title: Prehospital administration of morphine for isolated extremity injuries: a change in protocol reduces time to medication.
abstract: OBJECTIVE
  To evaluate the effect of a new protocol allowing paramedics to administer morphine without a physician order to patients with extremity trauma with respect to time of morphine administration, scene time, morphine amount and number of doses per patient, and proportion of patients receiving morphine.
  
  
  METHODS
  Data were abstracted from transport forms for a ten-month period prior to the implementation of the new protocol and for nine months after implementation. Data elements included patient age and sex, date, time of EMS arrival on scene, amount and number of morphine doses, and total number of patients transported.
  
  
  RESULTS
  Implementation of the new protocol was associated with a decrease in time between emergency medical services (EMS) arrival on scene and administration of the first dose of morphine from 18.8 to 16.7 minutes, a difference of 2.1 minutes [95% confidence interval (95%CI) 1.3, 2.9]. The proportion of patients receiving analgesia at the scene, rather than during transport, increased from 62.7% before the protocol change to 69.5% after, an increase of 6.8% (95% CI 2.7, 11.0). Transports before and after implementation of the new protocol did not differ with respect to patient sex, age, or chief complaint; number of morphine doses or total morphine administered per patient; or proportion of prehospital patients receiving morphine.
  
  
  CONCLUSIONS
  A change in protocol that permits trained paramedics to administer morphine without physician approval reduces time to analgesia administration without influencing the amount of morphine delivered per patient or the rate of prehospital morphine use. Further study should measure the effect on base hospital physician interruptions and patient outcome.
authors.affiliation: Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque 87131-5246, USA. lfullerton@salud.unm.edu
authors.forename: Lynne
authors.initials: L
authors.lastname: Fullerton-Gleason
authors.forename: Cameron
authors.initials: C
authors.lastname: Crandall
authors.forename: David P
authors.initials: DP
authors.lastname: Sklar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002648:Child; D002985:Clinical Protocols; D004632:Emergency Medical Services / Q000592:standards*; D004634:Emergency Medical Technicians / Q000592:standards*; D005121:Extremities / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009516:New Mexico; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D017009:Professional Autonomy; D014947:Wounds and Injuries / Q000150:complications
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine