Few emergency medical services patients with lower-extremity fractures receive prehospital analgesia |
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| Institution: | 1. Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Modena, Italy;2. Department of Diagnostic, Clinical and Public Health Medicine, Statistics Unit, University of Modena and Reggio Emilia, Modena, Italy;3. International Doctorate School in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Italy;1. Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA;2. Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA;3. Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA;4. Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA;1. Department of Obstetrics and Gynecology, Reproduction and Development, Amsterdam UMC, Location VU University Medical Center, De Boelelaan 1117, 1018 HV Amsterdam, the Netherlands;2. Department of Medical Informatics, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands;3. Department of Obstetrics and Gynecology, Reproduction and Development, Amsterdam UMC, Location Amsterdam Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands;1. University of North Carolina at Greensboro School of Nursing, United States;2. School of Nursing, Duke University, Durham, NC, United States;3. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States;4. University of North Carolina at Chapel- Hill School of Nursing, United States |
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| Abstract: | Previous literature has identified prehospital pain management as an important emergency medical services (EMS) function, and few patients transported by EMS with musculoskeletal injuries receive prehospital analgesia (PA). Objectives. 1) To describe the frequency with which EMS patients with lower-extremity and hip fracture receive prehospital and emergency department (ED) analgesia; 2) to describe EMS and patient factors that may affect administration of PA to these patients; and 3) to describe the time interval between EMS and ED medication administrations. Methods. This was a four-month (April to July 2000) retrospective study of patients with a final hospital diagnosis of hip or lower-extremity fracture who were transported by EMS to a single suburban community hospital. Data including patient demographics, fracture type, EMS response, and treatment characteristics were abstracted from review of EMS and ED records. Patients who had ankle fractures, had multiple traumatic injuries, were under the age of 18 years, or did not have fractures were excluded. Results. One hundred twenty-four patients met inclusion criteria. A basic life support (BLS)-only response was provided to 20 (16.0%). Another 38 (38.4%) received an advanced life support (ALS) response and were triaged to BLS transport. Of all the patients, 22 (18.3%) received PA. Patients who received PA were younger (64.0 vs. 77.3 years, p < 0.001) and more likely to have a lower-extremity fracture other than a hip fracture (31.8% vs. 10.7%, p < 0.004). Of all patients, 113 (91.1%) received ED analgesia. Patients received analgesia from EMS almost 2.0 hours sooner that in the ED (mean 28.4 ± 36 min vs. 146 ± 74 min after EMS scene arrival, p < 0.001). Conclusion. A minority of the study group received PA. Older patients and patients with hip fracture are less likely to receive PA. It is unclear whether current EMS system design may adversely impact administration of PA. Further work is needed to clarify whether patient need or EMS practice patterns result in low rates of PA. PREHOSPITAL EMERGENCY CARE 2002;6:406-410 |
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