Evidence-Based Guidelines for Prehospital Pain Management: Recommendations

Lindbeck, George; Shah, Manish I.; Braithwaite, Sabina; Powell, Jonathan R.; Panchal, Ashish R.; Browne, Lorin R.; Lang, Eddy; Burton, Brooke; Coughenour, Jeffrey P.; Crowe, Remle P.; Degn, Hannah; Hedges, Mary S.; Gasper, James J.; Guild, Kyle; Mattera, Connie J.; Nasca, Sandra; Taillac, Peter; Warth, M P N

doi:10.1080/10903127.2021.2018073

Cited by 19 publications

(11 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“… 7 , 27 , 30 However, access to pain management is a human right and clinicians have an ethical responsibility to relieve pain, 32 but effective pain control is a complex burden influenced by various types of barriers. 33 Two recent scoping reviews found that patient, practitioner, and environmental factors influenced the administration and practice of prehospital analgesia. 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.…”

Section: Discussionmentioning

confidence: 99%

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

Ferri¹,

Gambaretto²,

Alberti³

et al. 2022

JPR

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Ferri¹,

Gambaretto²,

Alberti³

et al. 2022

JPR

View full text Add to dashboard Cite

show abstract

“…In addition, an operational need for a sedation and amnesia effect has driven many medics to combine high-dose ketamine with benzodiazepines, greatly reducing the safety compared with that of ketamine alone at analgesic doses. Research involving ketamine as an adjunct to other analgesics and the role of ketamine in battlefield sedation is warranted 12,13 …”

Section: Resultsmentioning

confidence: 99%

“…Research involving ketamine as an adjunct to other analgesics and the role of ketamine in battlefield sedation is warranted. 12,13 Statement #3: Battlefield Pain Research Should Prioritize the Most Common Battlefield Patterns of Injury Extremity fracture and gunshot wounds, amputation of 1 or more extremities, and multiple fragment wounds are common battlefield injuries that result in significant pain and are usually survivable. 14 Torso and head injuries are less common since the advent of highly effective body armor and helmets; when present, these injuries also result in significant pain and are overall less survivable.…”

Section: Statement #2: Ketamine Is An Effective and Safe Analgesic Fo...mentioning

confidence: 99%

Battlefield pain summit 2022: Expert consensus statements

Stark¹,

Davidson²,

Cannon³

et al. 2022

J Trauma Acute Care Surg

View full text Add to dashboard Cite

BACKGROUND: Battlefield pain occurs in combat casualties who experience multiple severe injuries. The nature of battlefield scenarios requires a distinct approach to battlefield pain research. A battlefield pain summit was thus convened to identify shortcomings in the current understanding of battlefield pain management, review the current state of battlefield pain research, and shape the direction of future research. METHODS:On January 10 to 11, 2022, a hybrid in-person and virtual meeting hosted by the US Army Institute of Surgical Research defined research priorities for the Combat Casualty Care Research Program's Battlefield Pain research portfolio. Summit participants identified the following key focus areas under the umbrella of battlefield pain research: battlefield injury patterns; use of ketamine and nonopioid analgesics; analgesic delivery systems; the impact of analgesia on performance, cognition, and survival; training methods; battlefield regional anesthesia; and research models. Preliminary statements presented during the summit were refined and rank ordered through a Delphi process. RESULTS:Consensus was achieved on 7 statements addressing ideal analgesic properties, delivery systems, operational performance concerns, and pain training. Ketamine was identified as safe and effective for battlefield use, and further research into nonopioid analgesics represented a high priority. CONCLUSION: The 7 consensus statements that emerged from this battlefield pain summit serve as a template to define the near-term research priorities for military-specific battlefield pain research.

show abstract

“…The route of administration is variable, but not everyone is comfortable using all routes [ 42 ]. In patients with a threatened airway or haemodynamic compromise, ketamine is advised [ 44 ].…”

Section: Patient Comfort During Transportmentioning

confidence: 99%

Transport of the patient with trauma: a narrative review

et al. 2022

View full text Add to dashboard Cite

Trauma and injury place a significant burden on healthcare systems. In most high-income countries, welldeveloped acute pre-hospital and trauma care systems have been established. In Europe, mobile physicianstaffed medical teams are available for the most severely injured patients and apply a wide variety of lifesaving interventions at the same time as ensuring patient comfort. In trauma systems providing pre-hospital care, medical interventions are performed earlier in the patient journey and do not affect time to definite care. The mode of transport from the accident scene depends on the organisation of the healthcare system and the level of hospital care to which the patient is transported. This varies from `scoop and run´to a basic community care setting, to advanced helicopter emergency medical service transport to a level 4 trauma centre. Secondary transport of trauma patients to a higher level of care should be avoided and may lead to a delay in definitive care. Critically injured patients must be accompanied by at least two healthcare professionals, one of whom must be skilled in cardiopulmonary resuscitation and advanced airway management techniques. Ideally, the standard of care provided during transport, including the level of monitoring, should mirror hospital care. Pre-hospital care focuses on the critical care patient, but the majority of injured patients need only close observation and pain management during transport. Providing comfort and preventing additional injury is the responsibility of the whole transport team.

show abstract

Evidence-Based Guidelines for Prehospital Pain Management: Recommendations

Cited by 19 publications

References 32 publications

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

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

Battlefield pain summit 2022: Expert consensus statements

Transport of the patient with trauma: a narrative review

Contact Info

Product

Resources

About