Abstract

Introduction
This study aimed to investigate patient and practitioner factors affecting prehospital pain management practice and outcomes including use of analgesics and reduction in pain in adult patients attended by ambulance clinicians. The objective was to explore whether practitioner initiated analgesia or reduction in pain differed according to factors such as the adult patient’s age, sex, ethnicity or causation of pain and clinician factors such as sex or role seniority.
Methods
We employed a cross sectional design using routine retrospective data for a one-week sample of all 999 ambulance attendances in two large regional UK ambulance services for all patients aged 18 years or over, in people requiring primary transport to hospital. We excluded patients with a Glasgow Coma Scale score below 13. We used a multivariate multilevel (two-level) regression model to determine factors independently associated with use of analgesia and a clinically meaningful reduction in pain of 2 points or more on the numerical (0-10) verbal pain scale (NVPS), taking into account confounders including patient demographic and other variables.
Results
There were 28.8% non-paramedic staff , 29.5% paramedic and 37.1% mixed crew attending. At least two pain scores were recorded in 49.9% (4,773/9,574) of the sample and in this group, pain was reduced in 23.0% (1,100/4,773), increased in 102/4,773 (2.1) and unchanged in 3,571/4,773 (74.8%). For all models fitted there was no significant relationship between analgesic use or pain reduction and patient sex or sex or grade of ambulance staff member. Reduction in pain (NVPS of 2 points or more) was associated with an ambulance crew attending which included at least one paramedic (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.14 to 2.04, p<0.01), attending patients in moderate to severe pain (NVPS 4-10) and with certain groups of clinical conditions, e.g. cardiac, trauma, and other medical conditions. Use of paracetamol or an NSAID was not associated with clinician grade but was associated with any pain score above zero.
Conclusion
There was a high level of non-recording of pain scores. We found no significant association between analgesic use or pain reduction and patient sex or ambulance staff member sex or grade.