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

Abstract

Purpose Acute pain is a prevalent symptomatology in prehospital emergency care. Although inadequate assessment and treatment of acute pain are associated with various complications, about 43% of adults suffering from pain are undertreated. This phenomenon is poorly studied, and limited data are available in the literature. The objective was to investigate the pain management in a prehospital emergency health-care setting, verifying pain assessment, pharmacological treatment adherence and the effectiveness of pain relief therapy. Patients and Methods A retrospective observational study was conducted in a sample including all adults treated by the professionals of nurse-staffed ambulances and medical cars in an Italian Emergency Medical Services (EMS) from 1 January 2019 to 31 May 2019. We collected both demographic information and Numeric Rating Scale scores, which evaluated presence and intensity of pain, from the EMS paper forms. All analyses were performed using SPSS, version 27. Results The study sample was composed of 629 people: 310 males (49%) and 319 females (51%), with an average age of 64.2±22 years (range 18–108). Pain information was collected in 75.5% (n = 475) of our sample; among them 222 patients (46.7%) suffered from pain. We recorded that 79.7% (n = 177) of the subjects with pain received no pharmacological treatment, and in almost all of the treated cases they did not adhere to the analgesia algorithm in use. Among those who were pharmacologically treated, pain statistically significantly decreased in intensity, from before to after, in both emergency vehicles (nurse-staffed ambulances pre m = 8.36±0.9 vs post m = 4.18±2.2, p <0.001; medical cars pre m = 7.25±1.7 vs post m = 3.50±2.6, p <0.001). Subsequently, pain was only re-ascertained in 24.3% of subjects. Conclusion Our findings confirm that pain is a prevalent symptom in prehospital patients, especially in the younger age range, but that it remains an underrecognized, underestimated, and undertreated symptom with the risk of causing worse health outcomes.

Influence of patient sex on pain management practices in Paramedicine: A rapid review

“…An analysis of this would have strengthened conclusions on sex-specific disparities by O'Connor et al 37 Lourens et al 47 found an association with higher analgesic administration among higher qualified paramedics, which may be due to access to a wider range of medications. This was similar to Ferri et al 46 who found that statistically lower rates of analgesic administration were noted in nurse-staffed ambulances, as opposed to ambulances staffed by both a doctor and nurse acting in a paramedic capacity. These findings indicate the need to increase scope of practice through further inter-professional training and education, thorough investigation into how certain medications act differently in males and females, and how to incorporate sex-specificity in analgesic decision making.…”

“…This understanding was further highlighted in the other included studies which indicated that analgesic administration was not influenced by the sex of the patient, even after controlling for potential confounders. 39,45–48…”

“…All studies met the methodological quality rating threshold of 60% with four studies having a quality rating of 100%, 38,[40][41][42] seven having a quality rating of 75% 37,[43][44][45][46][47][48] and two having a quality rating of 62.5%. 39,49 All ROB scores are listed in Table 2.…”

“…The 13 included studies were conducted in ambulance services in multiple countries: USA (n = 5), [37][38][39][40][41] Australia (n = 3), [42][43][44] England (n = 1), 45 Italy (n = 1), 46 South Africa (n = 1), 47 Switzerland (n = 1) 48 and Sweden (n = 1). 49 All but one of the articles, 49 were conducted retrospectively, analysing data that had been routinely collected by an ambulance service as part of patient management.…”

“…This understanding was further highlighted in the other included studies which indicated that analgesic administration was not influenced by the sex of the patient, even after controlling for potential confounders. 39,[45][46][47][48] Effect of paramedic sex on provision of analgesia. Three studies investigated paramedic sex and its influence on analgesic administration.…”