Purpose
The aim of this study was to estimate the prevalence of pain, the extent of analgesics intake and the mental health status of German pre-hospital emergency medical service (EMS) personnel.
Methods
We conducted a nationwide online survey, which consisted of sociodemographic and job-related items, questions on pain and analgesics intake and the short-version of the validated Depression–Anxiety–Stress Scale (DASS-21).
Results
A total of 774 EMS personnel with a mean age of 33.03 (standard error [SE] 0.37) years were included into the final analysis of which 23.77% were female. Pain was reported by 58.64% (454 of 774) of the study participants with 10.72% (95% confidence interval [CI] 8.54%; 13.29%) suffering from chronic, 1.68% (95% CI 0.89%; 2.87%) from acute and 46.25% (95% CI 41.49%; 51.30%) from recurrent pain, respectively. Most frequent location of pain was lumbar spine. Analgesics were used by 52.76% (239 of 454) of pre-hospital EMS personnel with pain (acute 76.92% / chronic 69.88% / recurrent 47.90%). Moreover, participants with chronic and recurrent pain indicated significantly higher depression (p ≤ 0.001), anxiety (p ≤ 0.001), and stress (p ≤ 0.001) levels compared to those without pain, respectively.
Conclusion
This study indicates a high prevalence of pain and analgesics usage in participating German pre-hospital EMS personnel and a poorer mental health in those with chronic and recurrent pain. Therefore, disease prevention and health promotion measures are needed to preserve health of pre-hospital EMS personnel.
Sufentanil has so far seldom been used for intravenous postoperative patient-controlled analgesia (PCA), and the resulting serum concentrations have not yet been determined. Forty ASA I-III patients recovering from major gynecological operations were investigated to evaluate analgesic efficacy, side effects, patient acceptance and threshold concentrations of sufentanil in serum during the early postoperative period, using the On-Demand Analgesia Computer (ODAC). Following an individualized intravenous loading dose of 19.1 +/- 35.7 micrograms (mean +/- 1 s.d.), sufentanil demand doses were 6 micrograms with a concurrent infusion of 1.15 micrograms/h and a maximum hourly dose of 40 micrograms/h; the lockout time was set to 1 min. The duration of PCA was 17.3 +/- 2.1 h. During this time 16 +/- 11 demands per patient were recorded, resulting in an average sufentanil consumption of 131.1 +/- 69.4 micrograms or 7.5 +/- 3.7 micrograms/h (including loading dose). analgesia was mostly judged good. Side effects were only of minor intensity. Sufentanil proved to be about 2.2 to 3.8 times as potent an analgesic as fentanyl when both analgesic effect and duration were considered. Minimum effective sufentanil serum concentration (MEC) as determined by radioimmunoassay varied greatly and could be best described by a log-normal distribution (range less than 0.01-0.56 ng/ml, median 0.024 ng/ml). Intraindividual MEC variability was slightly lower than intersubject variability (76.0 vs. 84.8%). It is concluded that sufentanil is suitable for postoperative PCA. To get into the therapeutic window for analgesia, a serum sufentanil concentration of more than 0.03 ng/ml seems to be necessary.
Factors associated with pain and analgesic intake in German pre-hospital emergency medical services staff: A post-hoc analysis Objective: The aim of this analysis was to identify risk factors for chronic and recurring pain and for the use of analgesics in German emergency staff. Methods: For this post-hoc analysis with 774 participants, the odds ratios (OR) and adjusted OR (AOR) were determined using the chi-square test, Fishers’ exact test and logistic regression. Results: The duration of profession in emergency care is significantly associated with the occurrence of chronic pain (AOR: 1.07 [95% CI: 1.00; 1.14] p = 0.04). Men have a significantly lower risk than women for recurring pain (AOR: 0.63 [95% CI: 0.42; 0.93] p = 0.02). In addition, the use of painkillers by emergency medical staff was associated significantly with the presence of chronic pain (AOR: 2.46 [95% KI: 1.27; 4.77] p = 0.008) and headache (AOR: 4.98 [95% CI: 2.95; 8.40] p ≤ 0.001). Conclusion: Measures for preventing chronic and recurring pain should be developed for emergency staff. There is also a need for research on further risk factors for recurring and chronic pain and the use of analgesics. Keywords: chronic pain – analgesics – emergency medical services staff – prevention
The main objective of this study was to analyse the acute medical condition of patients at the earliest possible time after femoral neck fracture. Emergency medical services (EMS) data from five counties and cities in the state of Hesse, Germany, over 2017–2019 were analysed. The highest incidence of fracture was in those aged 80 years or above. Of all patients, 94.57%–95.49% were admitted to hospital for inpatient care, 3.40%–4.41% for outpatient care and 0.25%–0.60% for immediate intervention. Patients' hospital admission priority was significantly correlated with circulatory system impairment and severity of injury and pain. Other correlations were identified, indicating relationships between different organ systems in patients with femoral neck fractures. As expected, patients with femoral neck fracture are mainly treated as inpatients.
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