Barriers to and Enablers for Prehospital Analgesia for Pediatric Patients

Abstract

We have identified a number of previously unrecognized barriers to and enablers for prehospital pediatric analgesia. The majority of these factors lead to an overall preference of paramedics to defer administration of analgesic agents. A number of educational and EMS system changes could be made to address these barriers and increase the frequency of appropriate pediatric prehospital analgesia.

Prehospital pain management of injured children: a systematic review of current evidence

“…Emergency medical services (EMS) personnel report that the major challenges preventing or delaying the relief of acute pain during initial treatment include an inability to assess pain and fasting times, and a limited choice of agents and delivery routes. Variability in provider education and different beliefs have also been mentioned as barriers to providing this treatment, and they are potential areas of intervention [4,5]. These challenges, although present in the emergency department (ED), are even more pronounced in the prehospital setting and more marked in pediatric patients than in adults [6].…”

An Assessment of Newly Identified Barriers to and Enablers for Prehospital Pediatric Pain Management

“…Skill deficits include inability to obtain vascular access and concern about causing pain from intravenous catheter placement and medication injection. [14][15][16][17][18][19] A recently published hypothesis-generating qualitative study identified previously unrecognized barriers to and enablers for prehospital analgesic administration in children. 16 A novel barrier, termed unwanted attention from authority figures, was identified.…”

“…[14][15][16][17][18][19] Knowledge deficits reported include difficulty assessing pain in children as well as concern for masking symptoms of disease, allergic reactions, and drug-seeking behaviors. Skill deficits include inability to obtain vascular access and concern about causing pain from intravenous catheter placement and medication injection.…”

“…[14][15][16][17][18][19] A recently published hypothesis-generating qualitative study identified previously unrecognized barriers to and enablers for prehospital analgesic administration in children. 16 A novel barrier, termed unwanted attention from authority figures, was identified. Emergency medical services providers reported fearing punishment from physicians and supervisors should they make a mistake, as well as a desire to avoid criticism from emergency department (ED) staff, who may challenge their decision to administer analgesics.…”

Management of Pain in the Emergency Department

“…The extremes of age provide special challenges to pain care. Pediatric patients and geriatric patients have little in common physiologically, but they share a propensity towards undermedication for pain [19,[72][73][74][75][76][77]. There is some evidence that the undertreatment of pain in those at the extremes of age is improving [78], but the rule for acute care clinicians should be to pay particular attention to pain assessment and care in these patients.…”