Paramedics' attitudes towards prehospital pain management

Background/Purpose: Pain is a major reason why patients contact emergency medical services (EMS). However, paramedics remain hesitant to use the analgesic agents at their disposal. The objective of this study is to employ qualitative methods in order to explore paramedics' perceptions of their roles in prehospital pain management. Methods: Eight qualitative semi-structured interviews and two focus groups with experienced paramedics from five northeastern EMS agencies were conducted during the summer of 2010 (n = 15). Interviews were recorded and transcribed verbatim. The transcripts were topic-analyzed and iteratively coded by two independent investigators who met regularly to compare notes and resolve any ambiguities. After several iterations of conceptual mapping and code refinement, major themes/categories were generated. Results/Outcomes: Paramedics expressed a desire to treat “obvious” pain, frequently using a patient's physical presentation, vital signs, or behavior as indicators of need. They expressed concern about treating “drug-seekers” or “frequent flyers,” which contributed to an overall ambivalence about the degree of pain relief they should administer to fulfill their professional responsibilities. They preferred to “take the edge off,” rather than eliminate pain. Paramedics were committed to aggressively treating concomitant anxiety, but expressed concern regarding masking the symptoms of illness or injury, particularly in the abdomen. Conclusions: A number of potentially modifiable barriers to appropriate pain management were revealed in paramedic focus groups and interviews. Future work will assess the ability of tailored interventions to address these concerns and thereby enhance EMS professionals' willingness to use appropriate analgesia.