Nurse-Administered Analgesic Treatment in Italian Emergency Medical Services: A Nationwide Survey

Abstract

Background Acute pain is common among patients requiring assistance from prehospital emergency medical services (EMS). Nonetheless, the undertreatment of pain in this context remains a frequent phenomenon. Timely and effective analgesia is a crucial feature in emergency medicine. To ensure analgesia provision, prehospital paramedics and nurses can administer analgesics via standard operating protocols or under a physician’s remote supervision. Information about such protocols in Italian EMS is lacking. Objective Evaluation of the availability of nurse’s standard analgesia protocols in Italy’s prehospital EMS settings. Methods A cross-sectional online survey involved all 74 Italian emergency medical dispatch centres (EMDCs). Aside from descriptive statistics, we used χ 2 -analysis and Spearman-rank correlation to look for associations between geographical areas’ dependence upon independent variable categories and their correlations. Results Of all the 74 Italian EMDCs, 70 (94.6%) completed the survey, covering 100 provinces out of a total of 107 (93.5%). Operating nurses’ prehospital analgesia protocols are available in 46 provinces (46.0%). The availability of prehospital analgesia protocols is more extended in northern Italy EMDCs (n=30, 66.7%) than in central Italy (n=9, 42.8%) and southern Italy and islands (n=7, 20.6%). Morphine (76.1% for medical patients and 95.7% for trauma) and paracetamol (89.1% for both) are the most common drugs included in the prehospital analgesia protocols. Conclusion Despite international consensus on the necessity, efficacy, and safety of nurses’ prehospital analgesia provision, nurse-administered analgesia protocols are available in less than half of Italian provinces, with substantial differences between northern, central, and southern areas. These results indirectly indicate potential undertreatment of prehospital pain in Italy and yield practice improvements.

Pain Management in a Prehospital Emergency Setting: A Retrospective Observational Study

“…A recent Italian study (2021) 14 has suggested the need for EMS to improve the appropriateness of standard intervention protocols for ambulance nurses, although in our experience the presence of a specific algorithm does not seem to have been sufficient in reducing the risk of oligoanalgesia.…”

“… 14 Oligoanalgesia, defined as a complete lack of analgesia (unrelieved pain) or an insufficient dose of analgesics (unachieved analgesia) or a postponed analgesic treatment in the prehospital emergency setting, remains a widespread phenomenon. 3 , 7 , 14 , 15 It is estimated that in prehospital emergency care pain assessment is not performed in from one-third to almost a half of all cases and even when pain is recorded, in approximately 43% of adults and 85% of paediatric patients, it is undertreated. 7 , 13 , 16 However, the management of pain in this setting is often inadequate for several reasons: reduced frequency of measuring pain, reluctance of health-care professionals to prescribe or administer opioids (defined as opiophagia), failure to use pain management guidelines, prejudices and cultural factors, fear of excessive sedation and compromising an adequate clinical assessment.…”

“…4 , 13 , 16 , 17 In addition to these factors, there are others of a managerial-organizational nature such as reduced training and education of health personnel, the limited availability of staff and opioids in the prehospital emergency setting, and the lack of systematic quality management programmes for acute pain management. 9 , 13 , 14 …”

“… 14 The epidemiology of pain and its management among prehospital patients is still too little known, despite the relevance and potential impact of pain undertreatment. 5 , 8 , 10 , 14 , 22–24 …”

“…6,10 Inadequate assessment and treatment of acute pain are associated with various complications such as anxiety, heart complications and aggravation of general conditions (eg, tachycardia, blood hypertension or hypotension, hypoventilation in abdominal pain, delirium), longer admissions with an increased risk of infection and becoming chronic with long-term complications, such as post-traumatic syndrome and reduced quality of life. 3,[11][12][13][14] In addition to preventing potential hazards, effective pain treatment makes transport on emergency vehicles more tolerable for the patient. 14 Oligoanalgesia, defined as a complete lack of analgesia (unrelieved pain) or an insufficient dose of analgesics (unachieved analgesia) or a postponed analgesic treatment in the prehospital emergency setting, remains a widespread phenomenon.…”