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Emergency Medical Services Provider Comfort with Prehospital Analgesia Administration to Children

Published online by Cambridge University Press:  08 December 2014

Amaly Rahman ,
Sarah Curtis ,
Beth DeBruyne ,
Sunil Sookram ,
Denise Thomson ,
Shari Lutz  and
Samina Ali
Amaly Rahman
Affiliation:
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
Sarah Curtis
Affiliation:
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada Women and Children's Health Research Institute, Edmonton, Alberta, Canada
Beth DeBruyne
Affiliation:
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
Sunil Sookram
Affiliation:
Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
Denise Thomson
Affiliation:
Cochrane Child Health Field, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
Shari Lutz
Affiliation:
Emergency Medical Services, Alberta Health Services, Edmonton, Alberta, Canada
Samina Ali*
Affiliation:
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada Women and Children's Health Research Institute, Edmonton, Alberta, Canada
*
Correspondence: Samina Ali, MDCM Department of Pediatrics Edmonton Clinic Health Academy 11405 – 87 Avenue Edmonton, Alberta T6G 1C9 Canada E-mail sali@ualberta.ca
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Abstract

Introduction

The undertreatment of pediatric pain is a significant concern among families, clinicians, and researchers. Although some have examined prehospital pain management, the deterrents to pediatric analgesia administration by Emergency Medical Services (EMS) have not yet been examined in Canada.

Problem

This study describes EMS pain-management practices and prehospital provider comfort treating pediatric pain. It highlights differences in pain management between adults and children and assesses the potential barriers, misconceptions, difficulties, and needs related to provision of pediatric analgesia.

Methods

A study-specific survey tool was created and distributed to all Primary Care Paramedics (PCPs) and Advanced Care Paramedics (ACPs) over four mandatory educational seminars in the city of Edmonton (Alberta, Canada) from September through December 2008.

Results

Ninety-four percent (191/202) of EMS personnel for the city of Edmonton completed the survey. The majority of respondents were male (73%, 139/191), aged 26-35 (42%, 80/191), and had been in practice less than 10 years (53%, 101/191). Seventy-four percent (141/191) of those surveyed were ACPs, while 26% (50/191) were PCPs. Although the majority of respondents reported using both pain scales and clinical judgement to assess pain for adults (85%, 162/191) and adolescents (86%, 165/191), children were six times more likely than adults (31%, 59/191 vs 5%, 10/191) to be assessed by clinical judgement alone. Emergency Medical Services personnel felt more comfortable treating adults than children (P < .001), and they were less likely to treat children even if they were experiencing identical types and intensities of pain as adults (all P values <.05) and adolescents (all P values < .05). Twenty-five percent of providers (37/147) assumed pediatric patients required less analgesia due to immature nervous systems. Three major barriers to treating children's pain included limited clinical experience (34%, 37/110), difficulty in communication (24%, 26/110) and inability to assess children's pain accurately (21%, 23/110).

Conclusion

Emergency Medical Services personnel self-report that children's pain is less rigorously measured and treated than adults’ pain. Educational initiatives aimed at increasing clinical exposure to children, as well as further education regarding simple pain measurement tools for use in the field, may help to address identified barriers and discomfort with assessing and treating children.

RahmanA, CurtisS, DeBruyneB, SookramS, ThomsonD, LutzS, AliS. Emergency Medical Services Provider Comfort with Prehospital Analgesia Administration to Children. Prehosp Disaster Med. 2015;30(1):1-6.

Keywords

Emergency Medical Servicespainparamedicpediatricssurvey
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 30 , Issue 1 , February 2015 , pp. 66 - 71
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2014 

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Footnotes

Conflicts of interest/funding: Dr. Amaly Rahman secured funding through the Women and Children's Health Research Institute Trainee Grant Program (2009) for this project. The authors report no conflicts of interest.

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