title: An Assessment of Newly Identified Barriers to and Enablers for Prehospital Pediatric Pain Management.
abstract: OBJECTIVE
  The aim of this study was to quantitatively assess the prevalence of newly identified barriers and enablers to prehospital narcotic analgesic administration in a sample of paramedics and determine whether these barriers and enablers differ between new and experienced paramedics.
  
  
  METHODS
  We surveyed a convenience sample of paramedics from urban, suburban, and rural practice settings in an emergency medical services system. Descriptive statistics were calculated to describe responses, and differences between new (≤5 years) and experienced (>5 years) providers were assessed.
  
  
  RESULTS
  There were 127 surveys analyzed; 67% of our sample was experienced and 86% considered treating pain important. Notable barriers for analgesic administration include causing more pain from intravenous catheter insertion, parental influences, difficulty assessing pain, and worry about allergic reactions. Notable enablers include belief that analgesic administration is important, education to administer analgesics, and support from agency leadership. There were statistically significant differences between new and experienced providers in the distribution of responses for survey items regarding how the importance of treating pain in children was learned, overall comfort with pediatric patients, receiving negative responses from superiors about giving pediatric patients analgesics, and usefulness of the Broselow tape for dosing fentanyl for children. Other barriers and enablers were not significantly different between new and experienced providers.
  
  
  CONCLUSIONS
  Top barriers to prehospital pediatric analgesic administration are related to skills and knowledge deficits, whereas enablers include support from agency leadership and personal views on analgesics. This information can be used to guide interventions to improve the management of pain in children.
authors.affiliation: From the *University of Rochester School of Medicine and Dentistry, Departments of †Emergency Medicine, and ‡Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester; §Department of Surgery, New York University School of Medicine, New York; and ║Division of Geriatrics/Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Whitley
authors.forename: Timmy
authors.initials: T
authors.lastname: Li
authors.forename: Courtney M C
authors.initials: CMC
authors.lastname: Jones
authors.forename: Jeremy T
authors.initials: JT
authors.lastname: Cushman
authors.forename: David M
authors.initials: DM
authors.lastname: Williams
authors.forename: Manish N
authors.initials: MN
authors.lastname: Shah
mesh_terms: D000281:Administration, Intranasal; D061605:Administration, Intravenous; D000328:Adult; D000488:Allied Health Personnel / Q000523:psychology / Q000706:statistics & numerical data; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D057785:Catheters / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010372:Pediatrics
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D005283:Fentanyl