References
Paramedic adult pain assessment: pilot study
Abstract
Background:
An inability to assess pain may lead to poor or incorrect treatment. However, pain is often poorly assessed in the prehospital setting.
Objective:
This study aimed to determine the inter-rater reliability of the Wong-Baker FACES Pain Rating Scale in the prehospital setting in Qatar with five adult standardised patients.
Methods:
This prospective, quantitative pilot study gathered primary data using survey questionnaires. Five members of staff played the roles of standardised adult patients presenting with differing reference levels of pain. Thirty-five paramedics assessed and recorded the pain intensity score of these five patients using the Wong-Baker FACES Pain Rating Scale. Each participant was exposed to the same five patients and the same range of facial expressions in a random order.
Results:
The paramedics recorded the pain score of the five patients based on their observations of their facial expressions, often unexpectedly comparing these to the FACES tool. Overall, the inter-rater reliability as determined through Fleiss' kappa indicated only a poor-to-slight agreement of the allocated pain scores against the reference standards. There was a wide grouping of the pain score levels around the reference standard; most of the allocations were 1 to 2 pain score levels away from the reference standard, although not in a normal distribution, with some of the higher reference pain levels receiving lower scores and vice versa. Sensitivity was poor to very poor throughout.
Conclusion:
The inter-rater reliability of the participant sample when using the Wong-Baker FACES Pain Rating Scale to determine pain levels of five standardised patients was poor because the tool was surprisingly not used appropriately by most clinicians. This could be attributed to various factors including the multinational population, language barriers, a lack of familiarisation with the Wong-Baker FACES Pain Rating Scale and other environmental factors.
Qatar has a population of more than 2.6 million (MDPS, 2016). Nearly 90% are emigrant workers, mainly from Asia and North Africa (Goodman, 2015). Hamad Medical Corporation Ambulance Service (HMCAS) employs critical care paramedics (CCPs) and ambulance paramedics (Wilson et al, 2018), who have received a variety of training in pain assessment and in various pharmacological and non-pharmacological treatments for pain in their home countries.
CCPs are recruited primarily from Western countries. In the prehospital environment in Qatar, CCPs work with ambulance paramedics from various linguistic and cultural backgrounds such as from Tunisia, India, the Philippines, Jordan, Morocco, Egypt and Britain. Qatar's multinational population adds to the diversity of emergency medical care practice (Gangaram et al, 2017).
Globally, on average, four out of five (80%) of all patients seeking emergency medical service (EMS) help experience pain (Iqbal et al, 2015). Recent studies show that pain is poorly assessed in the prehospital setting (Lynde and Zorab, 2015). Delays in prehospital pain assessment and treatment are further prolonged in the emergency centre because of the initial triage processes (Hodkinson, 2016).
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