ABSTRACT
INTRODUCTION: The most common reason patients seek medical attention is pain. However, there may be significant delays in initiating prehospital pain therapy. In a 2001 quality improvement (QI) study, we demonstrated improvement in paramedic knowledge, perceptions, and management of pain. This follow-up study examines the impact of this QI program, repeated educational intervention (EI), and effectiveness of a new pain management standard operating procedure. METHODS: 176 paramedics from 10 urban and suburban fire departments and two private ambulance services participated in a 3-hour EI. A survey was performed prior to the EI and repeated one month after the EI. We reviewed emergency medical services (EMS) runs with pain complaints prior to the EI and one month after the EI. Follow-up results were compared to our prior study. We performed data analysis using descriptive statistics and chi-square tests. RESULTS: The authors reviewed 352 surveys and 438 EMS runs with pain complaints. Using the same survey questions, even before the EI, 2007 paramedics demonstrated significant improvement in the knowledge (18.2%; 95% CI 8.9%, 27.9%), perceptions (9.2%; 95% CI 6.5%, 11.9%), and management of pain (13.8%; 95% CI 11.3%, 16.2%) compared to 2001. Following EI in 2007, there were no significant improvements in the baseline knowledge (0%; 95% CI 5.3%, 5.3%) but significant improvements in the perceptions of pain principles (6.4%; 95% CI 3.9%, 9.0%) and the management of pain (14.7%; 95% CI 11.4%, 18.0%). CONCLUSION: In this follow up study, paramedics' baseline knowledge, perceptions, and management of pain have all improved from 6 years ago. Following a repeat educational intervention, paramedics further improved their field management of pain suggesting paramedics will still benefit from both initial and also ongoing continuing education on the topic of pain management.
ABSTRACT
INTRODUCTION: Pain is a common symptom evaluated by emergency medical services (EMS) providers. Hospital pain management programs began in the early 1990s based on a multidisciplinary approach and principles of total quality improvement. To date, these programs have had limited exposure in the prehospital setting. OBJECTIVES: To evaluate the effects of a pain management educational intervention (EI) for paramedic caregivers. METHODS: All ambulance providers from ten urban and suburban fire departments and two private ambulance companies participated in a three-hour EI during a quality improvement project. A survey was performed prior to the EI and repeated one month after the EI. A two-month collection of EMS runs for pain complaints was performed prior to the EI and repeated one month after the EI. Data analysis was performed using descriptive statistics and chi-square tests. RESULTS: The authors reviewed 397 surveys and 439 EMS runs for pain. Overall, after the EI, paramedics' knowledge of basic pain management principles increased from 57.3% to 74.9% (17.5%; 95% confidence interval (CI): 14.9%-20.2%; p < 0.001). Paramedics' utilization of nonpharmacologic pain therapies improved by 32.2% (95% CI: 25.3%-39.2%; p < 0.001), but there was no significant change in the use of pain medication (20.2% to 24.5%). There were 51.0% (95% CI: 44.1%-57.9%; p < 0.001) improvement in documentation of pain severity, 24% (95% CI: 21.2%-26.8%; p < 0.001) improvement in documentation of pain characteristics, and 13% (95% CI: 7.4%-18.7%; p < 0.001) improvement in pain reassessment following intervention. CONCLUSION: As a result of a three-hour educational intervention, paramedics had an increased understanding of pain principles, were more likely to provide prehospital nonpharmacologic pain therapy, and were more likely to document the results of their interventions.
