Open Access Open Access  Restricted Access Subscription or Fee Access

Analysis of the paramedic administration of fentanyl

Jocelyn Freeman Garrick, MD, FACEP, Senai Kidane, MD, EMS Fellow, James E. Pointer, MD, William Sugiyama, MA, RN, NREMT-P, Christopher Van Luen, EMT-P, Rebecca Clark, EMT-B

Abstract


Introduction: Pain is a common complaint among emergency medical services patients. When compared with the most commonly used morphine, fentanyl has a shorter onset of action, shorter duration, and far fewer side effects making it an appealing candidate for prehospital pain management. This study’s intent is to prospectively assess the feasibility and safety of fentanyl for pain in prehospital patients in comparison with morphine.
Methods: Observational trial to evaluate select characteristics of fentanyl administration. The primary outcome measure was the reduction of pain from time of initial patient assessment to transfer of care (TOC) to emergency department (ED) staff. Secondary outcome measures included the development of adverse outcomes and side effects related to fentanyl administration. Additionally, data obtained were compared with morphine retrospectively from an identical prior time period, ie, 1 year earlier.
Results: About 16.6 percent of the patients who received fentanyl reported subjective pain relief in less than 1 minute, 47 percent in 1-2 minutes, 19.9 percent in 2-3 minutes, and 16.6 percent at greater than 3 minutes. The reduction of pain after fentanyl administration, on a scale of 1-10, was 3.82 points in TOC at the ED. No significant adverse clinical outcomes or incidents of diversion were reported during the trial period.
Conclusions: Fentanyl can be used safely and effectively for pain control in the prehospital setting.


Keywords


fentanyl, prehospital, EMS, morphine, pain, analgesic

Full Text:

PDF

References


McLean SA, Maio RF, Domeier RM: The epidemiology of pain in the prehospital setting. Prehosp Emerg Care. 2002; 6(4): 402-405.

McManus JG Jr, Sallee DR Jr: Pain management in the prehospital environment. Emerg Med Clin North Am. 2005; 23(2): 415-431.

Kanowitz A, Dunn TM, Kanowitz EM, et al.: Safety and effectiveness of fentanyl administration for prehospital pain management. Prehosp Emerg Care. 2006; 10(1): 1-7.

Mayo E, Roethlisberger FJ: The human relations movement: Harvard Business School and the Hawthorne experiments (1924-1933). Available at http://www.library.hbs.edu. Accessed June 5, 2009.

DeVellis P, Thomas SH, Wedel SK: Prehospital and emergency department analgesia for air-transported patients with fractures. Prehosp Emerg Care. 1998; 2(4): 293-296.

Baskett PJ: Acute pain management in the field. Ann Emerg Med. 1999; 34(6): 784-785.

McEachin CC, McDermott JT, Swor R: Few emergency medical services patients with lower-extremity fractures receive prehospital analgesia. Prehosp Emerg Care. 2002; 6(4): 406-410.

Alonso HM, Wesleym K: National Association of EMS physicians position paper: Prehospital pain management. Prehos Emerg Care. 2003; 7: 482-488.

Abbuhl FB, Reed DB: Time to analgesia for patients with painful extremity injuries transported to the emergency department by ambulance. Prehosp Emerg Care. 2003; 7(4): 445-447.

Jones GE, Machen I: Pre-hospital pain management: The paramedics’ perspective. Accid Emerg Nurs. 2003; 11(3): 166-172

Ricard-Hibon A, Chollet C, Belpomme V, et al.: Epidemiology of adverse effects of prehospital sedation analgesia. Am J Emerg Med. 2003; 21(6): 461-466.

Vergnion M, Degesves S, Garcet L, et al.: Tramadol, an alternative to morphine for treating posttraumatic pain in the prehospital situation. Anesth Analg. 2001; 92(6): 1543-1546.

Fullerton-Gleason L, Crandall C, Sklar DP: Prehospital administration of morphine for isolated extremity injuries: A change in protocol reduces time to medication. Prehosp Emerg Care. 2002; 6(4): 411-416.




DOI: https://doi.org/10.5055/10.5055/jom.2011.00065

Refbacks

  • There are currently no refbacks.