Assessment of pain management and prehospital analgesia trends in selected emergency medical response teams in the Silesian Voivodeship

Abstract

Aim: Pain accompanies a large proportion of patients being taken care of by emergency medical teams (EMT). The catalogue of available medications ex¬tended to 45 positions from the previously used 23, with the amount of analgesics available doubling from 4 to 8.The purpose of the study is to answer the following questions: 1. What types of pain do patients report as most severe and for what types of pain do patients receive the most appropriate management in the prehospital setting? 2. Have changes in medical documentation and the introduction of mandatory pain intensity assessment affected the quality of prehospital pain management? 3. What changes have occurred in the use of analgesics during the study period? Material and methods: An analysis of medical documentation was performed in the months of September 2016, September 2017 and June 2020. Re¬spectively 688, 996 and 798 EMT medical cards were included. Inclusion criteria incorporated the following ICD-10 codes: M54, G54, R51, R52, R07, I21, R10, N20-N23, K80-K83, S10-S99, T00-T14, T20-T32. Results: Stenocardia was observed to have a lower severity compared to other types of pain (p<0,001). On the other hand, visceral pain was found to possess a greater intensity when compared to post-traumatic pain (p<0,001). An increase in the use of various drugs’ combinations and opioids was also noted. We observed that both metamizole and paracetamol have also seen increased use at the expense of ketoprofen (p<0,001). Conclusions: 1.In emergency medical teams in Silesia, patients suffering from visceral pain claimed the highest initial pain levels. However, prehospital analgesia in those patients was the greatest. EMT swere also effective in post-traumatic pain management.2.Introducing good practices coupled with the requirement for EMTs to evaluate pain intensity in medical documentation had a positive effect on prehospital analgesia in selected emergency medical teams in Silesia.3.In selected silesian EMTs advantageous changes in prehospital analgesia were observed, including the diminishing use of NSAIDs which are being replaced by metamizole and paracetamol and an increase in opioid drugs’ use.