Wilderness Medical Society Practice Guidelines for the Treatment of Acute Pain in Remote Environments: 2014 Update

Russell, Katie W.; Scaife, Courtney L.; Weber, David C.; Windsor, Jeremy S.; Wheeler, Albert R.; Smith, William R.; Wedmore, Ian; McIntosh, Scott; Lieberman, James R.

doi:10.1016/j.wem.2014.07.016

Cited by 25 publications

(54 citation statements)

References 50 publications

(40 reference statements)

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“…The two analgesic drugs used by our service, namely fentanyl and ketamine, are considered safe and effective in managing moderate to severe pain within the pre‐hospital environment . Fentanyl was the main drug used, which is in agreement with current pain management guidelines recommending a strong opioid for the pre‐hospital management of moderate to severe pain .…”

Section: Discussionsupporting

confidence: 71%

A two-year retrospective review of the determinants of pre-hospital analgesia administration by alpine helicopter emergency medical physicians to patients with isolated limb injury

Eidenbenz

Taffé

Albrecht³

et al. 2016

Anaesthesia

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SummaryUp to 75% of pre-hospital trauma patients experience moderate to severe pain but this is often poorly recognised and treated with insufficient analgesia. Using multi-level logistic regression analysis, we aimed to identify the determinants of pre-hospital analgesia administration and choice of analgesic agent in a single helicopter-based emergency medical service, where available analgesic drugs were fentanyl and ketamine. Of the 1156 patients rescued for isolated limb injury, 657 (57%) received analgesia. Mean (SD) initial pain scores (as measured by a numeric rating scale) were 2.8 (1.8), 3.3 (1.6) and 7.4 (2.0) for patients who did not receive, declined, and received analgesia, respectively (p < 0.001). Fentanyl as a single agent, ketamine in combination with fentanyl and ketamine as a single agent were used in 533 (84%), 94 (14%) and 10 (2%) patients, respectively. A high initial on-scene pain score and a presumptive diagnosis of fracture were the main determinants of analgesia administration. Fentanyl was preferred for paediatric patients and ketamine was preferentially administered for severe pain by physicians who had more medical experience or had trained in anaesthesia.

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Section: Discussionsupporting

confidence: 71%

A two-year retrospective review of the determinants of pre-hospital analgesia administration by alpine helicopter emergency medical physicians to patients with isolated limb injury

Eidenbenz

Taffé

Albrecht³

et al. 2016

Anaesthesia

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“…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].…”

Section: Analgesic Strategiesmentioning

confidence: 99%

“…Care in the wilderness is often limited to the essential procedures [1,2]. The priority may be to prevent hypothermia in this challenging and sometimes/often cold environment, where electronic devices may not be as reliable [2].…”

Section: Monitoring Equipment and Oxygen Therapymentioning

confidence: 99%

“…Non-pharmacological measures were not systematically documented by physicians in this study (reassurance, splinting, reduction of a joint dislocation, fracture realignment, etc.) although their role in pain management is essential [1,7], even if they impact the time spent at the scene. This limitation, however, is applicable to every patient in the study.…”

Section: Limitationsmentioning

confidence: 99%

“…Analgesia is an essential part of pre-hospital medicine and its efficient provision requires specific skills and knowledge [1][2][3]. Several analgesic strategies exist that consider the clinical situation, situational context, staffing, competencies of the pre-hospital providers, and, finally, the availability of drugs and materials.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Pasquier¹,

Eidenbenz²,

Dami³

et al. 2017

Emerg Med

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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.

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The role of wilderness medicine training in resource-limited settings

Matthew

2016

African Journal of Emergency Medicine

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Wilderness Medical Society Practice Guidelines for the Treatment of Acute Pain in Remote Environments: 2014 Update

Cited by 25 publications

References 50 publications

A two-year retrospective review of the determinants of pre-hospital analgesia administration by alpine helicopter emergency medical physicians to patients with isolated limb injury

A two-year retrospective review of the determinants of pre-hospital analgesia administration by alpine helicopter emergency medical physicians to patients with isolated limb injury

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

The role of wilderness medicine training in resource-limited settings

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