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Prehospital analgesia

Frank K Butler
BACKGROUND: Twenty years ago, the original Tactical Combat Casualty Care (TCCC) article was published in this journal. Since TCCC is essentially a set of best-practice prehospital trauma care guidelines customized for use on the battlefield, the presence of a journal with a specific focus on military medicine was a profound benefit to the initial presentation of TCCC to the U.S. Military. METHODS: In the two ensuing decades, which included the longest continuous period of armed conflict in our nation's history, TCCC steadily evolved as the prehospital trauma care evidence base was augmented and as feedback from user medics, corpsmen, and pararescuemen was obtained...
March 2017: Military Medicine
B Schempf, S Casu, D Häske
BACKGROUND: In some German emergency medical service districts, analgesia is performed by paramedics without support of emergency physicians on scene. With regard to safety and effectiveness, paramedics should not be overshadowed by emergency physicians. OBJECTIVES: Is prehospital analgesia performed by paramedics under medical supervision or emergency physicians comparable regarding processes and effectiveness in the case of isolated limb injury? MATERIAL AND METHODS: As a retrospective analysis of patients with isolated limb injury, analgesia performed by paramedics and by emergency physicians was analyzed...
March 3, 2017: Der Anaesthesist
Adam R Aluisio, Olivier Félix Umuhire, Gabin Mbanjumucyo, Naomi George, Alexis Kearney, Naz Karim, Jeanne DʼArc Nyinawankusi, Eric Uwitonze, Sam Enumah, John W Scott, Zeta Mutabazi, Georges Ntakiyiruta, Sudha Jayaraman, Robert Riviello, Jean Claude Byiringiro, Adam C Levine
BACKGROUND: Pediatric trauma is a significant public health problem in resource-constrained settings; however, the epidemiology of injuries is poorly defined in Rwanda. This study describes the characteristics of pediatric trauma patients transported to the emergency department (ED) of the Centre Hospitalier Universitaire de Kigali by emergency medical services in Kigali, Rwanda. METHODS: This cohort study was conducted at the Centre Hospitalier Universitaire de Kigali from December 2012 to February 2015...
February 4, 2017: Pediatric Emergency Care
Jenna K Bulger, Alan Brown, Bridie A Evans, Greg Fegan, Simon Ford, Katy Guy, Sian Jones, Leigh Keen, Ashrafunnesa Khanom, Ian Pallister, Nigel Rees, Ian T Russell, Anne C Seagrove, Helen A Snooks
BACKGROUND: Adequate pain relief at the point of injury and during transport to hospital is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilise and whose long-term outcomes may be adversely affected by administration of opiate analgesics. Fascia iliaca compartment block (FICB) is a procedure routinely undertaken by doctors and nurses in the emergency department for patients with hip fracture but not yet evaluated for use by paramedics at the scene of emergency calls...
2017: Pilot and Feasibility Studies
Gregory J Hollis, Toby M Keene, Rory M Ardlie, David Ge Caldicott, Stuart G Stapleton
OBJECTIVE: The aim of this study was to describe prehospital use of ketamine by ACT Ambulance Service, and frequency of endotracheal intubation. METHODS: This was a retrospective study of patients receiving prehospital ketamine between 1 January and 31 December 2013. Episodes were identified from the prehospital electronic patient care records, then linkage to ED records at two receiving hospitals. Demographics, dose, indication and occasions of intubation were analysed...
February 2017: Emergency Medicine Australasia: EMA
Lorin R Browne, Manish I Shah, Jonathan R Studnek, Daniel G Ostermayer, Stacy Reynolds, Clare E Guse, David C Brousseau, E Brooke Lerner
BACKGROUND: The National Association of Emergency Medical Services Physicians' (NAEMSP) Position Statement on Prehospital Pain Management and the joint National Highway Traffic Safety Administration (NHTSA) and Emergency Medical Services for Children (EMSC) Evidence-based Guideline for Prehospital Analgesia in Trauma aim to improve the recognition, assessment, and treatment of prehospital pain. The impact of implementation of these guidelines on pain management in children by emergency medical services (EMS) agencies has not been assessed...
