Adequacy of musculoskeletal pain control by emergency medical services providers compared to an emergency department gold standard

Abstract

Study objectives: Pain management by emergency medical services (EMS) personnel has received limited attention in the literature. We examine the adequacy of EMS pain control for musculoskeletal complaints compared with the criterion standard of subsequent emergency department (ED) pain management. Methods: This retrospective, consecutive case series examined EMS and ED records for all patients who had a chief complaint of musculoskeletal pain and were transported in a 3-month period to the sponsor hospital by a suburban or rural paramedic EMS system. Data collected included demographics, pain medications given, adverse drug reactions, EMS disposition, and ED medications given within 1 hour of physician examination. Patients with major trauma or injuries greater than 2 weeks old were excluded. Data were analyzed descriptively. Institutional review board approval was obtained. Results: Age and sex were similar among groups. Patients were determined to need pain medications if treated by the ED or if they were treated by EMS and there was no documentation in the ED record that treatment was inappropriate. Using these criteria, 64 of 173 patients required pain medication. Of patients requiring pain medications, EMS treated 23% (n=15). Patients with evidence of fracture were more likely to receive EMS pain medications (5/11, 45%). There were only 2 EMS adverse drug reactions; in both cases, the patients were sleepy but easily arousable. Conclusion: Of all patients requiring pain medications, EMS failed to treat 77% (49/64). Potential reasons for EMS undertreatment of musculoskeletal pain include failure to recognize pain, fear of adverse reactions, underappreciation of pain morbidity, and absence of pain control education.