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

Abstract

Objective: The delivery of a safe an effective analgesia is a core principle and a priority of prehospital care. Analgesia in hostile environments (mountain settings, etc.) presents various challenges, and the benefit-risk ratio of the procedure should be evaluated. The objective of this study was to examine pain management strategies and the time spent on scene for analgesia provisions in an alpine environment. Methods:We undertook a retrospective study from a single physician-staffed helicopter emergency medical service in the Swiss Alps. Patients with isolated limb injuries were included. We examined the choice and route of analgesic medication, patient monitoring, medical co-treatments and time delays during the rescue mission.Results: Analgesia was provided to 657 (57%) of the 1156 included patients. Fentanyl was most commonly administered followed by ketamine, with or without fentanyl. Heart rhythm monitoring, oxygen administration, and saline infusion were used infrequently, but were used significantly more often in patients treated with ketamine. The median time on site was 6 minutes longer for patients receiving intravenous analgesia compared with those not receiving it.Conclusion: Analgesia in hostile environments seems to be limited to essential procedures. The safety of this approach must be confirmed.

Prehospital Use of Ketamine in Mountain Rescue: A Survey of Emergency Physicians of a Single-Center Alpine Helicopter-Based Emergency Service

“…10,26,27 We found that, as in other prehospital studies, midazolam was frequently coadministered with ketamine. [28][29][30][31] The use of empathy (reassurance, addressing the patient by name, informing the patient about the dissociative effects and the ongoing procedure to reduce emergence reactions and pain) was another frequently proposed intervention. Many participants reported using therapeutic communications such as guiding patients to picture pleasant dreams, with the goal of reducing the occurrence of neuropsychiatric side effects.…”

“…A retrospective study conducted 6 y prior in the same HEMS reported no use of IM or IN ketamine. 28 Although IM use in pediatrics has been well demonstrated with a good efficacy and safety profile, 26,39 IV use is still preferred in adults because it allows rapid administration of midazolam in the case of unpleasant neuropsychiatric effects. IM administration is associated with more vomiting and a longer recovery time.…”