Few emergency medical services patients with lower-extremity fractures receive prehospital analgesia.
Previous literature has identified prehospital pain management as an important emergency medical services (EMS) function, and few patients transported by EMS with musculoskeletal injuries receive prehospital analgesia (PA).


OBJECTIVE
1) To describe the frequency with which EMS patients with lower-extremity and hip fracture receive prehospital and emergency department (ED) analgesia; 2) to describe EMS and patient factors that may affect administration of PA to these patients; and 3) to describe the time interval between EMS and ED medication administrations.


METHODS
This was a four-month (April to July 2000) retrospective study of patients with a final hospital diagnosis of hip or lower-extremity fracture who were transported by EMS to a single suburban community hospital. Data including patient demographics, fracture type, EMS response, and treatment characteristics were abstracted from review of EMS and ED records. Patients who had ankle fractures, had multiple traumatic injuries, were under the age of 18 years, or did not have fractures were excluded.


RESULTS
One hundred twenty-four patients met inclusion criteria. A basic life support (BLS)-only response was provided to 20 (16.0%). Another 38 (38.4%) received an advanced life support (ALS) response and were triaged to BLS transport. Of all the patients, 22 (18.3%) received PA. Patients who received PA were younger (64.0 vs. 77.3 years, p < 0.001) and more likely to have a lower-extremity fracture other than a hip fracture (31.8% vs. 10.7%, p < 0.004). Of all patients, 113 (91.1%) received ED analgesia. Patients received analgesia from EMS almost 2.0 hours sooner that in the ED (mean 28.4 +/- 36 min vs. 146 +/- 74 min after EMS scene arrival, p < 0.001).


CONCLUSIONS
A minority of the study group received PA. Older patients and patients with hip fracture are less likely to receive PA. It is unclear whether current EMS system design may adversely impact administration of PA. Further work is needed to clarify whether patient need or EMS practice patterns result in low rates of PA.
McEachin
Christine Clara
CC
Department of Emergency Medicine, William Beaumont Hospital,Royal Oak, MI 48073, USA. mcea1@aol.com
McDermott
Joseph Thomas
JT
Swor
Robert
R
D000367:Age Factors; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D017723:Drug Utilization Review; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000188:drug therapy*; D006620:Hip Fractures / Q000150:complications*; D006801:Humans; D035002:Lower Extremity / Q000293:injuries*; D008297:Male; D008824:Michigan; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010818:Practice Patterns, Physicians'
D000700:Analgesics