Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-26T07:11:59.310Z Has data issue: false hasContentIssue false
  • English
  • Français

Prehospital Analgesia in New South Wales, Australia

Published online by Cambridge University Press:  20 March 2012

Jason C. Bendall ,
Paul M. Simpson  and
Paul M. Middleton
Jason C. Bendall*
Affiliation:
Ambulance Research Institute, Ambulance Service of New South Wales, Rozelle NSW, Australia
Paul M. Simpson
Affiliation:
Ambulance Research Institute, Ambulance Service of New South Wales, Rozelle NSW, Australia
Paul M. Middleton
Affiliation:
Ambulance Research Institute, Ambulance Service of New South Wales, Rozelle NSW, Australia
*
Correspondence: Jason Bendall, MBBS, MM (ClinEpi), PhD Ambulance Research Institute, Ambulance Service of New South Wales, Locked Bag 105, Rozelle NSW 2039 Australia E-mail: jbendall@ambulance.nsw.gov.au
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction: With at least 20% of ambulance patients reporting pain of moderate to severe intensity, pain management has become a primary function of modern ambulance services. The objective of this study was to describe the use of intravenous morphine, inhaled methoxyflurane, and intranasal fentanyl when administered in the out-of-hospital setting by paramedics within a large Australian ambulance service.

Methods: A retrospective analysis was conducted using data from ambulance patient health care records (PHCR) for all cases from 01 July 2007 through 30 June 2008 in which an analgesic agent was administered (alone or in combination).

Results: During the study period, there were 97,705 patients ≤100 years of age who received intravenous (IV) morphine, intranasal (IN) fentanyl, or inhaled methoxyflurane, either alone or in combination. Single-agent analgesia was administered in 87% of cases. Methoxyflurane was the most common agent, being administered in almost 60% of cases. Females were less likely to receive an opiate compared to males (RR = 0.83, 95% CI, 0.82–0.84, p <0.0001). Pediatric patients were less likely to receive opiate analgesia compared to adults (RR = 0.65, 95% CI, 0.63–0.67, p <0.0001). The odds of opiate analgesia (compared to pediatric patients 0–15 years) were 1.47; 2.10; 2.56 for 16–39 years, 40–59 years, and ≥60 years, respectively. Pediatric patients were more likely to receive fentanyl than morphine (RR = 1.69, 95% CI, 1.64–1.74, p < 0.0001).

Conclusion: In this ambulance service, analgesia most often is provided through the use of a single agent. The majority of patients receive non-opioid analgesia with methoxyflurane, most likely because all levels of paramedics are authorized to administer that analgesic. Females and children are less likely to receive opiate-based analgesia than their male and adult counterparts, respectively. Paramedics appear to favor intranasal opiate delivery over intravenous delivery in children with acute pain.

