title: Effects of an educational intervention on prehospital pain management.
abstract: BACKGROUND
  Pain is a common symptom evaluated by emergency medical services (EMS) providers. Hospital pain management programs began in the early 1990s based on a multidisciplinary approach and principles of total quality improvement. To date, these programs have had limited exposure in the prehospital setting.
  
  
  OBJECTIVE
  To evaluate the effects of a pain management educational intervention (EI) for paramedic caregivers.
  
  
  METHODS
  All ambulance providers from ten urban and suburban fire departments and two private ambulance companies participated in a three-hour EI during a quality improvement project. A survey was performed prior to the EI and repeated one month after the EI. A two-month collection of EMS runs for pain complaints was performed prior to the EI and repeated one month after the EI. Data analysis was performed using descriptive statistics and chi-square tests.
  
  
  RESULTS
  The authors reviewed 397 surveys and 439 EMS runs for pain. Overall, after the EI, paramedics' knowledge of basic pain management principles increased from 57.3% to 74.9% (17.5%; 95% confidence interval (CI): 14.9%-20.2%; p < 0.001). Paramedics' utilization of nonpharmacologic pain therapies improved by 32.2% (95% CI: 25.3%-39.2%; p < 0.001), but there was no significant change in the use of pain medication (20.2% to 24.5%). There were 51.0% (95% CI: 44.1%-57.9%; p < 0.001) improvement in documentation of pain severity, 24% (95% CI: 21.2%-26.8%; p < 0.001) improvement in documentation of pain characteristics, and 13% (95% CI: 7.4%-18.7%; p < 0.001) improvement in pain reassessment following intervention.
  
  
  CONCLUSIONS
  As a result of a three-hour educational intervention, paramedics had an increased understanding of pain principles, were more likely to provide prehospital nonpharmacologic pain therapy, and were more likely to document the results of their interventions.
authors.affiliation: Resurrection Emergency medicine Residency program, Resurrection medical Center, Chicago, IL, USA. sfrench@infinityhealthcare.com
authors.forename: Scott C
authors.initials: SC
authors.lastname: French
authors.forename: Nabil P
authors.initials: NP
authors.lastname: Salama
authors.forename: Serena
authors.initials: S
authors.lastname: Baqai
authors.forename: Sonja
authors.initials: S
authors.lastname: Raslavicus
authors.forename: Jill
authors.initials: J
authors.lastname: Ramaker
authors.forename: Shu B
authors.initials: SB
authors.lastname: Chan
mesh_terms: D000328:Adult; D000488:Allied Health Personnel / Q000193:education*; D002983:Clinical Competence; D004282:Documentation; D004496:Education, Continuing / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007087:Illinois; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis*; D059408:Pain Management; D010147:Pain Measurement; D011446:Prospective Studies