A scoping review of qualitative studies on pre-hospital analgesia administration and practice

Teoh, Seth En; Loh, Caitlin Yuen Ling; Chong, Ryan Ian Houe; Yaow, Clyve Yu Leon; Han, Ming; Lin, Daryl Jimian; Lim, Yu Liang; Ng, Justin; Ng, Qin Xiang

doi:10.1016/j.ajem.2022.04.038

Cited by 3 publications

(14 citation statements)

References 48 publications

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“… 24 , 34 Among practitioner barriers, the accuracy of pain assessment is one of the main concerns, despite the advent of pain assessment tools, because of its subjective nature, the variability of expression and uncertainty of professionals. 34 , 35 …”

Section: Discussionmentioning

confidence: 99%

“…This could be correlated to the fact that the decision to treat pharmacologically, in any case, depended on the telephone instructions of the operating center physician. Decision-making based on distance communication can be difficult, as documented in the literature, 34 whereas the presence of the doctor in the medical cars made it possible to treat pain with medications other than the indication of algorithms.…”

Section: Discussionmentioning

confidence: 99%

“…When considering severe pain, the age range (65–85 years) was the one with the most no treatments, probably due to patient factors that can constitute a barrier, such as case complexity, patient cooperation and attitudes towards treatment. 34 …”

Section: Discussionmentioning

confidence: 99%

“…The ease of access and proximity to a hospital were identified as possible barriers to analgesia administration in the literature. 34 However, as suggested by the EUSEM guidelines, once analgesia is provided, patients should be re-evaluated to ensure they have received relief. 13 …”

Section: Discussionmentioning

confidence: 99%

“…In literature several solutions are proposed; 34 among those most easily applicable in the context of this study are developing enhanced pain assessment technology tools and placing a greater emphasis on communication skills in order to support making decisions and providing just in time feedback. In accordance with most guidelines, intervention protocols should be supported by the implementation of appropriate strategies as well as specific education initiatives of proven effectiveness in improving pain management.…”

Section: Discussionmentioning

confidence: 99%

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

Ferri¹,

Gambaretto²,

Alberti³

et al. 2022

JPR

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

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

Ferri¹,

Gambaretto²,

Alberti³

et al. 2022

JPR

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Patient, family member, and ambulance staff experiences of prehospital acute pain management in adults: A systematic review and meta‐synthesis

et al. 2023

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Background We aimed to synthesize the qualitative experiences of patients, their family members, and ambulance staff involved in the prehospital management of acute pain in adults and generate recommendations to improve the quality of care. Methods A systematic review was conducted following the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) guidelines. We searched from inception to June 2021: MEDLINE, CINAHL Complete, PsycINFO and Web of Science (search alerts were screened up to December 2021). Articles were eligible for inclusion if they reported qualitative data and were published in the English language. The Critical Appraisal Skills Program for qualitative studies checklist was used to assess risk of bias, thematic synthesis was performed on included studies and recommendations for clinical practice improvement were generated. Results Twenty‐five articles were included in the review, representing over 464 patients, family members, and ambulance staff from 8 countries. Six analytical themes and several recommendations to improve clinical practice were generated. Strengthening the patient–clinician relationship by building trust, promoting patient empowerment, addressing patient needs and expectations, and providing a holistic approach to pain treatment is key to improving prehospital pain management in adults. Shared pain management guidelines and training across the prehospital and emergency department intersection should improve the patient journey. Conclusion Interventions and guidelines that strengthen the patient‐clinician relationship and span the prehospital and emergency department phase of care are likely to improve the quality of care for adults suffering acute pain in the prehospital setting.

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Analgesic Therapy with the Opioids Fentanyl and Morphine by Ambulance Personnel in Rural Areas: An Observational Study Over 7 Years

Scharonow,

Vilcane,

Weilbach

et al. 2024

JPR

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Background The treatment of severe pain is one of the basic procedures of emergency medicine. In rural regions, longer arrival times of the emergency doctor prevent the earliest possible treatment of pain. Since 2014, a project for independent analgesia by ambulance personnel has been introduced in our ambulance service area. Methods Over a period of 7 years the mission protocols were recorded and statistically evaluated within the framework of an observational study. Among other things, the attendance and transport times, vital signs, pain level, symptom groups (body region) and classification according to disease or accident mechanism were recorded. Treatment data by medication, including dosages, were recorded for fentanyl (monotherapy), morphine (monotherapy) and a combination (change from morphine to fentanyl, additional application of esketamine, metamizole or butylscopolamine). Results In 659 patients, the opioids fentanyl and morphine were used by the ambulance staff, 596 data sets could be evaluated. When an emergency physician was requested, the average time of presence at the scene was 34.8 +- 11.7 min, in cases of unavailability it was 29.0 +-9.8 min (p<0.0001). Analgesic therapy resulted in a reduction of pain from NRS 8.4 (+-1.3) to NRS 3.5 +-1.8 (p<0.0001). Pain intensity after treatment by emergency paramedics compared to emergency physicians was not significantly different with NRS 3.5 +- 1.7 versus NRS 3.6 +-1.9 (p=0.788). Fentanyl was used at a mean dose of 0.18mg +- 0.11 and morphine at a mean dose of 4.4mg +- 3.6mg. There was no clinically relevant decrease in oxygen saturation or respiratory rate in any of the treatment groups. Antagonisation of the opioid effect with naloxone was not necessary in any case. Conclusion Analgesia with morphine and fentanyl by specially trained ambulance personnel according to defined rules of use is a safe and necessary procedure for patients, especially in rural regions.

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A scoping review of qualitative studies on pre-hospital analgesia administration and practice

Cited by 3 publications

References 48 publications

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

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

Patient, family member, and ambulance staff experiences of prehospital acute pain management in adults: A systematic review and meta‐synthesis

Analgesic Therapy with the Opioids Fentanyl and Morphine by Ambulance Personnel in Rural Areas: An Observational Study Over 7 Years

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