November 2016: Prehospital Emergency Care
Keng Sheng Chew, Abdul Hafiz Shaharudin
INTRODUCTION: The use of intranasal fentanyl as an alternative type of analgesia has been shown to be effective in paediatric populations and prehospital settings. Studies on the use of intranasal fentanyl in adult patients in emergency settings are limited. METHODS: An open-label study was conducted to evaluate the effectiveness of the addition of 1.5 mcg/kg intranasal fentanyl to 2 mg/kg intravenous tramadol (fentanyl + tramadol arm, n = 10) as compared to the administration of 2 mg/kg intravenous tramadol alone (tramadol-only arm, n = 10) in adult patients with moderate to severe pain due to acute musculoskeletal injuries...
May 19, 2016: Singapore Medical Journal
Sylvain Bussières, Alain Tanguay, Denise Hébert, Richard Fleet
Access to health care in Canada's rural areas is a challenge. The Unité de Coordination Clinique des Services Préhospitaliers d'Urgence (UCCSPU) is a telemedicine program designed to improve health care in the Chaudiere-Appalaches and Quebec City regions of Canada. Remote medical services are provided by nurses and by an emergency physician based in a clinical unit at the Alphonse-Desjardins Community Health and Social Services Center. The interventions were developed to meet two objectives. The first is to enhance access to quality health care...
January 2017: Journal of Telemedicine and Telecare
Björn Hossfeld, Susanne Holsträter, Michael Bernhard, Lorenz Lampl, Matthias Helm, Martin Kulla
After securing vital function, treatment of pain is an important aspect in emergency medical care. Irrespective of the underlying disease or injury, pain is an important warning symptom of the body and the most common reason for an emergency alert notification. A patient assesses quality of care and success of prehospital care using the criteria of the extent of pain relief he experiences. Since mild pain does not usually lead to an emergency alert, the criteria apply mainly to treatment of severe and very severe pain...
February 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
J C Brokmann, R Rossaint, F Hirsch, S K Beckers, M Czaplik, M Chowanetz, M Tamm, S Bergrath
BACKGROUND: In German emergency medical services (EMS), the analgesia is restricted to physicians. In this prospective, interventional, multicentre trial, complications with and quality of telemedically delegated analgesia were evaluated. METHODS: If prehospital analgesia was necessary, five telemedically equipped paramedic ambulances from four different districts could consult a telemedicine centre. Analgesics were delegated based on a predefined algorithm. Telemedically assisted cases were compared with local historical regular EMS missions using matched pairs...
August 2016: European Journal of Pain: EJP
Mazen El Sayed, Hani Tamim, N Clay Mann
BACKGROUND: Emergency Medical Services (EMS) preparedness and availability of essential medications are important to reduce morbidity and mortality from mass-casualty incidents (MCIs). OBJECTIVES: This study describes prehospital medication administration during MCIs by different EMS service levels. METHODS: The US National EMS Public-Release Research Dataset maintained by the National Emergency Medical Services Information System (NEMSIS) was used to carry out the study...
April 2016: Prehospital and Disaster Medicine
Lorin R Browne, Jonathan R Studnek, Manish I Shah, David C Brousseau, Clare E Guse, E Brooke Lerner
OBJECTIVE: Prior studies have identified provider and system characteristics that impede pain management in children, but no studies have investigated the effect of changing these characteristics on prehospital opioid analgesia. Our objectives were to determine: 1) the frequency of opioid analgesia and pain score documentation among prehospital pediatric patients after system wide changes to improve pain treatment, and 2) if older age, longer transport times, the presence of vascular access and pain score documentation were associated with increased prehospital administration of opioid analgesia in children...
2016: Prehospital Emergency Care
Erin R Weldon, Robert E Ariano, Robert A Grierson
In the treatment of acute coronary syndromes, reduction of sympathetic stress and catecholamine release is an important therapeutic goal. One method used to achieve this goal is pain reduction through the systemic administration of analgesia. Historically, morphine has been the analgesic of choice in ischemic cardiac pain. This randomized double-blind controlled trial seeks to prove the utility of fentanyl as an alternate first-line analgesic for ischemic-type chest pain in the prehospital setting. Successive patients who were treated for suspected ischemic chest pain in the emergency medical services system were considered eligible...
