An Evidence-based Guideline for Prehospital Analgesia in Trauma

Abstract

Background. The management of acute traumatic pain is a crucial component of prehospital care and yet the assessment and administration of analgesia is highly variable, frequently suboptimal, and often determined by consensus-based regional protocols. Objective. To develop an evidence-based guideline (EBG) for the clinical management of acute traumatic pain in adults and children by advanced life support (ALS) providers in the prehospital setting. Methods. We recruited a multi-stakeholder panel with expertise in acute pain management, guideline development, health informatics, and emergency medical services (EMS) outcomes research. Representatives of the National Highway Traffic Safety Administration (sponsoring agency) and a major children's research center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide the process of question formulation, evidence retrieval, appraisal/synthesis, and formulation of recommendations. The process also adhered to the National Prehospital Evidence-Based Guideline (EBG) model process approved by the Federal Interagency Council for EMS and the National EMS Advisory Council. Results. Four strong

Pain Management Strategies and Time Spent on Scene for Pre-Hospital Analgesia Provision in an Alpine Environment: A Retrospective Study

“…The mean dose of fentanyl used in our study is in line with the proposed doses in the literature [8,9,[12][13][14][15] including in the specific setting of mountain rescue [2]. The mean dose of intra-nasal fentanyl was lower than when used intravenously, which is partially explained by a significantly higher proportion of paediatric patients in the intranasal group.…”

“…Although a transient side-effect of opiates must be considered for patients who received fentanyl and experienced hypoxemia, erroneous low SpO 2 readings because of the cold environment may have also played a role. Although we cannot exclude that side-effects were either under-detected or under-reported, our findings support fentanyl as a safe analgesic, with minimal cardiorespiratory repercussions [8,11,12,35].…”

“…Both are considered safe and effective in managing moderate-to-severe pain, including pain experienced by patients during mountain rescue [1,2,[8][9][10][11].…”

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

“…In recent years, a few initiatives sought to develop treatment guidelines for acute pediatric pain [1,7,8]. All mentioned a lack of high-level evidence and a need for further research in prehospital pain management [9].…”

Evidence-based Guidelines for Prehospital Practice: A Process Whose Time Has Come

“…The specific results of this cooperative agreement effort are detailed in the remaining three EBG-related articles published in this issue. 5,6,7 The scientific contribution of these papers is without question. Although the application of evidence-based principles to prehospital protocol development is not new, never before has there been a uniform attempt to systematically incorporate such rigorous methodology as part of the initiation of a national process.…”