Safety of fentanyl for analgesia in adults undergoing air medical transport from trauma scenes

Introduction: Although proper analgesia provision for patients in the in hospital acute setting has received recent attention, little discussion has been done of prehospital pain relief. This study was conducted to evaluate the safety of fentanyl administration during air medical transport of adult trauma patients.Setting: Urban air medical transport program using a flight nurse/paramedic crew operating with patient care protocols and off-line medical control.Methods: Flight records for trauma patients transported directly from the scene receiving fentanyl were analyzed retrospectively. Study parameters were obtained for the times just preceding and after fentanyl administration. A t test (α = 0.05) comparison between before and after fentanyl administration was performed for the following study parameters: systolic blood pressure, heart rate, oxygen saturation, respiratory rate, and Glasgow coma score in non-intubated patients. Flight records were also reviewed for any administration of naloxone or subjective notation of complications possibly attributable to fentanyl.Results: Fentanyl was administered 154 times to 99 patients. No patient received in-flight naloxone, and no fentanyl-related complications were noted on flight record review.Conclusion: Administration of fentanyl for in-flight trauma analgesia in adults seems safe. Further study should investigate efficacy of in-flight fentanyl administration and determine whether prehospital opiate administration impairs emergency department evaluation of trauma patients.