314944
A survey study of barriers to and enablers for prehospital pain management in children
Qualitative studies have identified barriers to and enablers for narcotic analgesic administration to children in the prehospital emergency medical services (EMS) setting. This study aimed to quantitatively assess the prevalence of those barriers and enablers in a sample of paramedics.
Methods
We surveyed paramedics from urban, suburban, and rural settings. The survey was designed iteratively based on prior research and feedback from content experts. Descriptive statistics were calculated and differences were assessed between new (≤5 years) and experienced (>5 years) providers.
Results
There were 127 surveys analyzed; 67% of our sample was experienced, 86% considered treating pain important, and most expressed comfort caring for pediatric patients (91%). Top enablers for pain management include: belief that analgesic administration is important (98%), support from agency leadership (84%), and education to administer analgesics (87%). Top barriers were concern regarding pain of intravenous catheter placement (59%), allergic reactions (45%), and difficulty assessing pain (47%). The Broselow Tape was reported to be useful when dosing fentanyl for children by 74% of new providers and 47% of experienced providers (p<0.05). Statistically significant differences in other responses between new and experienced providers were not found.
Conclusions
Providers reported reasons for not administering analgesics to children, despite believing that treating pain in children is important and feeling that their education has prepared them to administer analgesics. These findings provide insight for future education of EMS providers and inform opportunities to improve prehospital pediatric pain management.
Learning Areas:
Provision of health care to the publicPublic health or related organizational policy, standards, or other guidelines
Public health or related research
Learning Objectives:
Explain why inadequate pain management in the prehospital setting is a public health problem.
Identify commonly endorsed barriers to and enablers for administering narcotic analgesics to children in the prehospital setting.
Assess whether barriers and enablers differ between new and experienced prehospital providers.
Keyword(s): Emergency Medical Services, Pediatrics
Qualified on the content I am responsible for because: I have completed all coursework for my doctoral degree in epidemiology and have been an emergency medical services provider for six years. I have been involved with emergency medicine and prehospital care research for over four years and my research interests include the evaluation of prehospital care protocols, clinical decision-making in the emergency care setting, and outcomes of patients with traumatic injuries.
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.