Involvement in the management of patients’ pain is a daily event for many ambulance crews, but is there room for improvement? This qualitative, phenomenological study (undertaken in the East Midlands, UK) set out to explore staff and patients’ experiences and opinions of pain management in pre-hospital settings.
Through a process of purposive sampling, 55 people (patients n=17; paramedics n=14; emergency medical technicians n=11; emergency department physicians n=9; emergency department nurses n=4) participated in the study either through focus groups (n=27) or individual interviews (n=28). The interviews enabled the researchers to explore any issues that were raised in the focus groups in more depth.
Patients in the study had to have used the ambulance service within the previous six months. Of the 17 patients, 13 were suffering pain from acute myocardial infarction and the remaining four individuals had sustained a fracture.
Once the audio-recordings of the interviews and focus groups had been transcribed, thematic content analysis facilitated the emergence of key themes, which the authors reported under five broad categories.
Readers should note that additional information about the study’s recruitment process, participants’ characteristics, interview/focus group topic guides, data coding and categorisation can be found in a supplementary document (available online only) to the published paper.
The five categories reported by the authors relate to the following areas: patients’ and staff’s expectations and beliefs in relation to pain management; pain assessment strategies; use of non-drug treatment options; issues around use of drugs to manage pain; enhanced communication and coordination during the pain management pathway. The authors suggest that all of these areas need consideration if pain management in pre-hospital care is to improve.
Patients expected immediate relief of pain but, at times, there was some confusion expressed around what constituted pain relief, what the options are for pain management in a pre-hospital setting, and some concern as to whether or not they should defer this treatment until they get to definitive care.
Unsurprisingly, ambulance clinicians frequently expressed frustration as to the limited choice of drugs available to manage patients’ pain. Some ambulance staff identified selecting drugs on the basis of cause of pain or distance to be travelled rather than the assessed level of severity of the patient’s pain.
Suggestions were made for improving pain management pathways including a wider range of available drugs, robust and detailed communication between ambulance staff and emergency department staff, increased education and training for staff, and development of shared pain management protocols between the different organisations.
This study enabled triangulation of views around the issue of pain management in pre-hospital care but the authors recognise this was a single system study involving one ambulance service and one emergency department; therefore, the findings may not be generalisable. Nonetheless, the study usefully provides a deep insight into some of the challenges that ambulance crews encounter when managing patients’ pain while, at the same time, the patients’ experiences of this phenomenon are considered.
The researchers conclude by recommending further research into this aspect of patient management, including a review of the range of analgesics that are available in ambulance settings; examination and development of a wider range of methods of pain assessment; use of patient reported outcome measures; and investigation into possible pain management pathways in order to develop a co-ordinated patient-centred approach to treatment.