Abstract
Acute pain is a common reason for summoning emergency medical services (EMS). Yet in several countries the law restricts opioid-based analgesia administration to physicians. Telemedical support of paramedics is a novel approach to enable timely treatment under the guidance of a physician. In this retrospective observational study, conducted in the EMS of Aachen, Germany, the analgesic quality and occurrence of adverse events were compared between telemedically-supported paramedics (July-December, 2014) and a historical control group (conventional on-scene EMS physicians; January-March, 2014). Inclusion criteria: pain (initial numerical rating scale (NRS) ≥5) and/or performed analgesia. Telemedically-assisted analgesia was performed in 149 patients; conventional analgesia in 199 control cases. Teleconsultation vs. control: Initial NRS scores were 8.0 ± 1.5 and 8.1 ± 1.7. Complete NRS documentation was carried out in 140/149 vs. 130/199 cases, p < 0.0001. NRS scores were reduced by 4.94 ± 2.01 and 4.84 ± 2.28 (p = 0.5379), leading to mean NRS scores at emergency room arrival of 3.1 ± 1.7 vs. 3.3 ± 1.9 (p = 0.5229). No severe adverse events occurred in either group. Clinically relevant pain reduction was achieved in both groups. Thus, the concept of remote physician-based telemedically-delegated analgesia by paramedics is effective compared to analgesia by on-scene EMS physicians and safe.
Highlights
Acute pain is a frequent and relevant symptom in prehospital emergency medical care
A previous pilot study from the research project “TemRas” compared the safety and quality of analgesic treatment between telemedically-supported paramedics and on-scene emergency medical services (EMS) physicians in different EMS districts. These results showed that both systems of care are safe and provide analgesia above the required minimum standard in a multicentre research project setting, but analgesia by on-scene physicians led to higher pain score reduction[12]
Telemedically-delegated analgesia led to adequate pain reduction[15], that was comparable to reductions obtained by prehospital EMS physicians
Summary
Acute pain is a frequent and relevant symptom in prehospital emergency medical care. While 20–31% of all patients being transported by emergency medical services (EMS) indicate experiencing moderate to severe pain, 35–70% of trauma patients experience pain in prehospital settings[1,2,3]. While many countries run EMS solely with paramedics, legal conditions in several countries restrict opioid-based analgesia administration to physicians This is one reason, why some countries (e.g., Germany) run two-tiered emergency response systems involving both ambulance units staffed by paramedics and units staffed with prehospital EMS physician. According to the recommendations of the German Medical Association, an EMS physician should be dispatched in all potentially life-threatening situations and severe pain conditions[17]. Due to both dispatch and staffing reasons, paramedics are often the first to arrive on-scene, and a substantial amount of time may pass before an EMS physician unit can arrive. Previous research has demonstrated positive impacts of telemedical systems on treatment processes and even patient outcomes[12, 18,19,20,21,22,23]
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