Pre-hospital pain management; a systematic review of proposed guidelines
Archives of Academic Emergency Medicine,
Vol. 7 No. 1 (2019),
11 November 2018
Introduction: A standard guideline concerning pre-hospital pain management is still a matter of discussion. Therefore, the current umbrella review is determined to perform a comprehensive search in databases and Grey literature and collect and summarize the guidelines and protocols dealing with prehospital pain management. Â Â Â Â Â Â
Methods: In the present study, all of the available guidelines and protocols concerning pre-hospital pain management were reviewed. Presented guidelines are from 2010 up to present, as the majority of guidelines are considered old and become renewed after 10 years. Finally, the development quality of each guideline was evaluated using AGREE II instrument.
Results: The search conducted in databases and non-indexed protocols resulted in inclusion of 12 pre-hospital pain management guidelines. The time interval of the guidelines was from 2010 to 2019. Four guidelines were designed for pain management in trauma patients and other guidelines were presented for all of the clinical conditions associated with pain. All of the 12 included guidelines presented pain management instructions in adults. Pain management in children was reported in 10 guidelines. All of the guidelines persisted on a standard method for pain evaluation. Pain management was categorized in three groups; mild, moderate and severe pain. Most of the guidelines recommend paracetamol as an optional treatment for management of mild pain in both adults and children. In management of moderate and severe pain, fentanyl and morphine were suggested for both adults and children. In most of the treatment guidelines fentanyl is the optional choice for children.
Conclusion: The present umbrella review has summarized the current evidence in pre-hospital pain management for the first time via investigation of guidelines and protocols related to the matter. Based on the obtained evidence, no guideline is yet presented concerning opioid-free management of moderate and severe pain. The evidence is insufficient for using non opioid medications such as ketamine.
- Pain management
- practice guideline
- drug therapy
- Emergency Medical Services
How to Cite
Borland ML, Jacobs I, Rogers IR. Options in prehospital analgesia. Emergency Medicine. 2002;14(1):77-84.
Demling R, Youn Y. The stress response to injury and critical illness. Surgical Critical Care Philadelphia: WB Saunders. 1996;286.
Moore EE, Mattox KL, Feliciano DV. Trauma manual. New York: McGraw-Hill; 2003.
Mauermann E, Ruppen W, Bandschapp O. Different protocols used today to achieve total opioid-free general anesthesia without locoregional blocks. Best Practice & Research Clinical Anaesthesiology. 2017;31(4):533-45.
Samuel N, Steiner IP, Shavit I. Prehospital pain management of injured children: a systematic review of current evidence. The American journal of emergency medicine. 2015;33(3):451-4.
Corrigan M, Wilson SS, Hampton J. Safety and efficacy of intranasally administered medications in the emergency department and prehospital settings. American Journal of Health-System Pharmacy. 2015;72(18):1544-54.
Gausche-Hill M, Brown KM, Oliver ZJ, Sasson C, Dayan PS, Eschmann NM, et al. An evidence-based guideline for prehospital analgesia in trauma. Prehospital Emergency Care. 2014;18(sup1):25-34.
Bulger JK, Brown A, Evans BA, Fegan G, Ford S, Guy K, et al. Rapid analgesia for prehospital hip disruption (RAPID): protocol for feasibility study of randomised controlled trial. Pilot and feasibility studies. 2017;3(1):8.
Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. Cmaj. 2010;182(18):E839-E42.
Scholten A, Berben S, Westmaas A, van Grunsven P, de Vaal E, Rood PP, et al. Pain management in trauma patients in (pre) hospital based emergency care: current practice versus new guideline. Injury. 2015;46(5):798-806.
Alabama Emergency Medical Services. Alabama EMS Patient Care Protocols. In: Office of EMS, editor. 9th ed. Montgomery, Alabama: Alabama Department of Public Health; 2018.
Douglas County Fire/EMS Department. Emergency Medical Services 2017 Guidelines for Therapy. In: Douglas County Fire/EMS Department, editor. Douglas: Douglas County Fire/EMS; 2017.
Ambulance Tasmania. Clinical Practice Guidelines for Paramedics & Intensive Care Paramedics. In: Department of Health and Human Services, editor. Hobart, Australia: Tasmanian Goverment; 2012.
The North Carolina Office of EMS. 2017 NCCEP Treatment Protocol In: Emergency Medical Services, editor. North Carolina, USA: The North Carolina Office of Emergency Medical Services (NC OEMS); 2017.
Medical Advisory Committee. Clinical Practice Guidelines - 2017 Edition (Updated 2018). In: Council TP-HEC, editor. Ireland: Pre-Hospital Emergency Care Council; 2018.
Ambulance Victoria. Clinical Practice Guidelines Ambulance and MICA Paramedics. In: Ambulance Victoria Medical Advisory Committee, editor. Melbourne, Australia: Ambulance Victoria; 2018.
Gausche-Hill M, Brown KM, Oliver ZJ, Sasson C, Dayan PS, Eschmann NM, et al. An Evidence-based Guideline for Prehospital Analgesia in Trauma. Prehospital Emergency Care. 2014;18(sup1):25-34.
Savoia G, Coluzzi F, Di CM, Ambrosio F, Della FC, Oggioni R, et al. Italian Intersociety Recommendations on pain management in the emergency setting (SIAARTI, SIMEU, SIS 118, AISD, SIARED, SICUT, IRC). Minerva anestesiologica. 2015;81(2):205-25.
new mexico emergency medical services. EMS Scope of Practice Guidelines for Drugs. In: New Mexico Department of Emergency Medicine, editor. New Mexico: New Mexico Department of Department of Health; 2018.
National Association of State EMS Officials. National Model EMS Clinical Guidelines. Washington, USA: National Association of State EMS; 2018.
Excellence TNIfHaC. Major trauma: assessment and initial management. London, UK: The National Institute for Health and Care Excellence; 2016.
Scholten AC, Berben SA, Westmaas AH, van Grunsven PM, de Vaal ET, Rood PP, et al. Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline. Injury. 2015;46(5):798-806.
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