2016: Prehospital Emergency Care
Robert T Gerhardt, Patrick T Reeves, Russ S Kotwal, Robert L Mabry, John B Robinson, Frank Butler
In addition to life-saving interventions, the assessment of pain and subsequent administration of analgesia are primary benchmarks for quality emergency medical services care which should be documented and analyzed. Analyze US combat casualty data from the Department of Defense Trauma Registry (DoDTR) with a primary focus on prehospital pain assessment, analgesic administration and documentation. Retrospective cohort study of battlefield prehospital and hospital casualty data were abstracted by DoDTR from available records from 1 September 2007 through 30 June 2011...
2016: Prehospital Emergency Care
Ole Kristian Losvik, Mudhafar Kareem Murad, Eystein Skjerve, Hans Husum
BACKGROUND: Opioid analgesics are used in most trauma systems, and only a few studies report on the use of ketamine for prehospital analgesia. In a low-cost rural trauma system in Iraq paramedics have been using prehospital ketamine analgesia for ten years. This study aims to evaluate the effects of prehospital analgesia on physiologic trauma severity indicators and compare the effect of ketamine and pentazocine on those indicators. METHODS: The investigation was conducted as a retrospective cohort study with parallel group design...
November 9, 2015: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
S Meyer, U Grundmann, J Reinert, L Gortner
Life-threatening pediatric emergencies are relatively rare in the prehospital setting. Thus, the treating emergency physician may not always be familiar with and well trained in these situations. However, pediatric emergencies require early recognition and initiation of specific diagnostic and therapeutic interventions to prevent further damage. The treatment of pediatric emergencies follows current recommendations as detailed in published international guidelines. The aim of this review is to familiarize the emergency physician with general aspects pertinent to this topic-most importantly anatomical and physiological characteristics in this cohort...
November 2015: Medizinische Klinik, Intensivmedizin und Notfallmedizin
T Luiz, G Scherer, A Wickenkamp, F Blaschke, W Hoffmann, M Schiffer, J Zimmer, S Schaefer, C Voigt
BACKGROUND: In contrast to the widespread practice in life-threatening emergencies, delegation of medical pain therapy to paramedics by the medical director  of Emergency Medical Services, EMS, are still the exception in Germany. This is due to the fact that in non-life-threatening situations, the expected benefit and potential side effects of drug therapy have to be carefully weighed. In addition, in Germany federal law generally restricts the administration of opiates to physicians...
October 26, 2015: Der Anaesthesist
Megan Corrigan, Suprat Saely Wilson, Jeremy Hampton
PURPOSE: The safety and efficacy of medications that may be administered via the intranasal route in adult patients in the prehospital and emergency department (ED) settings are reviewed. SUMMARY: When medications of appropriate molecular character and concentration are delivered intranasally, they are quickly transported across this capillary network and delivered to the systemic circulation, thereby avoiding the absorption-limiting effects of first-pass metabolism...
September 15, 2015: American Journal of Health-system Pharmacy: AJHP
Paul A Jennings, Bill Lord, Karen Smith
INTRODUCTION: Pediatric pain is a common presenting symptom in the prehospital setting; however, there is a lack of data identifying factors associated with effective pain management in this population. We sought to identify the factors associated with clinically meaningful pain reduction in children. METHODS: An analysis of electronic patient care records of all patients younger than 15 years presenting with pain to the emergency medical service of Victoria, Australia, over a 4-year period (2008-2011)...
November 2015: American Journal of Emergency Medicine
B Landsleitner, J Keil
BACKGROUND: Since pediatric emergencies and burn injuries are rare in prehospital emergency medicine, emergency teams can hardly develop routine in emergency care. OBJECTIVES: How to effectively treat burn injuries and avoid common errors? MATERIALS AND METHODS: A simple and severity-based therapy concept based on the current literature using the example of a case report is presented. RESULTS: About 80% of burns and scalds in children are not severe cases-in these patients an effective analgesia by intranasal administration is important and further invasive treatments are generally not necessary...
June 2015: Medizinische Klinik, Intensivmedizin und Notfallmedizin
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