Opioid administration in the prehospital setting for patients sustaining traumatic injuries: An evaluation of national emergency medical services data

Dalton, Michael K.; Semco, Robert; Ordoobadi, Alexander J.; Goralnick, Eric; Chovanes, John; Salim, Ali; Jarman, Molly P.

doi:10.1016/j.injury.2022.03.068

Cited by 3 publications

(13 citation statements)

References 38 publications

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“…However, our findings do not provide evidence of an association between prehospital analgesia and likelihood of inpatient delirium. These findings, combined with our prior findings that prehospital opioids effectively reduce pain scores in older trauma patients without increasing incidence of adverse events in the prehospital interval, 11 indicate use of prehospital opioid analgesia in injured older adults has both potential clinical benefits and implications for the course of subsequent care, highlighting the need for future investigation to inform specific guidelines for early pain management in this population.…”

Section: Discussionmentioning

confidence: 52%

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Short‐term outcomes of prehospital opioid pain management for older adults with fall‐related injury

Jarman,

Jin,

Chen

et al. 2024

J American Geriatrics Society

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BackgroundOpioids are recommended for pain management in patients being cared for and transported by emergency medical services, but no specific guidelines exist for older adults with fall‐related injury. Prior research suggests prehospital opioid administration can effectively manage pain in older adults, but less is known about safety in this population. We compared short‐term safety outcomes, including delirium, disposition, and length of stay, among older adults with fall‐related injury according to whether they received prehospital opioid analgesia.MethodsWe linked Medicare claims data with prehospital patient care reports for older adults (≥65) with fall‐related injury in Illinois between January 1, 2014 and December 31, 2015. We used weighted regression models (logistic, multinomial logistic, and Poisson) to assess the association between prehospital opioid analgesia and incidence of inpatient delirium, hospital disposition, and length of stay.ResultsOf 28,150 included older adults, 3% received prehospital opioids. Patients receiving prehospital opioids (vs. no prehospital opioids) were less likely to be discharged home from the emergency department (adjusted probability = 0.30 [95% CI: 0.25, 0.34] vs. 0.47 [95% CI: 0.46, 0.48]), more likely to be discharged to a non‐home setting after an inpatient admission (adjusted probability = 0.43 [95% CI: 0.39, 0.48] vs. 0.30 [95% CI: 0.30, 0.31]), had inpatient length of stay 0.4 days shorter (p < 0.001) and ICU length of stay 0.7 days shorter (p = 0.045). Incidence of delirium did not vary between treatment and control groups.ConclusionsFew older adults receive opioid analgesia in the prehospital setting. Prehospital opioid analgesia may be associated with hospital disposition and length of stay for older adults with fall‐related injury. However, our findings do not provide evidence of an association with inpatient delirium. These findings should be considered when developing guidelines for prehospital pain management specific to the older adult population.

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Section: Discussionmentioning

confidence: 52%

“…However, it is unlikely the relationship between prehospital opioids and clinical outcomes has changed. Our prior work indicated a correlation between pain scores and likelihood of prehospital opioid administration, 11 raising concerns about confounding by indication. We used IPTW to reduce likelihood of bias from confounding by indication.…”

Section: Discussionmentioning

confidence: 94%

Short‐term outcomes of prehospital opioid pain management for older adults with fall‐related injury

Jarman,

Jin,

Chen

et al. 2024

J American Geriatrics Society

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“…Providing opioid analgesia must be undertaken with care in the austere environment as opioid use can be associated with a wide range of side effects, most concerningly respiratory depression and loss of airway protective reflexes. Other opioid side effects include dysphoria, euphoria, pruritus, nausea, vomiting, and constipation.. 82,83,84 Nonetheless, opioids have an established role in the treatment of severe acute pain in the wilderness or austere environment. 82,85,86 Choice of opioid, route of administration, and dosage are dependent upon many factors, including scope of practice, mechanism and extent of injuries, logistical issues of extraction and transport of the patient, comorbidities, and presence of hypovolemic shock.…”

