title: Emergency medical services provider comfort with prehospital analgesia administration to children.
abstract: BACKGROUND
  The undertreatment of pediatric pain is a significant concern among families, clinicians, and researchers. Although some have examined prehospital pain management, the deterrents to pediatric analgesia administration by Emergency Medical Services (EMS) have not yet been examined in Canada. Problem This study describes EMS pain-management practices and prehospital provider comfort treating pediatric pain. It highlights differences in pain management between adults and children and assesses the potential barriers, misconceptions, difficulties, and needs related to provision of pediatric analgesia.
  
  
  METHODS
  A study-specific survey tool was created and distributed to all Primary Care Paramedics (PCPs) and Advanced Care Paramedics (ACPs) over four mandatory educational seminars in the city of Edmonton (Alberta, Canada) from September through December 2008.
  
  
  RESULTS
  Ninety-four percent (191/202) of EMS personnel for the city of Edmonton completed the survey. The majority of respondents were male (73%, 139/191), aged 26-35 (42%, 80/191), and had been in practice less than 10 years (53%, 101/191). Seventy-four percent (141/191) of those surveyed were ACPs, while 26% (50/191) were PCPs. Although the majority of respondents reported using both pain scales and clinical judgement to assess pain for adults (85%, 162/191) and adolescents (86%, 165/191), children were six times more likely than adults (31%, 59/191 vs 5%, 10/191) to be assessed by clinical judgement alone. Emergency Medical Services personnel felt more comfortable treating adults than children (P < .001), and they were less likely to treat children even if they were experiencing identical types and intensities of pain as adults (all P values <.05) and adolescents (all P values < .05). Twenty-five percent of providers (37/147) assumed pediatric patients required less analgesia due to immature nervous systems. Three major barriers to treating children's pain included limited clinical experience (34%, 37/110), difficulty in communication (24%, 26/110) and inability to assess children's pain accurately (21%, 23/110).
  
  
  CONCLUSIONS
  Emergency Medical Services personnel self-report that children's pain is less rigorously measured and treated than adults' pain. Educational initiatives aimed at increasing clinical exposure to children, as well as further education regarding simple pain measurement tools for use in the field, may help to address identified barriers and discomfort with assessing and treating children.
authors.affiliation: 1Department of Pediatrics,University of Alberta,Edmonton,Alberta,Canada.
authors.forename: Amaly
authors.initials: A
authors.lastname: Rahman
authors.affiliation: 1Department of Pediatrics,University of Alberta,Edmonton,Alberta,Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Curtis
authors.affiliation: 1Department of Pediatrics,University of Alberta,Edmonton,Alberta,Canada.
authors.forename: Beth
authors.initials: B
authors.lastname: DeBruyne
authors.affiliation: 3Department of Emergency Medicine, Faculty of Medicine and Dentistry,University of Alberta,Edmonton,Alberta,Canada.
authors.forename: Sunil
authors.initials: S
authors.lastname: Sookram
authors.affiliation: 4Cochrane Child Health Field,Department of Pediatrics,University of Alberta,Edmonton,Alberta,Canada.
authors.forename: Denise
authors.initials: D
authors.lastname: Thomson
authors.affiliation: 6Emergency Medical Services,Alberta Health Services,Edmonton,Alberta,Canada.
authors.forename: Shari
authors.initials: S
authors.lastname: Lutz
authors.affiliation: 1Department of Pediatrics,University of Alberta,Edmonton,Alberta,Canada.
authors.forename: Samina
authors.initials: S
authors.lastname: Ali
mesh_terms: D000416:Alberta; D000698:Analgesia / Q000379:methods*; D001291:Attitude of Health Personnel; D002648:Child; D003430:Cross-Sectional Studies; D004634:Emergency Medical Technicians / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D059408:Pain Management; D010147:Pain Measurement; D011795:Surveys and Questionnaires
keywords: ACP Advanced Care Paramedic; ED emergency department; EMS Emergency Medical Services; PCP Primary Care Paramedic; survey