title: Impact of liberalization of protocols for the use of morphine sulfate in an urban emergency medical services system.
abstract: OBJECTIVE
  To investigate the impact of liberalization of paramedic management protocols for the use of morphine sulfate (MS).
  
  
  METHODS
  A retrospective database analysis tallied and categorized MS use into seven conditions during two intervals--six months before (control) and six months after (study) the protocol change.
  
  
  RESULTS
  In the control interval, 760 of 34,020 (2.2%) patients received MS. In the study interval, 999 of 30,320 (3.3%) received the drug, a 50% relative increase in MS use. MS use dramatically increased in two assessment categories: other painful medical conditions (19.0% vs. 2.8% of transports, relative risk [RR] 6.8, 95% confidence interval [CI] 5.2-8.9) and nontraumatic abdominal pain (9.2% vs. 1.9% of transports, RR 4.8, 95% CI 3.3-6.9).
  
  
  CONCLUSIONS
  Liberalization of pain management protocols resulted in an appreciable increase in the use of MS only in medical categories, predominantly abdominal pain, with no apparent safety or misuse issues.
authors.affiliation: Alameda County EMS, San Leandro, California, USA. james.pointer@acgov.org
authors.forename: James E
authors.initials: JE
authors.lastname: Pointer
authors.forename: Kristine
authors.initials: K
authors.lastname: Harlan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002140:California; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D004363:Drug Utilization; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy*; D014505:Urban Population
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine