2.50
Hdl Handle:
http://hdl.handle.net/10755/163052
Type:
Presentation
Title:
Pain Management in the Prehospital Setting
Abstract:
Pain Management in the Prehospital Setting
Conference Sponsor:Emergency Nurses Association
Conference Year:2004
Author:Marcotte, Anne, RN, MSN, MICN
P.I. Institution Name:County of San Diego, Division of EMS
Title:Quality Assurance Specialist
Contact Address:6255 Mission Gorge Road, San Diego, CA, 92120, USA
Contact Telephone:(619) 285-6429
Co-Authors:Marcelyn Metz, RN, BS, CEN
Purpose: Pain exacerbates stress response, inhibits movement, and is aggravated by transport. Pain management
by paramedics can facilitate patient comfort, both in the field and upon admission to the emergency
department (ED). A previous countywide review demonstrated that although protocols allowed
paramedics to administer morphine to patients with extremity trauma, very few patients were treated and
even fewer were assessed for pain qualitatively. Untreated pain in the field can become significant pain in
the emergency department due to delay in pain management. Pain medication given by paramedics may
afford a positive impact on patient comfort in the emergency department. The purpose of this study was
to evaluate the effectiveness of a standardized education program and change in treatment protocol on the
assessment and management of pain by prehospital personnel.
Design: This study employed a prospective, population intervention design using pre- and post-intervention
data analysis.
Setting: San Diego is a diverse county with urban to wilderness densities and a resident population of 3
million. Transport times vary from less than 5 minutes to more than one hour.
Sample: The study sample included all prehospital patient records (PPRs) of all patients with extremity
trauma seen and transported by paramedics during July-September in 2002 and 2003. Data were extracted
from the PPR electronic database. There were 2,741 patients in the pre-intervention phase (2002) and
2,821 in the post-intervention phase (2003). Patients who presented as major trauma victims were excluded
from this study.
Methodology: A multidisciplinary subcommittee of the EMS Medical Director's Advisory Committee met
to address the issue of pain management. A standard treatment protocol for pain management for both
adults and pediatric patients (to include morphine as a standing order) and a standardized pain-scale
assessment tool were developed. All personnel were trained using a standardized education program.
Barriers to pain assessment, including cognitive dysfunction and language/age, were addressed through the
standardized pain scale. Variables assessed included the number of pain assessments performed and the
number of patients treated with morphine. Relative risks were calculated for the change in these variables
in the pre- and post- phases.
Results: Paramedics were 18 times more likely to assess pain after the educational intervention and
change in treatment protocol (RR 18.11; CI 10.61, 30.93) and twice as likely to administer morphine to
patients (RR = 1.82; CI 1.65, 2.01).
Conclusions: This program effectively increased the awareness of pain management in the field. After
education and a change in treatment protocol, paramedics were much more likely to assess and treat pain
in patients with extremity trauma.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titlePain Management in the Prehospital Settingen_GB
dc.identifier.urihttp://hdl.handle.net/10755/163052-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Pain Management in the Prehospital Setting</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2004</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Marcotte, Anne, RN, MSN, MICN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">County of San Diego, Division of EMS</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Quality Assurance Specialist<br/></td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">6255 Mission Gorge Road, San Diego, CA, 92120, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(619) 285-6429</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">anne.marcotte@sdcounty.ca.gov</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Marcelyn Metz, RN, BS, CEN</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Pain exacerbates stress response, inhibits movement, and is aggravated by transport. Pain management<br/>by paramedics can facilitate patient comfort, both in the field and upon admission to the emergency<br/>department (ED). A previous countywide review demonstrated that although protocols allowed<br/>paramedics to administer morphine to patients with extremity trauma, very few patients were treated and<br/>even fewer were assessed for pain qualitatively. Untreated pain in the field can become significant pain in<br/>the emergency department due to delay in pain management. Pain medication given by paramedics may<br/>afford a positive impact on patient comfort in the emergency department. The purpose of this study was<br/>to evaluate the effectiveness of a standardized education program and change in treatment protocol on the<br/>assessment and management of pain by prehospital personnel.<br/>Design: This study employed a prospective, population intervention design using pre- and post-intervention<br/>data analysis.<br/>Setting: San Diego is a diverse county with urban to wilderness densities and a resident population of 3<br/>million. Transport times vary from less than 5 minutes to more than one hour.<br/>Sample: The study sample included all prehospital patient records (PPRs) of all patients with extremity<br/>trauma seen and transported by paramedics during July-September in 2002 and 2003. Data were extracted<br/>from the PPR electronic database. There were 2,741 patients in the pre-intervention phase (2002) and<br/>2,821 in the post-intervention phase (2003). Patients who presented as major trauma victims were excluded<br/>from this study.<br/>Methodology: A multidisciplinary subcommittee of the EMS Medical Director's Advisory Committee met<br/>to address the issue of pain management. A standard treatment protocol for pain management for both<br/>adults and pediatric patients (to include morphine as a standing order) and a standardized pain-scale<br/>assessment tool were developed. All personnel were trained using a standardized education program.<br/>Barriers to pain assessment, including cognitive dysfunction and language/age, were addressed through the<br/>standardized pain scale. Variables assessed included the number of pain assessments performed and the<br/>number of patients treated with morphine. Relative risks were calculated for the change in these variables<br/>in the pre- and post- phases.<br/>Results: Paramedics were 18 times more likely to assess pain after the educational intervention and<br/>change in treatment protocol (RR 18.11; CI 10.61, 30.93) and twice as likely to administer morphine to<br/>patients (RR = 1.82; CI 1.65, 2.01).<br/>Conclusions: This program effectively increased the awareness of pain management in the field. After<br/>education and a change in treatment protocol, paramedics were much more likely to assess and treat pain<br/>in patients with extremity trauma.</td></tr></table>en_GB
dc.date.available2011-10-27T10:38:45Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:38:45Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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