SCOPE OF THE PROBLEM

Since its inception, emergency medical service (EMS) providers have desired to treat pain – and to a lesser extent agitation – in their patients. With a significant military influence on prehospital care, analgesia for traumatic injuries has received considerable attention in combat zones, though this has not always been a major focus for civilian EMS. Historically, physician concerns regarding safe medication administration and impeding diagnosis of underlying conditions have limited prehospital analgesia for many painful conditions. These ideas have been challenged, and prehospital pain management and sedation have become a greater focus for EMS providers and physicians.

As anyone with EMS experience can relate, the prehospital environment presents a significant set of unique challenges for health-care providers. During the time that patients are cared for in the prehospital environment, they may require splinting and stabilization of musculoskeletal injuries, extrication from wrecked vehicles, and transport under often suboptimal conditions. For patients suffering from painful conditions or trauma, each of these activities will increase the amount of pain and anxiety the patient experiences.

For intubated or combative patients, failure to effectively manage sedation can be dangerous to the patient and EMS providers. Additionally, care provided in the prehospital setting can directly impact care provided in the emergency department (ED).

SEDATION AND PAIN CONSIDERATIONS

Both analgesia and sedation are important in the prehospital setting. However, the sedation and treatment of pain for prehospital patients carry unique concerns and issues.