[National survey of emergency management of acute pain in prehospital setting].
OBJECTIVE
Assessment of skill of physicians staffed Mobile Intensive Care Units (MICU) in severe acute pain (SAP) management.


METHODS
This study was conducted with a phone questionnaire addressed to emergency physicians of all metropolitan Smur (N =360). This questionnaire included medical teaching, professional position, means of severe acute pain assessment and definition of SAP, treatment, analgesic drug availability, locals guidelines and personal assessment of national guidelines were studied.


RESULTS
Exhaustivity was more than 99% (359/360). Eighty percent of physicians were specialized in emergency care, 8% were anaesthesiologists (or intensivists), 78% worked in emergency department and 76% were full time. Forty nine percent of physicians did not know French Society of Anesthesiology and Intensive Care guidelines and 63% did not have locals analgesics guidelines. To define SAP, Visual Analogic Scale (VAS) or Numeric Scale (NS) >6/10 were mentioned only by 17%. Therapeutic efficiency was assessed and defined by VAS or NS <3/10 by 14%. Morphine was available in 90% of MICU, fentanyl in 79% and nalbuphine in 64%. Morphine was used in first intention by 71% of physicians. Guidelines about doses and waiting periods between 2 administrations were followed respectively by 6% and 28%. Ninety percent of physicians combined at least two treatments, 58 % combined at least three and 39%, at least four.


CONCLUSIONS
This survey showed a low knowledge about severe acute pain management in out-of-hospital setting, both for pain assessment and treatment. There were few locals guidelines to overcome this deficiency. A training work is essential to improve care of acute pain in out-of-hospital setting.
Galinski
M
M
Samu 93, EA 3409, hôpital Avicenne, université Paris-XIII, 125, route de Stalingrad, 93006 Bobigny, France. Michel.galinski@avc.ap-hop-paris.fr
Ruscev
M
M
Pommerie
F
F
Hubert
G
G
Srij
M
M
Lapostolle
F
F
Adnet
F
F
D000208:Acute Disease; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000776:Anesthesiology; D002983:Clinical Competence; D003625:Data Collection; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004635:Emergency Medicine; D005602:France / Q000453:epidemiology; D017408:Guidelines as Topic; D006801:Humans; D010146:Pain / Q000453:epidemiology; D059408:Pain Management; D010147:Pain Measurement; D011795:Surveys and Questionnaires; D000078329:Workforce
D000700:Analgesics; D000701:Analgesics, Opioid