Section: Opioid Analgesiamentioning

confidence: 99%

“…With careful titration and administration by experienced physicians and other providers, these problems can usually be avoided. 82,85 Whether opioids are part of the analgesic plan for an expedition, personal use, or wilderness EMS, consideration should be given to management of complications, and a risk/benefit analysis must be performed in advance of carrying and administering opioids. At a minimum, providers administering opioid analgesia should have basic training in airway management as this is the primary means of managing respiratory depression due to opioid use.…”

Section: Opioid Analgesiamentioning

confidence: 99%

“…IV opioid administration can provide fast and effective analgesia. 82,86,120,121,122 However, obtaining and maintaining IV access may be difficult in austere environments as it requires appropriate skills, suitable equipment, and ongoing maintenance. Environmental factors such as cold or freezing temperatures may also weigh on the decision to pursue IV access.…”

Section: Intravenous Intramuscular and Intraosseous Opioidsmentioning

confidence: 99%

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Wilderness Medical Society Clinical Practice Guidelines for the Treatment of Acute Pain in Austere Environments: 2024 Update

Fink,

Wheeler,

Smith

et al. 2024

Wilderness & Environmental Medicine

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The Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded based on the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians. This is an update of the 2014 version of the “WMS Practice Guidelines for the Treatment of Acute Pain in Remote Environments” published in Wilderness & Environmental Medicine 2014; 25:41–49.

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Characteristics of a trauma population in an ambulance organisation in Sweden: results from an observational study

Larsson

Axelsson

Hagiwara

et al. 2023

Scand J Trauma Resusc Emerg Med

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Background Globally, injuries are a major health problem, and in Sweden, injuries are the second most common reason for ambulance dispatch. However, there is a knowledge gap regarding the epidemiology of injuries requiring assessment by emergency medical services (EMS) in Sweden. The aim of the present study was to describe the prehospital population with injuries that have been assessed and treated by EMS. Methods A randomly selected retrospective sample was collected from 1 January through 31 December 2019 in a region in southwestern Sweden. Data were collected from ambulance and hospital medical records. Results Among 153,724 primary assignments, 26,697 (17.4%) were caused by injuries. The study cohort consisted of 5,235 patients, of whom 50.5% were men, and the median age was 63 years. The most common cause of injury was low-energy fall (51.4%), and this was the cause in 77.8% of those aged > 63 years and in 26.7% of those aged ≤ 63 years. The injury mechanism was a motor vehicle in 8.0%, a motorcycle in 2.1% and a bicycle in 4.0%. The most common trauma location was the residential area (55.5% overall; 77.9% in the elderly and 34.0% in the younger group). In the prehospital setting, the most frequent clinical sign was a wound (33.2%), a closed fracture were seen in 18.9% and an open fracture in 1.0%. Pain was reported in 74.9% and 42.9% reported severe pain. Medication was given to 42.4% of patients before arrival in the hospital. The most frequent triage colour according to the RETTS was orange (46.7%), whereas only 4.4% were triaged red. Among all patients, 83.6% were transported to the hospital, and 27.8% received fracture treatment after hospital admission. The overall 30-day mortality rate was 3.4%. Conclusion Among EMS assignments in southwestern Sweden, 17% were caused by injury equally distributed between women and men. More than half of these cases were caused by low-energy falls, and the most common trauma location was a residential area. The majority of the victims had pain upon arrival of the EMS, and a large proportion appeared to have severe pain.

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Opioid administration in the prehospital setting for patients sustaining traumatic injuries: An evaluation of national emergency medical services data

Cited by 3 publications

References 38 publications

Short‐term outcomes of prehospital opioid pain management for older adults with fall‐related injury

Short‐term outcomes of prehospital opioid pain management for older adults with fall‐related injury

Wilderness Medical Society Clinical Practice Guidelines for the Treatment of Acute Pain in Austere Environments: 2024 Update

Characteristics of a trauma population in an ambulance organisation in Sweden: results from an observational study

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