title: A qualitative study of the barriers to prehospital management of acute pain in children.
abstract: BACKGROUND
  Effective pain management in the prehospital setting is gaining momentum as a potential key performance indicator by many emergency medical service systems, but historically has been shown to be inadequate, particularly in the paediatric population. This study aimed to identify the barriers, as perceived by a national cohort of advanced paramedics (APs), to achieving optimal prehospital management of acute pain in children.
  
  
  METHODS
  A qualitative approach was employed to capture data through two focus group interviews. Sixteen APs were invited to participate in this study. Both focus groups were audio recorded, transcribed and analysed using Attride-Stirling's framework for thematic network analysis.
  
  
  RESULTS
  The global theme 'Understanding Barriers to the Prehospital Management of Acute Pain in Children' emerged from three organising themes as follows: AP education and training; current clinical practice guidelines for paediatric pain management; realities of prehospital practice. Limited exposure to children in the prehospital setting, difficulty assessing pain intensity in small children, and challenges in administering oral or inhaled analgesic agents to distressed and uncooperative children were highlighted by participants. Short transfer times to the emergency department, and a 'medical' cause of pain were also implicated as examples of when children are less likely to receive analgesia from practitioners.
  
  
  CONCLUSIONS
  The pathway to improving care must include an emphasis on improvements in practitioner education and training, offering alternatives to assessing pain in preverbal children, exploring the intranasal route of drug delivery in managing acute severe pain, and robustly developed evidence-based guidelines that are practitioner friendly and patient-focused.
authors.affiliation: Department of Paediatric Emergency Medicine, Paediatric Emergency Research Unit, National Children's Research Centre, Our Lady's Children's Hospital, Crumlin Dublin, Ireland.
authors.forename: Adrian
authors.initials: A
authors.lastname: Murphy
authors.affiliation: Department of Paediatric Emergency Medicine, Paediatric Emergency Research Unit, National Children's Research Centre, Our Lady's Children's Hospital, Crumlin Dublin, Ireland.
authors.forename: Michael
authors.initials: M
authors.lastname: Barrett
authors.affiliation: Department of Paediatric Emergency Medicine, Paediatric Emergency Research Unit, National Children's Research Centre, Our Lady's Children's Hospital, Crumlin Dublin, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Cronin
authors.affiliation: Department of Paediatric Emergency Medicine, Paediatric Emergency Research Unit, National Children's Research Centre, Our Lady's Children's Hospital, Crumlin Dublin, Ireland.
authors.forename: Siobhan
authors.initials: S
authors.lastname: McCoy
authors.affiliation: Midwifery and Health Systems & Our Lady's Hospice and Care Services, School of Nursing, Health Sciences Centre, University College Dublin, Dublin, Ireland.
authors.forename: Philip
authors.initials: P
authors.lastname: Larkin
authors.affiliation: Midwifery and Health Systems, School of Nursing, University College Dublin, Dublin, Ireland.
authors.forename: Maria
authors.initials: M
authors.lastname: Brenner
authors.affiliation: Emergency Care Research Unit (ECRU), Division of Population Health Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
authors.forename: Abel
authors.initials: A
authors.lastname: Wakai
authors.affiliation: Department of Paediatric Emergency Medicine, Paediatric Emergency Research Unit, National Children's Research Centre, Our Lady's Children's Hospital, Crumlin Dublin, Ireland Department of Emergency Medicine, Cork University Hospital, Ireland.
authors.forename: Ronan
authors.initials: R
authors.lastname: O'Sullivan
mesh_terms: D059787:Acute Pain / Q000175:diagnosis / Q000628:therapy*; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010372:Pediatrics / Q000379:methods*; D017410:Practice Guidelines as Topic; D036301:Qualitative Research
keywords: paediatrics, paediatric emergency medicine; paramedics, clinical management; pre-hospital