Pre-hospital pain management by ambulance staff

BACKGROUND In the 2004 Healthcare Commission report the majority of patients (4 out of 5) said they had suffered pain from their presenting conditions while in the ambulance. Although 81% felt that the ambulance crew did everything they could to control pain, 1 in 5 wanted more pain relief: 14% said the crew did this to some extent and 5% that the crew did not do everything they could to control the pain. The management of pain in the pre-hospital environment has been shown to be an important determinant of subsequent pain in the emergency department. How ambulance services manage pain is therefore clinically important and a key indicator of quality of service. Management of pain can be differentiated into a number of essential components. Recording of pain both at the scene (either the patient's home or the scene of an emergency) and on arrival at hospital has been shown to be feasible using numerical, verbal 1 and visual analogue scales 2 . Recording pain scores is valuable, not only because it is a simple method of assessing pain, but because it has been shown to increase the likelihood of administration of analgesia and facilitates an estimation of the effectiveness of treatment. 3 In one study, a reduction in pain score of at least 20mm out of 100mm on a visual analogue scale corresponded to a clinically meaningful reduction in the level of pain reported by patients experiencing acute pain 4 . The type, dose, route 5;6 and timeliness 7 of analgesia are important determinants of the effectiveness of pain relief. Strong analgesics including opiates have been available for use by paramedics for the management of pain since the early 1990s.. The feasibility of pain assessment in the prehospital setting. Prehosp.Emerg.Care 2004;8:155-61. 2 Lord BA,.Parsell B. Measurement of pain in the prehospital setting using a visual analogue scale. Prehospital.Disaster.Med. 2003;18:353-8. 3 Silka PA, Roth MM, Moreno G, Merrill L, Geiderman JM, Pain scores improve analgesic administration patterns for trauma patients in the emergency department. Acad.Emerg.Med. 2004;11:264-70. 4 Kelly AM. Setting the benchmark for research in the management of acute pain in emergency departments. Emerg.Med.(Fremantle.) 2001;13:57-60. 5 Woollard M, Jones T, Pitt K, Vetter N. Hitting them where it hurts? Low dose nalbuphine therapy. Emerg.Med.J. et al. Less IS less: a randomised controlled trial comparing cautious and rapid nalbuphine dosing regimens. Emerg.Med.J. 2004;21:362-4. 7 Karlson BW, Sjolin M, Herlitz J. Clinical factors associated with pain in acute myocardial infarction. Cardiology 1993;83:107-17. RESEARCH AIMS The aim of the study is to examine whether factors such age, sex, condition of the patient, and distance from hospital etc affect decisions to assess pain and/or administer analgesia.