R Efusal of B Ase S Tation P Hysicians to a Uthorize N Arcotic a Nalgesia

Prehospital Trauma Analgesia

“…In fact, even if some altered mental status is presumed to be present, consent and ability to make judgments about care are not necessarily invalidated. This is clear when it is considered that on a daily basis, EDs discharge patients who have received opioids, or who have non-zero alcohol levels; thus, patients are allowed to exercise judgment even when the mental status is altered (48).…”

“…In 2001, a research group questioned medical control physicians who refused prehospital analgesia, and found analgesia refusal was due to the following perceptions by base station physicians: 1) Pain is inevitable; 2) Pain treatment isn't a priority (i.e., as compared with diagnosis and other therapies); 3) Analgesics interfere with the diagnostic process and also have other (physiologic) side effects; and 4) Prehospital analgesia precludes hospital providers' obtaining informed consent for necessary interventions. The group found that medical control pain medication refusal was attributable to biases (race, sex, age), poor EMS-physician communications, inadequate assessment of pain levels, and physician indifference (48).…”

“…However, upon consideration of the facts, consent issues are no reason to withhold analgesia from suffering patients. The myth of analgesia's impairing the informed consent process has been debunked with respect to pain medications in the ED and medical, legal, and ethical experts also have firmly and consistently come down in favor of pain relief in the prehospital setting (48). For informed consent to be valid, the following circumstances should be present (48):…”

“…When patients who have had painful injuries are later asked about their participation in informed consent, many have (unsurprisingly) indicated that they just wanted the medical team to "do what they needed to do" to alleviate the condition. It is hard to imagine that a patient in agony can really give "informed consent"-the consent from a patient who is not in pain, but perhaps under mild influence from opioids, seems much preferable (48).…”

Compliance with a Morphine Protocol and Effect on Pain Relief in Out-of-Hospital Patients

“…Reasons for this insufficiency of analgesia are most often erroneous dogma and bad habits (2,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). To improve analgesia in emergency situations, recommendations about analgesia have been made by emergency physicians, with proposals for appropriate use of morphine for severe acute pain (16,(25)(26)(27).…”