title: Effects on patient care of introducing prehospital intravenous nalbuphine hydrochloride.
abstract: OBJECTIVE
  Since March 1992, intravenous nalbuphine hydrochloride has been used prehospital by paramedics in the Plymouth area. This study assesses the impact of this intervention.
  
  
  METHODS
  A prospective study of the parenteral analgesic requirements of 1000 consecutive patients arriving by ambulance at the accident and emergency (A&E) department of a large district general hospital. Where parenteral analgesia was given in the A&E department but not by ambulance personnel, a questionnaire was sent to the ambulance crew concerned to ascertain the reasons for not having given nalbuphine.
  
  
  RESULTS
  Of 1000 consecutive patients arriving by ambulance, 87 (8.7%) had been given parenteral analgesia either prehospital, in A&E, or in both places. Seventy five (7.5%) needed parenteral analgesia in the A&E department, 29 (2.9%) had been given prehospital intravenous analgesia by paramedics, and a further seven (0.7%) had been given parenteral analgesia by a general practitioner (GP). Thus 36 (3.6%) received prehospital analgesia. Ten patients who had been given analgesia by paramedics required no further analgesia in A&E, whereas 51 patients who had not been given prehospital analgesia required parenteral analgesia in the A&E department.
  
  
  CONCLUSIONS
  The introduction of nalbuphine for use by paramedics in prehospital care has increased prehospital parenteral analgesia from 1% in 1992 (given by GPs only) to 3.6% in the current study group, and 41% of patients requiring parenteral analgesia received analgesia prehospital. There may be further scope for extending the indications for nalbuphine use by ambulance personnel.
authors.affiliation: Accident and Emergency Department, Derriford Hospital, Plymouth, UK.
authors.forename: P
authors.initials: P
authors.lastname: Hyland-McGuire
authors.forename: H R
authors.initials: HR
authors.lastname: Guly
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D003625:Data Collection; D004363:Drug Utilization; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D006801:Humans; D007275:Injections, Intravenous; D009266:Nalbuphine / Q000008:administration & dosage*; D010147:Pain Measurement; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000701:Analgesics, Opioid; D009266:Nalbuphine