249091 Paramedics' attitudes towards prehospital pain management

Monday, October 31, 2011

Brooks Walsh, MD , Department of Emergency Medicine, Yale University, New Haven, CT
Emily Meyer, PhD , Department of Emergency Medicine, Yale University, New Haven, CT
David Cone, MD , Department of Emergency Medicine, Yale University, New Haven, CT
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.

Learning Areas:
Other professions or practice related to public health
Provision of health care to the public

Learning Objectives:
Identify the major factors that enhance or impede prehospital use of analgesics. Discuss the implications of paramedics' perceived role in patient pain management.

Keywords: Ambulatory Care, EMS/Trauma

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an expert in the conduct of qualitative research and analysis. I have extensive experience in the application of qualitative methods to injury prevention efforts and have worked closely with my co-authors to code focus group transcripts and identify salient themes. I currently work in the Office of Research in the Department of Emergency Medicine at Yale University, and one of my primary responsibilities is to consult with faculty and medical residents, providing qualitative methodological expertise as needed.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.