Objectives: The treatment of acute pain in the prehospital emergency setting remains a significant problem. We evaluated the incidence, site, and possible cause of acute pain in the prehospital period and also the current state of prehospital pain management by evaluating analgesic availability in emergency vehicles in Italy. Methods: First aid volunteers documented the presence, intensity, and site of acute pain by questionnaire for over 3 months. Emergency service operations completed a questionnaire on analgesic availability in ambulances and helicopters. Results: Pain symptoms were present in two-thirds of the patients (n = 383) and ranked as moderate to unbearable in 41.75%. Results of the analgesic availability survey indicate that 10.6% of the ambulance services carry no pain killers (including non-steroidal anti-inflammatory drugs [NSAIDs]and/or paracetamol) and 11.5% are without an opioid. The emergency helicopter survey showed a significant difference in analgesic availability compared with ambulances, with 97.6% having at least one opioid agent available (weak or strong). A wide geographical variation in the availability of analgesic agents in ambulance and helicopter services was seen. Conclusions: There is a high prevalence of pain among patients receiving prehospital emergency treatment in Italy and treatment for acute pain during emergency treatment of trauma patients is inadequate. All emergency vehicles, without distinction, should carry opioids and other analgesic drugs (NSAIDs and paracetamol) and there should be no geographic differences in the availability of pain medications. Â© Journal compilation Â© 2009 World Institute of Pain.

Acute pain and availability of analgesia in the prehospital emergency setting in Italy: a problem to be solved.

This study aimed to identify and map available evidence relating to patient safety when using ambulance services. There was inconsistency of information on attitudes and approaches to patient safety, exacerbated by a lack of common terminology. Patient safety needs to become a more prominent consideration for ambulance services and development of new models of working must include adequate training and monitoring of clinical risks. Providers and commissioners need a full understanding of the safety implications of introducing new models of care. Areas requiring further work include the safety surrounding discharging patients, patient accidents, equipment and treatment, delays in transfer/admission to hospital, and treatment and diagnosis, with a clear need for increased reliability and training for improving handover to hospital.

https://njl-admin.nihr.ac.uk/document/download/2003770

Patient safety in ambulance services: a scoping review

Background Prehospital care (PHC) pain evaluation is an essential patient assessment to be performed by paramedics. Pain intensity is frequently assessed using Verbal Numerical Rating Scale (VNRS) or Visual Analog Scale (VAS). Objective Our aim was to evaluate the agreement between VNRS and VAS in measuring acute pain in prehospital setting and to identify the preference among paramedics and patients. Methods This was a 3-month cross-sectional study. Convenience sampling was used to enroll patients with acute pain responded to by the ambulance team. Data from consented patients were analyzed using Bland-Altman method, Spearman's correlation test, and Cohen's κ test. Results One hundred and thirty-three patients participated in this study (median age 32 years; 72.2% male). The median for pain score at the scene was 7.50 (interquartile range [IQR]: 5.00) for VAS and 7.00 (IQR: 5.00) for VNRS. The median for pain score on arrival at the hospital was 7.00 (IQR: 3.10) for VAS and 7.00 (IQR: 4.00) for VNRS. There was a strong correlation between VNRS and VAS at the scene ( r  = 0.865; p r  = 0.933; p Conclusions VAS performs as well as VNRS in assessing acute pain in PHC. VAS and VNRS must not be used interchangeably to assess acute pain; either method should be used consistently.

The Assessment of Acute Pain in Pre-Hospital Care Using Verbal Numerical Rating and Visual Analogue Scales.

Background Pain during transportation is a common phenomenon in emergency medicine. As acupressure has been deemed effective for pain management by the National Institutes of Health, we conducted a study to evaluate its effectiveness in prehospital patients with isolated distal radial fracture. Methods This was a prospective, randomized, double-blind study. Thirty-two patients were enrolled. Acupressure was performed either at "true" points or at "sham" points. Vital signs and pain and anxiety scores were recorded before and after the acupressure treatment. Normally distributed values were compared using the Student t test. Results Pretreatment scores for pain and anxiety were similar in the 2 groups (47.6 ± 8.9 vs 51.2 ± 8.7 visual analog scale [VAS] score for pain, 52.4 ± 6.0 vs 47.5 ± 9.3 VAS score for anxiety). At the hospital, patients in the true-points group had significantly lower pain (36.6 ± 11.0 vs 56.0 ± 13.3 VAS score, P P = .022). Conclusion Acupressure in the prehospital setting effectively reduces pain and anxiety in patients with distal radial trauma.

Prehospital analgesia with acupressure at the Baihui and Hegu points in patients with radial fractures: a prospective, randomized, double-blind trial.

Introduction:The aim of this study was to use a visual analogue scale (VAS) to measure the adequacy of prehospital pain management. Patients reported pain severity at two points in time during treatment and transport by ambulance paramedics. The change in pain score was compared with a benchmark reduction of 20 mm that has been shown to correspond with the minimum clinically significant change in pain perception reported by patients.Methods:This prospective, observational study used a VA S to record pain severity among patients reporting pain who were transported to a hospital by paramedics. Patients used a VAS to score pain severity during the initial patient assessment process (T0), and again at the hospital of destination (Tend). This study reports the mean changes in the scores, and the percentage of cases for whom the difference between T0and Tend in the study population achieved or exceeded the 20 mm benchmark. A survey also was administered to paramedics who participated in this study in order to identify attitudes, values, and beliefs relating to the measurement of pain.Results:A total of 262 patients were enrolled in this study. The mean value for thereduction in VAS (T0-Tend) was 18.2±23.9 mm [±SD] (Median = 14.0mm, 95% confidence interval (CI) = 15.3–21.1 mm). One hundred and thirty-four patients (51.1%) did not receive analgesia (either morphine sulfate or methoxyflurane). The mean initial (T0) pain score for the no-analgesia group was 54.5 ±24.7 mm [±SD], with the mean value for the change in VAS (T0-Tend) = 10.6 mm (median = 5 mm, 95% CI = 6.4–14.8 mm). Fo rty-six patients (17.6%) recorded some deterioration in their pain score at Tend (T0-Tend<0 mm). Survey results identified attitudes that may affect paramedics' pain management practice.Conclusion:The results suggest that inadequate analgesia is an issue in this study setting. Effective analgesia requires formal protocols or guidelines supported by effective analgesic therapies along with education that addresses attitudes that may inhibit pain assessment or management by paramedics. Regular audits form part of clinical quality assurance programs that assess analgesic practice. However, such auditsmust have access to data obtained from patient self-reporting of pain using a valid and reliable pain measurement tool.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S1049023X0000131X

Measurement of pain in the prehospital setting using a visual analogue scale.

Use of Visual Analogue Scale for Measurement of Pain in the Prehospital Setting

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Measurement of pain in the prehospital setting using a visual analogue scale.

Use of Visual Analogue Scale for Measurement of Pain in the Prehospital Setting