Clinical practice of pre-hospital analgesia: An observational study of 20,978 missions in Switzerland

• Published in: The American journal of emergency medicine Vol. 38; no. 11; pp. 2318 - 2323
• Main Authors: Kiavialaitis, Greta Emilia, Müller, Stefan, Braun, Julia, Rössler, Julian, Spahn, Donat R., Stein, Philipp, Kaserer, Alexander
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2020; Elsevier Limited
• Subjects: Adult; Age; Aged; Analgesia; Analgesics; Analgesics - administration & dosage; Anesthesia; Data collection; Emergency medical care; Emergency medical services; Emergency Medical Services - statistics & numerical data; Emergency Medical Technicians; Emergency Medicine - methods; Emergency Medicine - statistics & numerical data; Emergency physician; Female; Fentanyl; Gender; Health services; Hospitals; Humans; Injury Severity Score; Ketamine; Male; Middle Aged; Morphine; Narcotics; Observational studies; Pain; Pain management; Pain Management - methods; Pain Management - standards; Pain perception; Paramedic; Paramedics; Patients; Physicians; Pre-hospital analgesia; Retrospective Studies; Sufficient analgesia; Trauma; Switzerland; Sufficient analgesia; Pain; NACA; Paramedic; GCS; Emergency physician; EMS; SRZ; NRS; Pre-hospital analgesia
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2019.10.033

Pain is a frequent problem faced by emergency medical services (EMS) in pre-hospital settings. This large observational study aims to assess the prevalence of sufficiently provided analgesia and to analyze the efficacy of different analgesics. Moreover, we evaluated if quality of analgesia changed with an emergency physician on scene or depended on paramedics’ gender.
This is a retrospective analysis of all pre-hospital medical charts from adults and adolescents treated by the municipal EMS Schutz & Rettung Zürich over a period of 4 years from 2013 to 2016. Inclusion criteria were age ≥16 years, initial GCS > 13, NACA score ≥I and ≤V, an initial numeric rating scale (NRS) ≥ I and a documented NRS at hospital admission. 20,978 out of 142,484 missions fulfilled the inclusion criteria and therefore underwent further investigation. Descriptive, univariate and multivariate analyses were applied.
Initial NRS on scene was on average 5.2 ± 3.0. Mean NRS reduction after treatment was 2.2 ± 2.5 leading to a NRS at hospital admission of 3.0 ± 1.9. This resulted in sufficient analgesia for 77% of included patients. Among analgesics, the highest odds ratio for sufficient analgesia was observed for ketamine (OR 4.7, 95%CI 2.2–10.4, p < 0.001) followed by fentanyl (OR 1.4, 95%CI 1.1–1.7, p = 0.004). Female paramedics provided better analgesia (OR 1.2, 95%CI 1.1–1.2; p < 0.001). Patient’s sex had no influence on analgesia. In patients with a NACA score > 2, the presence of an emergency physician on scene improved the quality of analgesia significantly.
Pre-hospital analgesia is mostly adequate, especially when done with ketamine or fentanyl. Female paramedics provided better analgesia and in selected patients, an emergency physician on scene improved quality of analgesia in critical patients.