Keywords

analgesiafentanylmethoxyfluranemorphineopiateparamedicprehospital
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 26 , Issue 6 , December 2011 , pp. 422 - 426
Copyright
Copyright Bendall © World Association for Disaster and Emergency Medicine 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Galinski, M, Ruscev, M, Gonzalez, G, et al. : Prevalence and management of acute pain in prehospital emergency medicine. Prehosp Emerg Care 2010;14:334–339.CrossRefGoogle ScholarPubMed
2.Lord, B, Woollard, M: The reliability of vital signs in estimating pain severity among adult patients treated by paramedics. Emerg Med J 2010;28(2);147–150.CrossRefGoogle ScholarPubMed
3.Middleton, PM, Simpson, PM, Sinclair, G, Dobbins, TA, Math, B, Bendall, JC: Effectiveness of morphine, fentanyl, and methoxyflurane in the prehospital setting. Prehosp Emerg Care 2010;14(4):439–447.CrossRefGoogle ScholarPubMed
4.Raftery, KA, Smith-Coggins, R, Chen, AH: Gender-associated differences in emergency department pain management. Ann Emerg Med 1995;26(4):414–421.CrossRefGoogle ScholarPubMed
5.Lord, B, Cui, J, Kelly, AM, Lord, B, Cui, J, Kelly, A-M: The impact of patient sex on paramedic pain management in the prehospital setting. Am J Emerg Med 2009;27(5):525–529.CrossRefGoogle ScholarPubMed
6.Michael, GE, Sporer, KA, Youngblood, GM: Women are less likely than men to receive prehospital analgesia for isolated extremity injuries. Am J Emerg Med 2007;25(8):901–906.CrossRefGoogle ScholarPubMed
7.Johnston, S, Wilkes, GJ, Thompson, JA, Ziman, M, Brightwell, R: Inhaled methoxyflurane and intranasal fentanyl for prehospital management of visceral pain in an Australian ambulance service. Emerg Med J 2010;28(1):57–63.CrossRefGoogle Scholar
8.Bendall, J, Simpson, P, Middleton, P: Effectiveness of prehospital morphine, fentanyl and methoxyflurane in pediatric patients. Prehosp Emerg Care 2011;15(2): 158–165.CrossRefGoogle ScholarPubMed
9.Rickard, C, O'Meara, P, McGrail, M, Garner, D, McLean, A, Le Lievre, P: A randomized controlled trial of intranasal fentanyl vs intravenous morphine for analgesia in the prehospital setting. Am J Emerg Med 2007;25(8):911–917.CrossRefGoogle ScholarPubMed
10.Borland, M, Jacobs, I, King, B, O'Brien, D: A randomized controlled trial comparing intranasal fentanyl to intravenous morphine for managing acute pain in children in the emergency department. Ann Emerg Med 2007;49(3):335–340.CrossRefGoogle ScholarPubMed
11.Ambulance Service of New South Wales: Demand for our services. Available at http://www.ambulance.nsw.gov.au/Our-performance/Demand-for-Our-Services.html Accessed 21 December 2011.Google Scholar
12.Petrack, EM, Christopher, NC, Kriwinsky, J: Pain management in the emergency department: patterns of analgesic utilization. Pediatr 1997;99(5):711–714.CrossRefGoogle ScholarPubMed
13.Watkins, N: Paediatric prehospital analgesia in Auckland. Emerg Med Australas 2006;18(1):51–56.CrossRefGoogle ScholarPubMed
14.White, LJ, Cooper, JD, Chambers, RM, Gradisek, RE: Prehospital use of analgesia for suspected extremity fractures. Prehosp Emerg Care 2000;4(3):205–208.Google ScholarPubMed
15.McEachin, CC, McDermott, JT, Swor, R, McEachin, CC, McDermott, JT, Swor, R: Few emergency medical services patients with lower-extremity fractures receive prehospital analgesia. Prehosp Emerg Care. 2002;6(4):406–410.CrossRefGoogle ScholarPubMed
16.Vassiliadis, J, Hitos, K, Hill, CT: Factors influencing prehospital and emergency department analgesia administration to patients with femoral neck fractures. Emerg Med (Fremantle) 2002;14(3):261–266.Google ScholarPubMed
17.Jennings, PA, Cameron, P, Bernard, S: Epidemiology of prehospital pain: an opportunity for improvement. Emerg Med J 2011;28(6):530–531.CrossRefGoogle ScholarPubMed
18.Borland, ML, Jacobs, I, Geelhoed, G, Borland, ML, Jacobs, I, Geelhoed, G: Intranasal fentanyl reduces acute pain in children in the emergency department: a safety and efficacy study. Emerg Med (Fremantle) 2002;14(3):275–280.CrossRefGoogle ScholarPubMed
19.Borland, ML, Clark, LJ, Esson, A: Comparative review of the clinical use of intranasal fentanyl versus morphine in a paediatric emergency department. Emerg Med Australas 2008;20(6):515–520.CrossRefGoogle Scholar
20.Kober, A, Scheck, T, Tschabitscher, F, et al. : The influence of local active warming on pain relief of patients with cholelithiasis during rescue transport. Anesth Analg 2003;96(5):1447–1452.CrossRefGoogle ScholarPubMed
21.Nuhr, M, Hoerauf, K, Bertalanffy, A, et al. : Active warming during emergency transport relieves acute low back pain. Spine 2004;29(14):1499–1503.CrossRefGoogle ScholarPubMed
22.Barker, R, Kober, A, Hoerauf, K, et al. : Out-of-hospital auricular acupressure in elder patients with hip fracture: a randomized double-blinded trial. Acad Emerg Med 2006;13(1):19–23.Google ScholarPubMed
23.Kober, A, Scheck, T, Greher, M, et al. : Prehospital analgesia with acupressure in victims of minor trauma: a prospective, randomized, double-blinded trial. Anesth Analg 2002;95(3):723–727.Google ScholarPubMed
24.Lang, T, Hager, H, Funovits, V, et al. : Prehospital analgesia with acupressure at the Baihui and Hegu points in patients with radial fractures: a prospective, randomized, double-blind trial. Am J Emerg Med 2007;25(8):887–893.CrossRefGoogle ScholarPubMed