title: Undertreatment of pain in the prehospital setting: a comparison between trauma patients and patients with chest pain.
abstract: The aim of this study was to evaluate pain treatment with morphine administered by emergency medical service personnel (EMSP) to patients with chest pain and patients with pain in extremities because of trauma. This is a retrospective chart review of 2021 patients with chest pain and 887 patients with trauma. Pain was assessed using a 0-10 Numerical Rating Scale, and measured at the beginning and at the end of the ambulance care period. Trauma patients experienced more pain both at the start and at the end of the treatment than patients with chest pain [median 8 (interquartile ranges (IQR 6-9)) vs. 6 (IQR 4-7) and 4 (IQR 2-6) vs. 2 (IQR 0-4), P<0.001], but were treated with similar doses as in patients with chest pain [median 7.5 (IQR 5-10) and 5 (IQR 2.5-7.5), P=0.09]. Inadequate analgesia was frequently observed for both patient groups. The protocol was not fully utilized, suggesting that education in pharmacology and follow-up of the EMSP is required.
authors.affiliation: aDepartment of Anaesthesiology and Emergency Medicine, St Olav University Hospital bDepartment of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Trondheim cRed Cross Ambulance, Melhus, Norway.
authors.forename: Karin E
authors.initials: KE
authors.lastname: Bakkelund
authors.forename: Erlend
authors.initials: E
authors.lastname: Sundland
authors.forename: Siv
authors.initials: S
authors.lastname: Moen
authors.forename: Gunnar
authors.initials: G
authors.lastname: Vangberg
authors.forename: Sindre
authors.initials: S
authors.lastname: Mellesmo
authors.forename: Pål
authors.initials: P
authors.lastname: Klepstad
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis / Q000188:drug therapy*; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D020380:Needs Assessment; D009664:Norway; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D009020:Morphine