Opioid administration in the prehospital setting for patients sustaining traumatic injuries: An evaluation of national emergency medical services data |
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| Affiliation: | 1. Center for Surgery and Public Health, Department of Surgery, Brigham and Women''s Hospital, Harvard Medical School, Harvard T. H. Chan School of Public Health, Boston, MA, United States;2. Department of Surgery, Rutgers - New Jersey Medical School, Newark, NJ, United States;3. Department of Emergency Medicine, Brigham and Women''s Hospital, Boston, MA, United States;4. Division of Trauma, Department of Surgery, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, United States;5. Section of Military, Diplomatic, and Field Affairs, Cooper University Hospital, Camden, NJ, United States;1. State Major Trauma Unit, Royal Perth Hospital, GPO Box X2213, Perth WA 6847, Australia;1. Department of Emergency Medicine, Haaglanden Medical Centre, PO Box 432, 2501 CK The Hague, the Netherlands;2. Department of Emergency Medicine, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands;3. Department of Public Health, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands;4. Department of Neurology, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands;5. Department of Neurology, University of Groningen, University Medical Centre Groningen, PO Box 30001, 9700 RB Groningen, the Netherlands;6. Department of Neurosurgery, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, the Netherlands;7. Department of Emergency Medicine, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, the Netherlands;8. Department of Emergency Medicine, ADRZ, PO Box 15, 4460 AA Goes, the Netherlands;9. Department of Emergency Medicine, Jeroen Bosch Hospital, PO 90153, 5200 ME ‘s-Hertogenbosch, the Netherlands;10. Department of Neurology, Jeroen Bosch Hospital, PO 90153, 5200 ME ‘s-Hertogenbosch, the Netherlands;11. Department of Radiology, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands;12. Department of Epidemiology, Erasmus MC University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands;13. Centre for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, USA;14. formerly Department of Emergency Medicine, Elisabeth-Tweesteden Hospital, PO Box 90151, 5000 LC Tilburg, the Netherlands;15. Department of Neurology, Bravis Hospital, PO Box 999, 4624 VT Bergen op Zoom, the Netherlands;p. Department of Neurology, Elisabeth-Tweesteden Hospital, PO Box 90151, 5000 LC Tilburg, the Netherlands;q. Department of Biomedical Data Sciences, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands;r. Department of Neurology, Haaglanden Medical Centre, PO Box 432, 2501 CK The Hague, the Netherlands;1. Department of Surgery, National Taiwan University Hospital, Yunlin Branch, No. 579, Yunlin Road, Douliu City, 640 Yunlin, Taiwan (R.O.C.);2. Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan (R.O.C.);3. Department of Emergency Medicine, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan (R.O.C.);4. Department of Orthopedic Surgery, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan (R.O.C.);1. Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia;2. Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong NSW, Australia;3. Illawarra Health and Medical Research Institute, Building 32 University of Wollongong, Northfields Avenue, Wollongong NSW, Australia;4. Emergency Department, St George Hospital, Kogarah, NSW, Australia;5. St George Clinical School, Faculty of Medicine, University of New South Wales, NSW, Australia;6. School of Nursing and Midwifery and Centre for Quality and Patient Safety Experience in the Institute for Health Transformation, Deakin University, Geelong, VIC, Australia;7. Centre for Quality and Patient Safety Experience, Eastern Health Partnership, Box Hill, VIC, Australia;8. Nursing Research Institute, St Vincent''s Health Network Sydney, St Vincent''s Hospital Melbourne;9. Australian Catholic University, NSW Australia;10. Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2113, Australia;11. Sydney Institute for Infectious Diseases, The University of Sydney, Camperdown, NSW 2006, Australia;12. Division of Infectious Diseases and Sexual Health, Westmead Hospital and Western Sydney Local Health District, Westmead, NSW, 2145, Australia;13. New South Wales Biocontainment Centre, Western Sydney Local Health District and New South Wales Health, NSW, 2145, Australia;14. School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia;15. University of Technology Sydney, Faculty of Health, NSW, Australia;p. Northern Sydney Local Health District, NSW, Australia;1. Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine;2. Department of Surgery, University of Pennsylvania Perelman School of Medicine;3. Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania;4. Naval Strategic Health Alliance for Readiness and Performance, Navy Medicine Operational Training Command |
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| Abstract: | IntroductionDespite concerns about long-term dependence, opioids remain the mainstay of treatment for acute pain from traumatic injuries. Additionally, early pain management has been associated with improved long-term outcomes in injured patients. We sought to identify the patterns of prehospital pain management across the United States.MethodsWe used 2019 national emergency medical services (EMS) data to identify the use of pain management for acutely injured patients. Opioid specific dosing was calculated in morphine milligram equivalents (MME). The effects of opioids as well as adverse events were identified through objective patient data and structured provider documentation.ResultsWe identified a total of 3,831,768 injured patients, 85% of whom were treated by an advanced life support (ALS) unit. There were 269,281 (7.0%) patients treated with opioids, including a small number of patients intubated by EMS (n = 1537; 0.6%). The median opioid dose was 10 MME IQR 5–10] and fentanyl was the most commonly used opioid (88.2%). Patients treated with opioids had higher initial pain scores documented by EMS than those not receiving opioids (median: 9 vs 4, p<0.001), and had a median reduction in pain score of 3 points (IQR 1–5) based on the final prehospital pain score. Adverse events associated with opioid administration, including episodes of altered mental status (n = 453; 0.2%) and respiratory compromise (n = 252; 0.1%), were rare. For patients with severe pain (≥8/10), 27.3% of patients with major injuries (ISS ≥15) were treated with opioids, compared with 24.8% of those with moderate injuries (ISS 9–14), and 21.4% of those with minor (ISS 1–8) injuries (p<0.001).ConclusionThe use of opioids in the prehospital setting significantly reduced pain among injured patients with few adverse events. Despite its efficacy and safety, the majority of patients with major injuries and severe pain do not receive opioid analgesia in the prehospital setting. |
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